1. Unit 9 Seminar Chapters 3 & 4
HS225 Medical Coding I
Unit 9 Seminar
Chapters 3 & 4

2. Index to Diseases, Tabular List of Diseases, and Index to Procedures
Format
Spacing
Coding Conventions: are general rules used in classification, they are independent of the coding guidelines, they are in all three volumes of the ICD-9 book.
Format—refers to “indentations” to make using the book easier to use.
All subterms in the Aplhabetic Index are indented two spaces.
2nd and 3rd qualifiers associate with the main term are further indented two and four spaces
If an index entry requires more than one line the additonal text is printed on the next line and indented five spaces.

3. Eponyms Diseases or syndromes that are named for persons
For example, Meniere’s disease
Colle’s Fracture
Grave’s Disease

4. Abbreviations NEC (not elsewhere classifiable)
“Other specified”
For example, 250.8
Diabetes with other specified manifestations
NOS (not otherwise specified)
Equivalent to unspecified
For example, 250.9
Diabetes with unspecified complication
NEC-Documentation specifies what it is, but there are no specific classifications in the book.
NOS-Documentation is not specific.
You should contact the doctor to ask for additional documentation.

5. Punctuation Slanted brackets Square brackets Parentheses Colon [ ] ( )
[ ]
Square brackets
Parentheses
( )
Colon :

6. Slanted Brackets [ ] Located in Index to Diseases
Identify manifestation codes
For example, [357.4]
Slanted brackets—used to identify manifestation codes.
Manifestation is a condition that occurs as the result of another condition and may appear in italics in the Tabular List
Manifestations are always reported as a secondary code.

7. Square Brackets [ ]
Located in Tabular List of Diseases and Tabular List of Procedures
Enclose synonyms, alternative wording, or explanatory phrases
For example: Pituitary dwarfism Isolated deficiency of (human) growth Hormones [HGH]
Chronic Obstructive Pulmonary Disease [CPOD]

8. Parentheses ( )
May be present or absent in the doctor’s diagnostic statement
Enclose nonessential modifiers
For example, (acute) (chronic)
Diverticulitis (acute)
Hypertension (essential, vascular, crisis)
Parentheses—Used in both the index and tabular list as nonessential modifier that are supplementary words that may be present in or absent from the physician’s statement of disease or procedure. It does not affect the code number to which it is assigned.

9. Colon :
Used after an incomplete term in Tabular List of Diseases and Tabular List of Procedures
Indicates when one or more additional terms (modifiers) located after the colon are to be included in diagnostic statement
Colon—Used after an incomplete term in the Tabular List of disease and Tabular list of procedures when one or more additional terms (called Modifiers) included after the colon
Modifier should be are to be included in the diagnostic statement to classify a condition or procedure.
(continued)

10. Colon :
For example: Other acute otitis externa Acute otitis externa: actinic chemical contact eczematoid reactive

11. Boxed Notes Define terms Provide coding instruction
List fifth-digit subclassifications
(continued)

12. Boxed Notes
For example: 249 Secondary diabetes melltus
The following fifth digit sub-classification is for use with 249: 0 not stated as uncontrolled or unspecified 1 uncontrolled

13. Tables
Organize sub-terms, second qualifiers, third qualifiers, and their codes in columns and rows to make it easier to select proper code
Examples of tables:
Hypertension, hypertensive
Neoplasms
Table of Drugs and Chemicals
(continued)

14. Includes Notes
Located immediately below ICD-9-CM Tabular List of Diseases and Tabular List of Procedures Codes
Further defines or provides examples
(continued)

15. Includes Notes INCLUDES For example: 023 Brucellosis
Fever: Malta Mediterranean undulant
INCLUDES

16. Excludes Notes
Located in ICD-9-CM Tabular List of Diseases and Tabular List of Procedures
Directs coder to another location in the tabular list to classify conditions
(continued)

17. Excludes Notes
For example: Other primary progressive tuberculosis
tuberculous erythema nodosum (017.1)
Excludes

18. Inclusion Terms
Listed below certain four- and five-digit ICD-9-CM codes
Include conditions or procedures for which that code number is to be assigned
May be synonyms for code title
Include terms that do not appear in tabular list

19. Other and Other Specified Codes
Assigned when documentation provides detail for a code that does not exist in ICD-9-CM
Usually represented by a fourth and/or fifth digit of 8 and/or 9

20. Unspecified Codes
Assigned because documentation is insufficient to assign a more specific code
Usually represented by a fourth digit of 9 and/or a fifth digit of 0

21. Etiology and Manifestation Rules
Include the following notes in the Tabular List of Diseases:
Code first underlying disease
If applicable, code any causal condition first
Use additional code
In diseases classified elsewhere
Code first-assists the coder in the proper sequence the codes
Etiology code followed by manifestation code

22. And
Located in category titles and code descriptions in Tabular List of Diseases and Tabular List of Procedures
Interpreted as meaning “and/or”
464 Acute laryngitis and tracheitis
Means Acute laryngitis and/or tracheitis

23. Due To Located in Index to Diseases as sub-term Alphabetic order
Causal relationship
For example, meningitis due to adenovirus
Indicates a (casual) cause-and-effect relationship between two conditions

24. In Located in Index to Diseases in alphabetic order below main term
For example, pneumonia in candidiasis
These conditions often appear together

25. With
Located in Index to Diseases or Index to Procedures immediately below main term
Physician must document both conditions or procedures for code to be assigned

26. Cross-References
See
See also
See category
See condition

27. Chapter 4 Coding Guidelines

28. Guidelines
Signs and symptoms that are integral to the disease should not be assigned as additional codes.
The etiology and manifestation convention requires two codes to be reported to completely describe a single condition.
Signs and symptoms are codes that are used when there is no definitive diagnosis confirmed by a provider.
If they are not integral to the disease they should be coded when present.
(continued) 28

29. Guidelines Multiple coding for a single condition
Use additional code
Code first
If applicable, code any causal condition first
Acute (or subacute) and chronic conditions
Combination code versus multiple code
Acute and chronic may be used for the same condition and you must code both when present. Acute conditions should be coded first then the chronic condition. 29

30. Late Effect
Residual condition that develops after acute phase of illness or injury has ended
No time limit on reporting these codes
Combination code assigned
For example, painful cicatrix following severe burn to the elbow or left-sided paralysis due to previous cerebrovascular accident (CVA) 30

31. General Procedure Guidelines
Based on anatomy rather than surgical specialty
Numeric codes
Use both Index to Procedures and Tabular List of Procedures
(continued) 31

32. General Procedure Guidelines
Index to Procedures main terms organized in alphabetic order according to type of procedure
Report codes using highest number of digits available
— omit code
If omit code is found then don’t assign the procedure code
(continued) 32

33. General Procedure Guidelines
Common key terms:
Application
Closure
Correction
Destruction
Division
Incision
Insertion
Operation
Procedure
Release
Removal
Repair
(continued) 33

34. General Procedure Guidelines
Common key terms:
Resection
Revision
Suture
Test
Therapy
Transfer
(continued) 34

35. General Procedure Guidelines
Combination codes
Multiple codes
And/Or
Open procedure versus closed procedure
Endoscopic procedures
Biopsies
Canceled surgery
Assign comibation or multiple codes as appropriate
Combination: tonsilectomy and adenoidectomy.—use one combination code not two separate codes.
Open procedure is when an incision is made through the skin.—abdominal hernia repair or abdominal hysterectomy.
Closed procedure done by using an endoscope—colonoscopy, laparoscopic cholecystectomy
Biopsy—review the record to determine if it is closed or open.
Most closed biopsies are combination codes and the endoscopic procedure is coded first.
When a biopsy and subsequent removal of tissue is done at the same time code the removal of the tissue first and then the biopsy code.
When the surgeon an aspiration, bristle or brush or needle biopsy is done at the time of another open procedure, assign the closed biopsy code.
Cancelled surgery-if a procedure is cancelled after the patient was admitted but has not been prepped for surgery then do not report the procedure code.
If the patient has been prepped and/or the procedure had to stop during surgery it is considered an incomplete procedure;
IF the doctor makes an incision then code the incision of the site.
If the endoscopic approach does not result in the intended procedure then just code the type of endoscopy.
If a cavity or anatomic site was entered and the surgery was halts at that point, assign a code for the exploration of the cavity or site. 35

36. Questions