1. 1 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. CHAPTER 14 AN OVERVIEW OF THE ICD-9-CM

2. 2 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. An Overview of the ICD-9-CM Classification SystemClassification System –Morbidity (illness) –Mortality (death) ICD = International Classification of DiseasesICD = International Classification of Diseases WHO’s ICD-9 used globallyWHO’s ICD-9 used globally –World Health Organization ICD-9-CM = 9th edition; CM, Clinical ModificationICD-9-CM = 9th edition; CM, Clinical Modification –Continuity of data (Cont’d…)

3. 3 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Overview (…Cont’d) 1977: US develops ICD-9-CM version1977: US develops ICD-9-CM version More code subsets define medical careMore code subsets define medical care ICD-9-CM data comparable to global data (ICD-9)ICD-9-CM data comparable to global data (ICD-9) Updated October 1 of each yearUpdated October 1 of each year Must use new codes as of October 1Must use new codes as of October 1 Also updates April 1 with no grace periodAlso updates April 1 with no grace period

4. 4 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Medicare Medicare Catastrophic Act of 1988Medicare Catastrophic Act of 1988 –Required use of ICD-9-CM codes for diagnosis Act repealed 1989, but codes still usedAct repealed 1989, but codes still used Effective 2003, all claims must have valid diagnosisEffective 2003, all claims must have valid diagnosis –Excludes ambulance suppliers

5. 5 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Uses of ICD-9-CM Facilities track patient use through codesFacilities track patient use through codes Fiscal entities track health care costsFiscal entities track health care costs(Cont’d…)

6. 6 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Uses of ICD-9-CM (…Cont’d) ResearchResearch –Health care quality –Future needs Newer cancer center built if patient use warrantsNewer cancer center built if patient use warrants

7. 7 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. ICD-9-CM Documents Medical Necessity Diagnoses establish medical necessityDiagnoses establish medical necessity Services and diagnoses must correlateServices and diagnoses must correlate Correct diagnosis codes allow:Correct diagnosis codes allow: –Accurate reimbursement –Fewer rejected claims –Reduced risk of sanctions/fines from audit

8. 8 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. 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.

9. 9 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. UB04 in Blocks 66-74 (Inpatient) Replaced UB-92, 02/07Replaced UB-92, 02/07 Courtesy U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

10. 10 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Ethics Documentation must support diagnosisDocumentation must support diagnosis Example:Example: –Services provided –Diagnosis justifies services If in doubt, check it out; don’t make assumptionsIf in doubt, check it out; don’t make assumptions

11. 11 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Your Job Translate documentation into ICD-9-CM codesTranslate documentation into ICD-9-CM codes –Legionnaires’ disease = 482.84 Assign code to highest level specificityAssign code to highest level specificity Medical record must substantiate diagnosis code assignmentMedical record must substantiate diagnosis code assignment

12. 12 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Format of the ICD-9-CM Volume 1, Diseases, Tabular List (diagnosis) (17 chapters)Volume 1, Diseases, Tabular List (diagnosis) (17 chapters) Volume 2, Diseases, Alphabetic Index (diagnosis) (3 sections)Volume 2, Diseases, Alphabetic Index (diagnosis) (3 sections) Volume 3, Procedures, Tabular List and Alphabetic Index (inpatient)Volume 3, Procedures, Tabular List and Alphabetic Index (inpatient)

13. 13 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 1, Diseases, Tabular List Contains code numbersContains code numbers 001.0-999.9 Diagnosis codes describe condition001.0-999.9 Diagnosis codes describe condition V and E codes = supplemental informationV and E codes = supplemental information

14. 14 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 2, Diseases, Alphabetic Index Appears first in bookAppears first in book Terms and code numbers verified in Volume 1Terms and code numbers verified in Volume 1 Never code directly from Index!Never code directly from Index! Read all notes and follow instructions (ex., see also)Read all notes and follow instructions (ex., see also) Tables (ex., Drugs/Chemicals, Hypertension)Tables (ex., Drugs/Chemicals, Hypertension)

15. 15 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 3, Procedures, Tabular List and Alphabetic Index Not used for physician servicesNot used for physician services Index and Tabular List used for procedures and therapiesIndex and Tabular List used for procedures and therapies Inpatient settings onlyInpatient settings only Procedures and therapiesProcedures and therapies Maximum 4 digitsMaximum 4 digits –20.41 Simple mastoidectomy

16. 16 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. ICD-9-CM Conventions Punctuation: [ ], ( ), :, }, italicized and bold type, [ ]Punctuation: [ ], ( ), :, }, italicized and bold type, [ ] Symbols: § Symbols: §  Abbreviation: NEC, NOSAbbreviation: NEC, NOS Notations: Includes, Excludes, Use Additional Code, And/With, Code if ApplicableNotations: Includes, Excludes, Use Additional Code, And/With, Code if Applicable

17. 17 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. [ ] Brackets Enclose synonyms, alternative wording, or explanatory phrasesEnclose synonyms, alternative wording, or explanatory phrases Helpful, additional informationHelpful, additional information Can affect codeCan affect code Found only in Tabular List (001.0-999.9)Found only in Tabular List (001.0-999.9)

18. 18 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. ( ) Parentheses Contain non-essential modifiersContain non-essential modifiers –Take them or leave them –Do not affect code Found in Tabular List and IndexFound in Tabular List and Index Do not affect codeDo not affect code

19. 19 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Colon and Brace : Colon: In Tabular List, completes a statement with one or more modifiers: Colon: In Tabular List, completes a statement with one or more modifiers } Brace: In Tabular List, modifies statements to the right of the brace} Brace: In Tabular List, modifies statements to the right of the brace

20. 20 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Italicized and Bold Type ItalicizedItalicized –All Excludes notes –Codes not used as principal diagnosis BoldBold –Codes and code titles in Tabular List, Volume 1

21. 21 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Slanted Brackets [ ] Enclose manifestations of underlying conditionEnclose manifestations of underlying condition –“Code first underlying disease”

22. 22 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Lozenge and Section Mark  Lozenge: Indicates codes unique to ICD-9-CM  Lozenge: Indicates codes unique to ICD-9-CM § Section: Can be footnote indicator§ Section: Can be footnote indicator

23. 23 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Abbreviations NEC: Not elsewhere classifiableNEC: Not elsewhere classifiable –No more specific code exists NOS: Not otherwise specifiedNOS: Not otherwise specified –Unspecified in documentation

24. 24 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Includes, Excludes, and Use Additional Code Includes notes: In chapter, section, or categoryIncludes notes: In chapter, section, or category Excludes notes: Conditions are coded elsewhereExcludes notes: Conditions are coded elsewhere Use Additional Code: Assignment of other code(s) is necessaryUse Additional Code: Assignment of other code(s) is necessary

25. 25 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. And/With And: Means and/orAnd: Means and/or –Example: 237.0, Neoplasm of uncertain behavior of pituitary gland and craniopharyngeal duct With: Means one condition with (in addition to) another conditionWith: Means one condition with (in addition to) another condition –Example: 070.41, acute hepatitis C with hepatic coma

26. 26 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Code, If Applicable, Any Causal Condition First May be primary diagnosis if no causal condition applicable or known or documentedMay be primary diagnosis if no causal condition applicable or known or documented(Cont’d…)

27. 27 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Code, If Applicable, Any Causal Condition First (…Cont’d) Example: 707.10, Ulcer of lower limb, except decubitus; states:Example: 707.10, Ulcer of lower limb, except decubitus; states: –Chronic venous hypertension with ulcer (459.31) If ulcer caused by chronic venous hypertension:If ulcer caused by chronic venous hypertension: –First: 459.31 chronic venous hypertension –Second: 707.10 ulcer of lower limb

28. 28 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 2, Alphabetic Index Nonessential modifiers enclosed in parentheses (does not have to be in diagnostic statement)Nonessential modifiers enclosed in parentheses (does not have to be in diagnostic statement) Have no effect on code selectionHave no effect on code selection Clarify diagnosisClarify diagnosis –Example: Ileus (adynamic) (bowel)….

29. 29 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 2, Terms Main terms (bold typeface)Main terms (bold typeface) –Subterms –Indented two spaces to right –Not bold ExampleExample Pain (Main term in bold) Pain (Main term in bold) orbital region 379.91 (subterm indented) orbital region 379.91 (subterm indented)

30. 30 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 2, Cross References Directs you: see, see also, see categoriesDirects you: see, see also, see categories “see” directs you to specific term“see” directs you to specific term –Example: Panotitis—“see” Otitis media “see also” directs you to another term for more information“see also” directs you to another term for more information –Example: Perivaginitis (see also Vaginitis) (Cont’d…)

31. 31 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 2, Cross References (…Cont’d) “see category” Volume 1, Tabular List, specific information about use of code“see category” Volume 1, Tabular List, specific information about use of code –Example: Mesencephalitis (see also Encephalitis) 323.9; late effect—see category 326

32. 32 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 2, Notes Define termsDefine terms Give further coding instructionsGive further coding instructions –Example: Index: “Melanoma,” Note: “Except where otherwise indicated….”Note: “Except where otherwise indicated….”(Cont’d…)

33. 33 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 2, Notes Mandatory fifth digits also appear as notes (one reason to never code from Index)Mandatory fifth digits also appear as notes (one reason to never code from Index) (…Cont’d) Figure: 14.4 From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

34. 34 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 2, Eponyms Disease or syndrome named for personDisease or syndrome named for person –Example: Arnold-Chiari (see also Spina bifida)Arnold-Chiari (see also Spina bifida) Sturge-WeberSturge-Weber Prader-WilliPrader-Willi

35. 35 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 2, Etiology and Manifestation of Disease Etiology = cause of diseaseEtiology = cause of disease Manifestation = symptomManifestation = symptom Etiology + Manifestation = Combination codesEtiology + Manifestation = Combination codes

36. 36 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Combination Code Figure: 14.5 From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

37. 37 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Multiple Coding No combination code, use individual code(s) in this orderNo combination code, use individual code(s) in this order –250.4x –581.81 Figure: 14.6 From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

38. 38 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 2, Neoplasm In Volume 2, Index, locate Neoplasm Table under the alphabetic entry “N”In Volume 2, Index, locate Neoplasm Table under the alphabetic entry “N” Do not reference Neoplasm table when diagnostic statement states “mass”Do not reference Neoplasm table when diagnostic statement states “mass” Figure: 14.7 From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

39. 39 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 2, Sections Section 1, Index to DiseasesSection 1, Index to Diseases Section 2, Table of Drugs and ChemicalsSection 2, Table of Drugs and Chemicals Section 3, Index to External Causes of Injuries and Poisonings (E Codes)Section 3, Index to External Causes of Injuries and Poisonings (E Codes) –Never primary diagnosis –Medicare does not accept for professional billing

40. 40 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Section 1, Index to Diseases Largest part of Volume 2—IndexLargest part of Volume 2—Index First step in coding, locate main bold term in the IndexFirst step in coding, locate main bold term in the Index Subterms indented 2 spaces to the rightSubterms indented 2 spaces to the right May have more than one subtermMay have more than one subterm 3 digits = category codes3 digits = category codes 4 digits = subcategory4 digits = subcategory 5 digits = subclassification codes5 digits = subclassification codes

41. 41 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Section 2, Table of Drugs and Chemicals Drug name placed alphabetically on left under heading “Substance”Drug name placed alphabetically on left under heading “Substance”(Cont’d…) From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

42. 42 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Table of Drugs and Chemicals (…Cont’d) First column: “Poisoning” code for substance involved, wrong substance given or takenFirst column: “Poisoning” code for substance involved, wrong substance given or taken First-listed before manifestation conditionFirst-listed before manifestation condition(Cont’d…) From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

43. 43 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Table of Drugs and Chemicals (…Cont’d) E codes identify how poisoning occurredE codes identify how poisoning occurred –Example: If analgesics poisoning occurred by accident, E850.9 Correct order poisoningCorrect order poisoning –3 codes required: Identify agent analgesic 965.9Identify agent analgesic 965.9 Condition—coma 780.01Condition—coma 780.01 Accidental poison E850.9Accidental poison E850.9 Adverse effectAdverse effect –2 codes required Condition—coma 780.01Condition—coma 780.01 Therapeutic E935.9Therapeutic E935.9

44. 44 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Table of Drugs and Chemicals: Headings Accident: UnintentionalAccident: Unintentional Therapeutic: Correct dosage, correctly administered, with adverse effects (example, allergic reaction)Therapeutic: Correct dosage, correctly administered, with adverse effects (example, allergic reaction) Suicide attempt (must be documented)Suicide attempt (must be documented) Assault: Intentionally inflicted by another personAssault: Intentionally inflicted by another person Undetermined: Unknown intentUndetermined: Unknown intent

45. 45 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Section 3, E Codes Alphabetic Index to External Causes of Injuries and PoisoningsAlphabetic Index to External Causes of Injuries and Poisonings Provide additional information about the nature of injury/poisoning and localityProvide additional information about the nature of injury/poisoning and locality Never a principal (inpatient) or first- listed (outpatient) diagnosisNever a principal (inpatient) or first- listed (outpatient) diagnosis(Cont’d…)

46. 46 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Section 3, E Codes (…Cont’d) Separate Index to External CausesSeparate Index to External Causes Alphabetical, main terms in boldAlphabetical, main terms in bold Subterms are indented 2 to right under main termSubterms are indented 2 to right under main term Some words in Index not in Tabular—saves spaceSome words in Index not in Tabular—saves space That is why you must locate the term in the Index, then locate in TabularThat is why you must locate the term in the Index, then locate in Tabular

47. 47 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Index to External Causes: Example Main terms are type of accident (Collision)Main terms are type of accident (Collision) Subterms are circumstancesof the accident (motor vehicle)Subterms are circumstances of the accident (motor vehicle) From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

48. 48 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. A Word of Caution About the Alphabetic Index (Section I, Vol. 2) Some words in Index do not appear in Tabular—saves spaceSome words in Index do not appear in Tabular—saves space Exact word may not be in code Tabular descriptionExact 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)

49. 49 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 1, Tabular List Two major divisionsTwo major divisions –Classification of Diseases and Injuries (codes 001.0-999.9) –Supplementary Classification (V codes and E codes)

50. 50 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Classification of Diseases and Injuries Main portion of ICD-9-CMMain portion of ICD-9-CM Codes from 001.0-999.9Codes from 001.0-999.9 Most chapters are body systemsMost chapters are body systems –Digestive System –Respiratory System

51. 51 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Divisions of Classification of Diseases and Injuries Chapters: 1 through 17Chapters: 1 through 17 Section: A group of related conditionsSection: A group of related conditions

52. 52 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Category Code Category : Represents single disease/condition (3 digits)Category : Represents single disease/condition (3 digits) Figure: 14.16 From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

53. 53 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Subcategory Code Subcategory: More specific (4th digit)Subcategory: More specific (4th digit) Figure: 14.17

54. 54 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Subclassification Code Subclassification: More specific (5th digit)Subclassification: More specific (5th digit) Figure: 14.18

55. 55 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Specificity in ICD-9-CM Codes Each digit adds to the specificity (detail)Each digit adds to the specificity (detail) Figure: 14.19

56. 56 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 1, Diseases, Format Figure: 14.14 From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

57. 57 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Remember Assign to the highest level possible, based on documentationAssign to the highest level possible, based on documentation If 4-digit code exists, do not report 3-digit codeIf 4-digit code exists, do not report 3-digit code If 5-digit code exists, do not report 4-digit codeIf 5-digit code exists, do not report 4-digit code

58. 58 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. V Codes (V01.0-V86.1) Patient not ill but encounters health servicesPatient not ill but encounters health services –e.g., Vaccination Patient presents for treatmentPatient presents for treatment –e.g., Chemotherapy Some V codes are primary only (ex., V58.11, encounter for chemotherapy)Some V codes are primary only (ex., V58.11, encounter for chemotherapy)(Cont’d…)

59. 59 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. V Codes (V01.0-V86.1) (…Cont’d) Factors that influence patient’s health statusFactors that influence patient’s health status –e.g., Personal history of [PHO] malignant tumor, organ transplant –Birth status and outcome of delivery

60. 60 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. E Codes (E800-E999) Supplementary Classification of External Causes of Injury and PoisoningSupplementary Classification of External Causes of Injury and Poisoning Alpha-numerical designations for injuries and poisoningsAlpha-numerical designations for injuries and poisonings(Cont’d…)

61. 61 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. E Codes (E800-E999) (…Cont’d) Provides additional information about external causesProvides additional information about external causes Never a principal (inpatient) diagnosisNever a principal (inpatient) diagnosis Separate E code indexSeparate E code index –Locate the E Code index in your ICD-9-CM now

62. 62 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Appendices in Volume 1 There are five appendices in official ICD-9-CMThere are five appendices in official ICD-9-CM Private publishers may have morePrivate publishers may have more

63. 63 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Appendix A, Morphology of Neoplasms Used in conjunction with codes from Chapter 2, NeoplasmUsed in conjunction with codes from Chapter 2, Neoplasm –Inpatient setting: Cancer registries and claim forms –Not placed on a billing claim form (Cont’d…)

64. 64 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Appendix A, Morphology of Neoplasms (…Cont’d) Begins with M followed by 5 digitsBegins with M followed by 5 digits –M8400/0, Sweat gland adenoma First four digits: Histologic type of neoplasmFirst four digits: Histologic type of neoplasm Fifth digit: Behavior (e.g., 0 = benign)Fifth digit: Behavior (e.g., 0 = benign)

65. 65 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Appendix B, Glossary of Mental Disorders Deleted in 2004Deleted in 2004

66. 66 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Appendix C, Drugs American Hospital Formulary Service (AHFS) publishes list of all drugsAmerican Hospital Formulary Service (AHFS) publishes list of all drugs Tracks drugs nationally; used by pharmacistsTracks drugs nationally; used by pharmacists Each drug coded with up to five-digit code (e.g., 8:12.04)Each drug coded with up to five-digit code (e.g., 8:12.04)(Cont’d…)

67. 67 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Appendix C, Drugs (…Cont’d) AHFS listing correlated to ICD-9-CM Table of Drugs and ChemicalsAHFS listing correlated to ICD-9-CM Table of Drugs and Chemicals New drugs not identified by nameNew drugs not identified by name –Rather listed under heading “Drug” in Table of Drugs and Chemicals –Example: 84:04.04 antibiotics

68. 68 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Appendix D, Industrial Accidents Three-digit codes that identify occupational hazardsThree-digit codes that identify occupational hazards Not placed on insurance or billing formNot placed on insurance or billing form Used by state and federal organizations (OSHA) Occupational Safety and Health Administration to summarize industrial accident dataUsed by state and federal organizations (OSHA) Occupational Safety and Health Administration to summarize industrial accident data

69. 69 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Appendix E, Three-Digit Categories Presented by chapterPresented by chapter Categories are labeled 1 through 17Categories are labeled 1 through 17 Provides quick overview of ICD-9-CM contentsProvides quick overview of ICD-9-CM contents

70. 70 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 3, Procedures 90% of codes refer to surgical procedures90% of codes refer to surgical procedures (Cont’d…) Figure: 14.20 From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

71. 71 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 3, Procedures 10% refer to diagnostic and therapeutic procedures10% refer to diagnostic and therapeutic procedures (Cont’d…) (…Cont’d) Figure: 14.21 From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

72. 72 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 3, Procedures (…Cont’d) Procedures done in physician’s office or outpatient ASC are coded using CPT codesProcedures done in physician’s office or outpatient ASC are coded using CPT codes –Surgeon uses CPT to report services to inpatients Volume 3, Procedure codes are used by hospitals to code facility services provided to inpatientsVolume 3, Procedure codes are used by hospitals to code facility services provided to inpatients

73. 73 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 3, Table of Contents Chapter 0Chapter 0 –Procedures and Interventions, Not Elsewhere Classified Chapters 1-15Chapters 1-15 –Operations on body systems Chapter 16Chapter 16 –Miscellaneous Diagnostic and Therapeutic Procedures –Most nonsurgical codes (Cont’d…)

74. 74 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 3, Table of Contents (…Cont’d) Figure: 14.22 From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

75. 75 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 3, Tabular List Conventions in Volume 3 same as those in Volumes 1 and 2Conventions in Volume 3 same as those in Volumes 1 and 2 “Code also...” Volume 3“Code also...” Volume 3 –Additional information about coding various components or special adjunctive services of procedure

76. 76 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 3, Alphabetic Index Contains terms that do not appear in Volume 3 Tabular ListContains 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 (Cont’d…)

77. 77 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 3, Alphabetic Index (…Cont’d) Terms in boldTerms in bold Subterms not in boldSubterms not in bold Never code directly from IndexNever code directly from Index Index example followsIndex example follows

78. 78 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Example Figure: 14.23 From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

79. 79 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 3, Alphabetic Index Index alphabeticalIndex alphabetical Ignores single spaces and hyphensIgnores single spaces and hyphens –Example: Opening and open reduction –“Opening” appears before “open reduction” because space between two words ignored (Cont’d…)

80. 80 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 3, Alphabetic Index (…Cont’d) Often necessary and permissible to code individual components of procedureOften necessary and permissible to code individual components of procedure –Example: During a procedure, a portion of intestine was removed and reconstruction of urinary bladder was done Both reconstruction (57.87) and resection (45.51) are codedBoth reconstruction (57.87) and resection (45.51) are coded(Cont’d…)

81. 81 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 3, Alphabetic Index (…Cont’d) Cross references of see, see also, and see category appear as they did in Volume 1Cross references of see, see also, and see category appear as they did in Volume 1 Many operations named for surgeon who developed procedure (eponyms)Many operations named for surgeon who developed procedure (eponyms) –These procedures located under person’s name or name of operation

82. 82 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 3, Tabular List Format same as Volume 1, Tabular List of Diseases, except Volume 3 codes have two digits before decimalFormat same as Volume 1, Tabular List of Diseases, except Volume 3 codes have two digits before decimal(Cont’d…)

83. 83 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Volume 3, Tabular List (…Cont’d) Category, subcategory, and subclassificationCategory, subcategory, and subclassification Figure: 14.24 From International Classification of Diseases, 9th Revision, U.S. Department of Health and Human Services, Public Health Service, Centers for Medicare and Medicaid Services.

84. 84 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Bundling Included in all surgical procedures opening and closing of surgical siteIncluded in all surgical procedures opening and closing of surgical site –Do not unbundle and code these separately –If closure takes place during separate surgical procedure, closure can be reported separately

85. 85 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Conclusion CHAPTER 14 AN OVERVIEW OF THE ICD-9-CM