1. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 1 CHAPTER 8 AN OVERVIEW OF ICD-9-CM

2. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 2 An Overview of the ICD-9-CM Classification System –Morbidity (illness) –Mortality (death) ICD = International Classification of Diseases WHO’s ICD-9 used globally –World Health Organization ICD-9-CM = 9th Revision; CM, Clinical Modification –Continuity of data (Cont’d…)

3. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 3 Overview (…Cont’d) 1977: US develops ICD-9-CM version More code subsets define medical care ICD-9-CM data comparable to global data in ICD-9 Updated October 1 of each year Must use new codes as of October 1 Also updates April 1with no grace period

4. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 4 Medicare Medicare Catastrophic Act of 1988 –Required use of ICD-9-CM codes for diagnosis Act later repealed, but codes still used Effective 2003, all claims must have valid diagnosis –Excludes ambulance suppliers

5. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 5 Uses of ICD-9-CM Facilities track facility use through codes Fiscal entities track health care costs (Cont’d…)

6. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 6 Uses of ICD-9-CM (…Cont’d) Research –Health care quality –Future needs Newer cancer center built if patient use warrants (…Cont’d)

7. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 7 Uses of ICD-9-CM Use and results evident every day –Newscaster reference to number of AIDS cases –Newspaper article about measles epidemic

8. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 8 ICD-9-CM Principles/Practices Four groups function together to maintain ICD-9-CM Centers for Medicare and Medicaid Services (CMS), formerly known as Health Care Financing Administration (HCFA) (Cont’d...)

9. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 9 ICD-9-CM Principles/Practices (...Cont’d) National Center for Health Statistics (NCHS) American Health Information Management Association (AHIMA) American Hospital Association (AHA)

10. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 10 ICD-9-CM Documents Medical Necessity Diagnoses establish medical necessity Services and diagnoses must correlate Correct diagnosis codes allow: –Accurate reimbursement –Fewer rejected claims –Reduced risk of sanctions/fines from audit

11. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 11 CMS-1500 (08/05) in Blocks 21 and 24E (Outpatient) Courtesy U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

12. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 12 UB04 in Blocks 66-74 (Inpatient) Courtesy U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

13. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 13 Ethics Documentation must support diagnosis Example: –Services provided –Diagnosis justifies services If in doubt, check it out; don’t make assumptions

14. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 14 The Job of a Biller/Coder Translate documentation into ICD-9-CM codes –Legionnaires’ disease = 482.84 Assign code to highest level specificity Medical record must substantiate diagnosis code assignment

15. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 15 Format of the ICD-9-CM Volume 1, Diseases, Tabular List (diagnosis) (17 chapters) Volume 2, Diseases, Alphabetic Index to Diseases and Injuries (diagnosis) (3 sections) Volume 3, Procedures, Tabular List and Alphabetic Index (inpatient procedures)

16. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 16 Classification of Diseases and Injuries Main portion of ICD-9-CM Codes from 001.0-999.9 Most chapters are organ systems –Digestive System –Respiratory System

17. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 17 Volume 1, Tabular List Two major divisions –Classification of Diseases and Injuries (codes 001.0-999.9) –Supplementary Classification (V codes and E codes)

18. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 18 Volume 1, Diseases, Tabular List Contains code numbers 001.0-999.9 Diagnosis codes describe condition V and E codes = supplemental information (Cont’d…)

19. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 19 Divisions of Classification of Diseases and Injuries Chapters: 1 through 17 Section: A group of related conditions

20. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 20 Volume 1, Diseases, Tabular List (...Cont’d) Divided into: Chapter –Section Category –Subcategory »Subclassification

21. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 21 Volume 1, Diseases, Format Figure: 8.5 Modified from Buck CJ: 2012 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St. Louis, 2012, Saunders.

22. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 22 Category Code Category: Represent single disease/condition (3 digits) Figure: 8.6 Modified from Buck CJ: 2012 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St. Louis, 2012, Saunders.

23. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 23 Subcategory Code Subcategory: More specific (4th digit) Figure: 8.7 Modified from Buck CJ: 2012 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St. Louis, 2012, Saunders.

24. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 24 Subclassification Code Subclassification: More specific (5th digit) Referenced from Buck CJ: 2012 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St. Louis, 2012, Saunders.

25. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 25 Specificity in ICD-9-CM Codes Each digit adds to the specificity (detail) Figure: 8.9

26. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 26 Remember Assign to the highest level possible, based on documentation If 4-digit code exists, do not report 3-digit code If 5-digit code exists, do not report 4-digit code

27. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 27 Appendices in Volume 1 There are five appendices in official ICD-9-CM Private publishers may have more

28. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 28 Appendix A, _________ of Neoplasms Used in conjunction with codes from Chapter 2, Neoplasm –Inpatient setting: Cancer registries and claim forms –M codes not placed on a billing claim form Morphology (Cont’d…)

29. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 29 Appendix A, Morphology of Neoplasms (…Cont’d) Begins with M followed by 5 digits –M8400/0, Sweat gland adenoma First four digits: Histologic type of neoplasm Fifth digit: Behavior (e.g., 0 = benign)

30. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 30 Appendix B, Glossary of Mental Disorders Deleted in 2004 Most psychiatric disorders are classified using: –The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)

31. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 31 Appendix C, Drugs American Hospital Formulary Service (AHFS) publishes list of all drugs Tracks drugs nationally; used by pharmacists Each drug coded with up to six-digit code (e.g., 84:04.04) (Cont’d…)

32. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 32 Appendix C, Drugs (…Cont’d) AHFS listing correlated to ICD-9-CM Table of Drugs and Chemicals New drugs not identified by name –Rather listed under heading “Drug” in Table of Drugs and Chemicals –Example: 84:04.04 antibiotics

33. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 33 Appendix D, Industrial Accidents Three-digit codes that identify occupational hazards Not placed on insurance or billing form Used by state and federal organizations (OSHA) Occupational Safety and Health Administration to summarize industrial accident data

34. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 34 Appendix E, Three-Digit Categories Presented by chapter Categories are labeled 1 through 17, followed by V and E code categories Provides quick overview of ICD-9-CM contents

35. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 35 V Codes (V01.0-V91.9) Patient not ill but encounters health services –e.g., Vaccination Patient presents for treatment –e.g., Chemotherapy Some V codes are primary only (e.g., V58.11, encounter for chemotherapy) (Cont’d…)

36. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 36 V Codes (V01.0-V91.9) (…Cont’d) Factors that influence patient’s health status –e.g., Personal history of [PHO] malignant tumor, organ transplant –Birth status and outcome of delivery

37. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 37 Volume 2, Sections Section 1, Index to Diseases Section 2, Table of Drugs and Chemicals Section 3, Index to External Causes of Injuries and Poisonings (E Codes) –Never primary diagnosis –Medicare does not accept for professional billing

38. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 38 Volume 2, Diseases, Alphabetic Index Appears first in book (may vary with publishers) Terms and code numbers verified in Volume 1 Never code directly from Index! Read all notes and follow instructions (e.g., see also) Tables (e.g., Drugs/Chemicals, Hypertension, Neoplasm)

39. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 39 Volume 2, Terms Main terms (bold typeface) –Subterms –Indented two spaces to right –Not bold Example Pain (Main term in bold) orbital region 379.91 (subterm indented)

40. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 40 Volume 2, Alphabetic Index Nonessential modifiers enclosed in parentheses (does not have to be in diagnostic statement) Have no effect on code selection Clarify diagnosis –Example: Ileus (adynamic) (bowel)….

41. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 41 Section 1, Index to Diseases Largest part of Volume 2—Index First step in coding, locate main bold term in the Index Subterms indented 2 spaces to the right May have more than one subterm 3 digits = category codes 4 digits = subcategory codes 5 digits = subclassification codes

42. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 42 A Word of Caution About the Alphabetic Index (Section I, Vol. 2) Some words in Index do not appear in Tabular—saves space Exact word may not be in code Tabular description –But found in Alphabetic Index –That is why you must locate term in Index and then locate Tabular (follow where Index directs)

43. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 43 ICD-9-CM Conventions Punctuation: [ ] ( ) : } italicized and bold type [ ] Symbols: §  Abbreviations: NEC, NOS Notations: Includes, Excludes, Use Additional Code, And/With, Code if Applicable

44. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 44 Abbreviations NEC: Not elsewhere classifiable –No more specific code exists NOS: Not otherwise specified –Unspecified in documentation

45. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 45 [ ] Brackets Enclose synonyms, alternative wording, or explanatory phrases Used to identify manifestation codes Helpful, additional information Can affect code Found only in Tabular List (001.0-999.9)

46. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 46 Slanted Brackets [ ] Enclose manifestations of underlying condition –“Code first underlying disease” Used in the Alphabetic Index-Volume 2

47. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 47 Etiology and Manifestation of Disease Etiology = cause of disease Manifestation = symptom Etiology + Manifestation = Combination codes

48. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 48 Combination Code Modified from Buck CJ: 2012 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St. Louis, 2012, Saunders.

49. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 49 Multiple Coding No combination code, use individual code(s) in this order –250.4x –581.81 Modified from Buck CJ: 2012 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St. Louis, 2012, Saunders.

50. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 50 ( ) Parentheses Contain non-essential modifiers –Take them or leave them –Informational descriptive terms Found in Tabular List and Index Does not affect code selection

51. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 51 Colon and Brace : Colon: In Tabular List, completes a statement with one or more modifiers } Brace: In Tabular List, modifies statements to the right of the brace

52. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 52 Includes, Excludes, and Use Additional Code Includes notes: In chapter, section, or category Excludes notes: Conditions are coded elsewhere Use Additional Code: Assignment of other code(s) is necessary

53. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 53 Italicized and Bold Type Italicized –All Excludes notes –Codes not used as principal diagnosis Bold –Codes and code titles in Tabular List, Volume 1

54. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 54 Lozenge and Section Mark  Lozenge: Indicates codes unique to ICD-9-CM § Section: Can be footnote indicator

55. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 55 And/With And: Means and/or –Example: 237.0, Neoplasm of uncertain behavior of pituitary gland and/or craniopharyngeal duct With: Means one condition with (in addition to) another condition –Example: 070.41, acute hepatitis C with hepatic coma

56. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 56 Volume 2, Cross References Directs you: see, see also, see category “see” directs you to specific term –Example: Panotitis—“see” Otitis media “see also” directs you to another term for more information –Example: Perivaginitis (see also Vaginitis) (Cont’d…)

57. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 57 Volume 2, Cross References (…Cont’d) “see category” Volume 1, Tabular List, specific information about use of code –Example: Mesencephalitis (see also Encephalitis) 323.9; late effect—see category 326

58. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 58 Code, If Applicable, Any Causal Condition First May be primary diagnosis if no causal condition applicable or known or documented Instructional note in Tabular List (Cont’d…)

59. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 59 Code, If Applicable, Any Causal Condition First (…Cont’d) Example: 707.10, Ulcer of lower limb, except decubitus; states: –Chronic venous hypertension with ulcer (459.31) If ulcer caused by chronic venous hypertension: –First: 459.31 chronic venous hypertension –Second: 707.10 ulcer of lower limb

60. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 60 Volume 2, Notes Define terms Give further coding instructions –Example: Index: “Melanoma,” Note: “Except where otherwise indicated….” (Cont’d…)

61. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 61 Volume 2, Notes Mandatory fifth digits also appear as notes (one reason to never code from Index) (…Cont’d) Figure: 8.13 From Buck CJ: 2012 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St. Louis, 2012, Saunders.

62. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 62 Volume 2, Eponyms Disease or syndrome named for person –Example: Arnold-Chiari (see also Spina bifida) Sturge-Weber Prader-Willi

63. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 63 Section 2, Table of Drugs and Chemicals Drug name placed alphabetically on left under heading “Substance” Modified from Buck CJ: 2012 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St. Louis, 2012, Saunders. (Cont’d…)

64. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 64 Table of Drugs and Chemicals (…Cont’d) First column: “Poisoning” code for substance involved, wrong substance given or taken First-listed before manifestation condition (Cont’d…) Modified from Buck CJ: 2012 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St. Louis, 2012, Saunders.

65. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 65 Table of Drugs and Chemicals (…Cont’d) E codes identify how poisoning occurred –Example: If analgesics poisoning occurred by accident, E850.9 Correct order poisoning –3 codes required: Identify agent analgesic 965.9 Condition—coma 780.01 Accidental poison E850.9 Correct order adverse effect –2 codes required: Condition—coma 780.01 Therapeutic E935.9

66. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 66 Table of Drugs and Chemicals: Headings Accident: Unintentional Therapeutic: Correct dosage, correctly administered, with adverse effects (example, allergic reaction) Suicide attempt: (must be documented) Assault: Intentionally inflicted by another person Undetermined: Unknown intent

67. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 67 Section 3, E Codes Alphabetic Index to External Causes of Injuries and Poisonings Provide additional information about the nature of injury/poisoning and locality Never a principal (inpatient) or first-listed (outpatient) diagnosis

68. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 68 Section 3, E Codes (…Cont’d) Separate Index to External Causes Alphabetical, main terms in bold Subterms are indented two to right under main term Some words in Index not in Tabular—saves space That is why you must locate the term in the Index, then locate in Tabular

69. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 69 E Codes (E000-E999) Supplementary Classification of External Causes of Injury and Poisoning Alpha-numerical designations for injuries and poisonings (Cont’d…)

70. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 70 E Codes (E000-E999) (…Cont’d) Provides additional information about external causes Never a principal (inpatient) diagnosis Separate E code index –Locate the E Code index in your ICD-9-CM now

71. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 71 Index to External Causes: Example Main terms are type of accident (Collision) Subterms are circumstances of the accident (motor vehicle) Modified from Buck CJ: 2012 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St. Louis, 2012, Saunders.

72. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 72 Volume 2, Neoplasm In Volume 2, Index, locate Neoplasm Table under the alphabetic entry “N” Do not reference Neoplasm table when diagnostic statement states “mass” From Buck CJ: 2012 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St. Louis, 2012, Saunders.

73. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 73 Volume 3, Procedures, Tabular List and Alphabetic Index Not used for physician services Index and Tabular List for code assignment of procedures and therapies Inpatient settings only Maximum 4 digits –20.41 Simple mastoidectomy

74. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 74 Volume 3, Procedures 90% of codes refer to surgical procedures (Cont’d…) Figure: 8.14 Volume 3, Surgical procedures. (Modified from Buck CJ: 2012 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St. Louis, 2012, Saunders.)

75. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 75 Volume 3, Procedures 10% refer to diagnostic and therapeutic procedures (Cont’d…) (…Cont’d) Figure: 8.15 Modified from Buck CJ: 2012 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St. Louis, 2012, Saunders.

76. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 76 Volume 3, Procedures (…Cont’d) Procedures performed in a physician’s office or outpatient ASC are reported with CPT codes –Surgeon uses CPT to report services to inpatients Volume 3, Procedure codes are used by hospitals to code facility services provided to inpatients

77. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 77 Chapter 0 –Procedures and Interventions, Not Elsewhere Classified Chapters 1-15 –Operations on organ systems Chapter 16 –Miscellaneous Diagnostic and Therapeutic Procedures –Most nonsurgical codes Volume 3, Table of Contents (Cont’d…)

78. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 78 Volume 3, Table of Contents (…Cont’d) Figure: 8.16 Modified from Buck CJ: 2012 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St. Louis, 2012, Saunders.

79. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 79 Volume 3, Tabular List Conventions in Volume 3 are the same as those in Volumes 1 and 2 “Code also...” Volume 3 –Additional information about coding various components or special adjunctive services or procedures –“…any synchronous” means occurring at the same time

80. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 80 Volume 3, Alphabetic Index Contains terms that do not appear in Volume 3 Tabular List –Example: In Index, the entry Gastrostomy, subterm Janeway, directs you to 43.19 –Janeway not mentioned in Tabular List at code 43.19 (Cont’d…)

81. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 81 Volume 3, Alphabetic Index (…Cont’d) Terms in bold Subterms not in bold Never code directly from Index Index example follows Includes non-essential modifiers, as in Volume 1

82. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 82 Example Figure: 8.17 Modified from Buck CJ: 2012 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St. Louis, 2012, Saunders.

83. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 83 Volume 3, Alphabetic Index Index alphabetical Ignores single spaces and hyphens –Example: Opening and open reduction –“Opening” appears before “open reduction” because space between two words ignored –Opening –Openreduction (Cont’d…)

84. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 84 Volume 3, Alphabetic Index (…Cont’d) Often necessary and permissible to report individual components of procedure –Example: During a procedure, a portion of intestine was removed and reconstruction of urinary bladder was performed Both reconstruction (57.87) and resection (45.51) are reported (Cont’d…)

85. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 85 Volume 3, Alphabetic Index (…Cont’d) Cross references of see, see also, and see category appear as they did in Volume 1 Many operations named for surgeon who developed procedure (eponyms) –These procedures located under person’s name or name of operation

86. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 86 Volume 3, Tabular List Format same as Volume 1, Tabular List of Diseases, except Volume 3 codes have two digits before decimal (Cont’d…)

87. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 87 Volume 3, Tabular List (…Cont’d) Category, subcategory, and subclassification Figure: 8.18 Modified from Buck CJ: 2012 ICD-9-CM for Hospitals, Volumes 1, 2, & 3, Professional Edition, St. Louis, 2012, Saunders.

88. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 88 Bundling Opening and closing of surgical site included in all surgical procedures –Do not unbundle and code separately –If closure takes place during separate surgical procedure, closure may be reported separately The Index also contains “omit code” that directs the service not be reported –Example: Craniotomy 01.24; as operative approach– omit code

89. Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 89 Conclusion CHAPTER 8 AN OVERVIEW OF ICD-9-CM