ICD-9-CM Diagnostic & Reimbursement for Physician Services 2010 edition

1. ICD-9-CM Diagnostic & Reimbursement for Physician Services 2010 edition Chapter 1: Introduction to ICD-9-CM

2. Coding is… Classifying data Assigning a representation for that data Telling a story to the insurance company using numbers instead of letters. Example: A zip code is the representation of the area in which a person lives.

3. Purposes of Coding Retrieval of information By diagnosis (why the patient is in the office) By procedure (what was done to the patient) Reimbursement- money received from insurance company for correct coding.

4. Resources for Coding ICD-9-CM Volumes 1 & 2 are used to code diagnoses in office and hospital settings Volume 3 is used for hospital procedure coding This book is updated annually in October for all settings

5. Volume 2: Alphabetic Index • This is where you look first. • Volume 2 is divided into three major sections: • Index to Diseases and Injuries • Table of Drugs and Chemicals • Alphabetic Index to External Causes of Injury and Poisoning

6. Volume 1 Tabular Index • This is where you look second. • Volume 1 contains the following major subdivisions: • Classification of Diseases and Injuries • Supplementary Classifications • V Codes • E Codes • Appendices

7. Volume 1-Tabular Index • Volume 1 is divided into 17 chapters (000–999). • Each chapter is structured into the following subdivisions: • Sections • Categories • Subcategories • Subclassifications

8. Sections & Categories • Sections • A group of three-digit categories • Represent a single disease entity or a group of similar or closely related conditions • Example: Disorders of Thyroid Gland (240–246) • Categories • Consist of three digits • Represent a single disease entity or a group of similar or closely related conditions • Example: Disorders of tooth development and eruption (520)

9. Subcategories & Fifth digit Subclassifications • Subcategories • Represented by fourth digit • 4th digit provides more specificity or information regarding the condition’s etiology, site, or manifestation • Fifth digit subclassifications • The fifth digit adds greater specificity to certain fourth-digit codes. • Fifth-digit assignments and instructions appear at the beginning of a chapter, section, category, or subcategory in the ICD-9cm book

10. Coding to specificity • You must code to the highest level of specificity. Otherwise you won’t get paid! • Third-digit code must only be used when there is no subcategory or subclassification. • Fourth-digit code must only be used when there is no subclassification with it. • Watch for required fourth and fifth digits, there will be a shaded box to the left of the code with a 4 or 5 in the box. Look down to the bottom of the page for the description of the shaded box and what is needed.

11. Residual Subcategories • Allow every disease or condition to have a code • Code title includes “other,” “unspecified,” or “other and unspecified.” • Usually designated by fourth-digit 8 or 9 • Do NOT use unspecified codes unless you really cannot find another code!

12. Appendices • Look in your book for the different Appendices. • Morphology of Neoplasms • Classification of Drugs by AHFS List • Classification of Industrial Accidents according to Agency • List of three-digit categories • c/c Exclusion List

13. Index to Diseases and Injuries • Main terms • Subterms • Carryover lines • Nonessential modifiers • Eponyms • Neoplasm and hypertension tables • Table of Drugs and Chemicals

14. Main Terms & Subterms • Main Terms • Set flush with the left margin of each column • In boldface type • Represent: • Diseases (influenza, bronchitis) • Conditions (fatigue, fracture) • Nouns (disease, syndrome) • Adjectives (double, large, kink) Subterms • Indented under the main term to the right by one standard indentation • Alphabetical order under main term • Describe differences in condition such as anatomic site, cause, or clinical type

15. Carryover Lines • Carryover Lines (page 14) • Needed for main terms or subterms because the number of words that fit on a single line of print is limited in the Alphabetic Index. • Indented two standard indents • Do not confuse with another subterm • Nonessential Modifiers (page 14-15) • Series of terms in parentheses that may follow a main term or subterm • Presence or absence of parenthetical terms has no effect on code assignment. • Word in parentheses may or may not appear in the diagnostic statement without affecting the code assignment.

16. Eponyms & Index Tables • Eponyms • The name of a disease, structure, operation, or procedure usually derived from the name of the person who discovered or described it first • May be found under eponymic name or under “Disease,” “Syndrome,” or “Disorder” • Index Tables • Main terms and subterms are arranged in tables instead of standard columns. • Hypertension Table • Neoplasm Table • Table of Drugs and Chemicals

17. Inclusion Notes • Further define or provide an example of code(s) • They can appear at the beginning of a chapter or section. • The notes usually list other common phrases used to describe the same condition but it may not be an exhaustive list. • Because an inclusion list is not repeated, coder must look back to the beginning of the chapter, section, category, or subcategory • Look at page 18 for examples

18. Excludes Notes • Appear in italicized print in a box • Provide a direction to code the particular condition listed elsewhere, usually with the code listed in the exclusion notes. • May have 3 different meanings.

19. Excludes 3 Meanings • 3: Note indicates additional code may be required to explain the condition. • The condition in the exclusion note is not included in the code under review. • If the condition specified in the exclusion note is present, the additional code should be assigned • See codes 280-289 for example. 1: Code under consideration cannot be assigned if the associated condition specified in the exclusion note is present. • See subcategory 424.3 for an example 2: Condition may have to be coded elsewhere. • The etiology of the condition determines whether the code under review or the code suggested in the exclusion note should be assigned. • One or the other code is used but not both. • See category 603 for an example.

20. Instructional Notes • Appear in the Tabular List and Alphabetic Index • Describe needed instruction to assign fifth digits • Provide additional coding instruction • Provide definition of terms • Alphabetic Index notes are boxed and in italic type. Tabular notes are located at various levels and are not boxed. • See page 20 for example.

21. Mandatory Multiple Code Assignment • Certain conditions require multiple coding with one code for the underlying condition (cause, etiology) and another code for the manifestation(s). • Instructions on the sequence of codes is listed as well and should be followed. • The Alphabetic Index identifies both codes with the second code in brackets.

22. Multiple Code Assignment • Code first underlying condition. Pg 22 • Appears in the Tabular List • Found under codes that should not be listed first or as a single code • The underlying condition and code number(s) appear after the phrase, “Code first.” • Used with codes that are in italicized print, which indicates that the code is not listed first or appears as a single code • Mandatory coding • First code is the underlying condition. • Second code in brackets is the manifestation. • Both codes are assigned. • Sequence the codes in the order listed in Alphabetic Index. • Use additional code, if desired. Pg 21 • Appears in the Tabular List • “If desired” should be ignored. • The use of an additional code may provide more complete information. • The additional code must be assigned if the health information provides supportive documentation.

23. Connecting Words • Appear in the Alphabetic Index • Indicate a relationship between conditions • Examples: • And – Secondary to • Associated with – With • Due to – With mention of • Refer to page 23 for example

24. Abbreviations, Page 23-24 • Not Elsewhere Classified (NEC) • Used with ill-defined terms in the Tabular List to warn the coder that specified forms of the condition are coded differently • Can be used with terms for which a more specific code is unavailable, even if the diagnostic statement is very specific. • Not Otherwise Specified (NOS) • Equivalent of unspecified • Used in the Tabular List • Usually included with .9 codes • Diagnostic statement does not contain enough information to assign a more specific code

25. Punctuation, page 24-25 • Parentheses ( ) • Enclose supplementary words or explanatory information that may or may not be present in the diagnosis or procedure statement • Words in parentheses do not affect the code number assigned. • These terms are called nonessential modifiers • Square Brackets [ ] • Only used in the Tabular List • Enclose synonyms, alternative wording, abbreviations, and explanatory phrases

26. More Punctuation • Slanted Brackets [ ] page 25 • Appear only in the Alphabetic Index • Enclose a code that must be used in conjunction with the code immediately preceding it • Code in the slanted brackets is always listed second. • Code in the slanted brackets is the disease’s manifestation • Colon : • Used in the Tabular List • Appears after an incomplete term that needs one or more modifiers or adjectives in order to be assigned to a given category or code • See Category 204 for an example on page 26

27. Punctuation (continued) • Brace } • Appears in the Tabular List • Intended to simplify entries and save printing space by reducing repetitive wording • Connects a series of terms on the left or the right with a statement on the other side of the brace • A term on the left must appear with a term on the right before this code can be used See page 26 for example.

28. Symbols • Section Mark § • Indicates a footnote or reference concerning this code appears on the page or preceding pages • Not all codebook publishers use the section mark. Some have substituted another symbol to alert the coder of special instructions • Lozenge ■ • Found immediately preceding a fourth digit to indicate the code is unique to ICD-9-CM and does not correlate directly to ICD-9 • Has no significance to coding • May not be found in all codebooks

29. Basic Steps in ICD-9-CM Coding • 5. Verify the code selected in the Tabular List • 6. Read and be guided by any instructional terms in the Tabular List. • 7. Assign codes to their highest level of specificity. • 1. Identify all main terms. • 2. Locate each main term in the Alphabetic Index. • 3. Refer to any subterms indented under the main term. • 4. Follow cross-reference instructions for codes not located under the main term.

30. Signs and Symptoms When a definitive diagnosis is not available, the chief complaint should be used for coding Do not code diagnoses documented as “probable,” “suspected,” “questionable,” “rule out,(R/O)” or “working diagnosis.” Code symptoms to the highest degree of certainty for the visit Chronic diseases requiring ongoing treatment may be reported as many times as the patient receives treatment