Master Core Curriculum

1
Master Core Curriculum

• Part A Basic
• Module 4
• ICD-9 CM

2
Learning Outcomes

• At the end of this module, participants will
• be able to
• identify which ICD-9 CM tools will be most
  beneficial to their practice
• effectively navigate the ICD-9 CM manual/tools
• select LCDs applicable to their common situations
• select ICD-9 CM codes to the highest level of
  specificity by description

3
What is ICD-9-CM?

• Acronym for International Classification of
  Diseases, 9th Revision, Clinical Modification
• Often referred to as ICD-9
• Coding system used to describe disease, injury,
  and location of the disease or injury
• Health care professionals use it to code
  procedures and diagnoses

4
History of ICD-9-CM

• Medicare Catastrophic Coverage Act of 1988
• Use of codes versus written text
• April 1, 1989 coding system implemented

5
Who uses the ICD-9-CM coding system?

• Health care professionals
• Medicare billers and/or billing services
• Customer service representatives

6
Inside the ICD-9-CM

• The ICD-9-CM book consists of three volumes.
• Volume 1 Diseases Tabular List
• Two Sections Supplementary V and E Codes
• Appendices
• Volume 2 Diseases Alphabetic Index
• Volume 3 Procedures Tabular List and
  Alphabetic Index

7
Conventions

• CONVENTIONS (Symbols, punctuation, abbreviations
  and notations)
• Refer to hand out
• Some conventions used in all three volumes
• Others are only found in volume one or two
• It is necessary to understand their use when
  assigning codes

8
Volume 1, Tabular List

• Each chapter of the Tabular List is divided into
  four components
• Sections / Group of three (3) digit code numbers
• Fracture of Upper Limb (810-819)
• Categories / Three digit code numbers i.e.,
• Fracture of the Humerus (812)
• Subcategory / Four digit numbers
• Upper end, closed (812.0)
• Fifth-digit Subclassifications / Five digit code
  numbers
• Surgical Neck (812.01)

9
Volume 2, Alphabetic Index

• Diagnosis Codes (Main Terms) listed
  alphabetically.
• i.e., Fever 780.6
• with chills 780.6
• Two Supplementary Sections following alphabetic
  listing
• Two Special Tables found within the alphabetic
  listing

10
Etiology and Manifestation Codes

• Need to record both etiology (cause)
• Manifestation (symptom)
• Many times a single five-digit code can be used
• Multiple coding may be required

11
Hypertension Table

• Located in Volume 2 in the Alphabetic Index
• Hypertensive disease is classified to the
  categories 401-405
• Contains sub-terms to identify types of
  hypertension related to specific conditions
• The table is categorized by 3 types
• Malignant
• Benign
• Unspecified

12
Neoplasm Table

• In coding a neoplasm, consider these three
  factors
• Behavior of the neoplasm
• Site of the neoplasm
• Reason for the admission

13
Table of Drugs Chemicals

• Alphabetic Index
• Classifies drugs chemical substances
• External causes of adverse effects

14
Volume 3, Inside the Procedures List

• Contains two sections
• A Tabular List of Codes
• An Alphabetic Index
• Codes found in Volume 3 are primarily used in the
  hospital setting
• These codes define procedures instead of
  diagnoses

15
Coding Fundamentals

• When locating and choosing codes, use both
• The Alphabetic Index (Volume 2) and
• Coding ONLY from the Alphabetic Index will cause
  you to miss any additional information provided
  only in the Tabular List, such as exclusions,
  instructions to use additional codes or the need
  to add a fifth digit
• The Tabular List (Volume 1)
• Use the HIGHEST level of specificity

16
Manifestation Codes

• Manifestations (multiple coding of diagnoses)
• Manifestations are telling signs or symptoms of
  an illness
• Chapter 16 of the Tabular List includes
  ill-defined conditions and symptoms that may
  suggest two or more diseases or may point to two
  or more systems of the body, and are used in
  cases missing the necessary study to make a final
  diagnosis
• A Headache 784.0 is an example of a diagnosis
  that cannot be more specific, even after all
  facts have been investigated

17
Local Coverage Determinations (LCDs)

• An LCD is a determination about the
  reasonableness and necessity of a service
• LCDs specify the clinical circumstances a service
  is believed to be reasonable and necessary
• Frequent denials (following routine or complex
  review) may prompt the development of an LCD by a
  contractor

18
ICD-9-CM coding and LCDs

• Contractors are notified of each LCD that is
  affected by an update to a HCPC or ICD-9-CM code
• The database automatically includes code
  deletions into revised LCDs that are placed in
  to be reviewed status
• Contractors are alerted only to the existence of
  NEW codes if the new code falls within a code
  range listed in the LCD
• Only codes that describe what is and is not
  covered can be part of the LCD

19
References

• www.cms.hhs.gov/manuals/
• Chapter 13 of the Medicare Program Integrity
  Manual, Local Coverage Determinations
• CMS Internet Only Manual
• Luguna Medical Systems
• The Coding Edge Archives, Sept. 2004
• Carol J. Buck
• Step by Step Medical Coding