Intro to ICD9 Coding

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Intro to ICD-9 Coding

• Nancy Clark, M.Ed.
• Director of Medical Informatics Education
• FSU College of Medicine

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Class Resources Needed

• ICD-9 Coding book
• Pages refer to Medicode book. Page numbers may
  not match other books.
• A medical reference with ICD-9 codes
• Online ICD-9 coder at CDC Wonder

• PDA Coding Programs
• InfoRetriever
• Epocrates ICD
• Bluefish RX ICD and CPT
• CodeMeister
• ICD Notes
• Pocket ICD/CPT
• StatICD, StatEM, others
• ICD-9-CM pocket

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Objectives

• Learner will correctly describe a diagnosis so
  that a billing clerk can assign an ICD-9 code(s)
  to the encounter
• Learner will correctly assign an ICD-9 code(s) to
  an encounter using the ICD-9 book
• Learner will correctly assign an ICD-9 code(s) to
  an encounter using a computer program, PDA
  program or web site.

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International Classification of Disease, 9th
Revision

• 1948 - WHO developed to track diseases
• 1977 - 9th revision published
• 1988 - Congress passed Medicare Catastrophic
  Coverage Act requiring use of ICD-9 on all
  claims.
• 1996 - mandated codes be of highest possible
  specificity.

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HCFA Guidelines

• Identify each service, procedure, or supply with
  an ICD-9 code from 001.0 through V82.9 to
  describe the diagnosis, symptom, complaint,
  condition, or problem
• Identify services or visits for circumstances
  other than disease or injury, such as follow-up
  care after chemotherapy, with V codes provided
  for this purpose.

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HCFA Guidelines

• Code the primary diagnosis first, followed by the
  secondary, tertiary and so on. Code any
  coexisting conditions that affect the treatment
  of the patient for that visit or procedure as
  supplementary information. Do not code a
  diagnosis that is no longer applicable.

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HCFA Guidelines

• Code to the highest degree of specificity. Carry
  the numerical code to the 4th or 5th digit when
  necessary. Remember, there are only
  approximately 100 valid three digit codes all
  other ICD-9 codes require additional digits

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HCFA Guidelines

• Code a chronic diagnosis as often as it is
  applicable to the patients treatment at this
  encounter.
• When only ancillary services are provided, list
  the appropriate V code first and the problem
  second.
• For surgical procedures, code the diagnosis
  applicable to the procedure.

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Anatomy of ICD-9 Code
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Organization of ICD-9 Volume 1

• 001-139 Infectious and Parasitic Diseases
• 140-239 Neoplasms
• 240-279 Endocrine, Nutritional and Metabolic
  Diseases
• 280-289 Diseases of the Blood and Blood-forming
  Organs
• 290-319 Mental Disorders
• 320-389 Diseases of the Nervous System and Sense
  Organs
• 390-459 Diseases of the Circulatory System
• 460-519 Diseases of the Respiratory System
• 520-579 Diseases of the Digestive System
• 580-589 Diseases of the Genitourinary System
• 630-676 Complications of Pregnancy, Childbirth,
  and the Puerperium
• 680-709 Diseases of the Skin and Subcutaneous
  Tissue

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Organization of ICD-9 Volume 1

• 710-739 Diseases of the Musculoskeletal System
  Connective Tissue
• 740-759 Congenital Anomalies
• 760-779 Certain Conditions Originating in the
  Perinatal Period
• 780-799 Symptoms, Signs and Ill-defined
  Conditions
• 800-999 Injury and Poisoning
• E800-E999 Supplementary Classification of the
  External Causes of Injury and Poisoning
• V01-V82 Supplementary Classification of factors
  influencing Health Status and Contact with Health
  Services

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Key to Symbols

• Additional Digits Required
• Nonspecific Code
• Not a Primary Diagnosis
• Not Elsewhere Classified
• Not Otherwise Specified

NEC
NOS
EXCLUDES
INCLUDES
Symbols may vary with different books. Look for
Key at beginning of Volume 1.
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Volume 1 Structure
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ICD-9 Volume 2

• Section 1 - Alphabetic Index to Diseases
• Section 2 - Table of Drugs and Chemicals
• Section 3 - Index to External Causes
• Handy Tables
• Hypertension
• Neoplasms

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Using Book

• Look up first 3 digits in Volume 2 Indices
• Pain, Chest 786.5

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Using Book

• Turn to that ICD code in Volume 1
• 786.5 Chest pain
• 786.50 Chest pain, unspecified
• 786.51 Precordial pain
• 786.52 Painful respiration
• Pain Pleurodynia
• anterior chest wall
• pleuritic
• epidemic pleurodynia (074.1)
• 786.59 Other
• Discomfort
• Pressure in chest
• Tightness

EXCLUDES
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New, Acute Problem, Diagnosable

• Look up diagnosis in Volume 2
• Go to Code in Volume 1
• Pick specific location, type, severity,
  complication, and/or manifestation
• Find appropriate 4th and 5th digits
• Bronchitis, acute, probably viral
• 466.0

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New Acute or Chronic Problem that you cant
diagnose this visit

• Code the symptom
• Abdominal swelling or mass in epigastric area
• 789.36
• Elevated blood pressure
• 796.2

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Check-up for Chronic Problem, Well Child, Well
Adult with No Complaints, Sequelae, or
Complications

• Use a V Code and/or Code for Chronic Problem
• Look up Examination in Volume 2
• Well Child v20.2 (EPSDT different)
• General Physical v70.0
• Gynecological exam v72.3

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More on Annual Physicals

• Use Family History of as second diagnosis when
  applicable to justify
• Family History of colon cancer V16.0

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Follow-up for Previous Acute Condition, with no
problems

• Dont Code for the acute condition which no
  longer exists
• Use a V Code
• Look up History of or Aftercare unless it was
  an accident
• Follow-up for pneumonia (fully healed)
• v12.6

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Follow-up to Previous Acute Problem, there are
complications

• Look up Late Effects or the specific
  condition(s)
• Patient develops infection in wound on hand you
  sutured three days ago
• 906.1

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Chronic Problems with Sequelae

• Requires two codes
• Code the Chronic Problem first
• Code the Complication second
• Type 2 diabetic develops peripheral neuropathy
• Type 2 DM with neurological manifestations
  250.60
• Peripheral neuropathy 337.1

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Accidents, Suicides, Poisonings . . . External
Causes

• Use E codes and/or Injury and Poisoning
• Look up injury in Index, circumstances in E-Codes
• Elderly patient fell, sprained internal
  collateral ligament in ankle while stepping from
  curb
• Sprains and strains of ankle and foot 845.01
• Fall on or from sidewalk curb E880.1

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Drug Side-Effects

• Use Section 2 of Volume 2, p353
• Will require 3 codes the side effect, the code
  for poisoning for the drug and the E-code for the
  therapeutic use of the drug.
• Patient develops hives after taking penicillin
• Allergic urticaria 708.0
• Penicillin poisoning 960.0
• Therapeutic penicillin E930.0

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Using IT Coding Aids

• Online ICD-9 Search at CDC Wonder
• InfoRetriever on PDA, desktop or online
• ICD-9 Coding module
• 5 Minute Clinical Consult
• Encoder Pro and Code-it-Fast
• First Consultonline

• Other PDA coding software
• Bluefish RX ICD and CPT
• CodeMeister
• ICD Notes
• Pocket ICD/CPT
• StatICD, StatEM, others
• ICD-9-CM pocket

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References and Resources

• Sulkes, S. Coding and Documenting for
  Reimbursement. In Coleman, W. (2001) Family
  Focused Behavioral Pediatrics. Lippincott
  Williams Wilkins, Philadelphia, PA. Available
  at Books_at_OVID

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Look up some diagnoses