chapter 4 icd-9-cm medical coding

Comprehensive Health Insurance

Billing, Coding, and Reimbursement

Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Comprehensive Health Insurance: Billing, Coding, and ReimbursementDeborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes

Chapter 4ICD-9-CM Medical Coding




Definition of Diagnosis Coding

Describes services and procedures diagnoses

ICD-9-CM:– Volumes are now used for coding the

appropriate medical conditions




Coding History

Bills of mortality 1665: some of the earliest uses of coding

Warnings of plague epidemics Diagnoses were often wrong or vague 18th century: Cause of death was noted




Purpose of the ICD-9-CM

Establishes medical necessity Translates written terminology into

common language Provides data for statistical analysis




The Yearly Addenda

Includes the addition of new codes Deletes old codes Includes descriptor revisions




The Three Volumes of the ICD-9-CM

Volume 1: Tabular/numerical list of diseases

Volume 2: Alphabetic index of disease Volume 3: Tabular and alphabetic index of

procedures




ICD-10-CM

Replaces volumes 1 and 2 of the ICD-9-CM

Uses alphanumeric codes Is much more detailed than ICD-9-CM Includes ambulatory and managed care

encounters Contains injury codes




ICD-10-CM

Combines many codes to give a more detailed description of the injury or illness

No implementation date has been set yet for the ICD-10-CM. Implementation will be based on the process for adoption of standards under HIPAA.




Common Terminology

Encounter: Refers to all healthcare settings

Provider: Physician or qualified healthcare provider

Diagnostic statement: The main reason for encounter

Primary diagnosis: The main reason for visit or encounter




Common Terminology

Principal diagnosis: The final diagnosis Manifestation: The sign or symptom of a

disease NEC: Not elsewhere classified NOS: Not otherwise specified




Symbols and Typeface and Terms

Boldface: Main term Subterms: Indented two spaces to the

right Supplementary term: Assists coder in

finding correct term ( ): Parentheses enclose supplementary

words




Symbols and Typeface and Terms

Colon (:) is used after incomplete phrase or term requiring indented term(s)

[ ]: used to enclose synonyms, alternate wordings, or explanatory phrases

Instructional terms: Assists coder in finding most specific term




Volume 2, The Alphabetical Index

Use this volume first to search for the correct code or condition.

After you find the code, use Volume 1 (tabular list) to research the specific code.




Volume 1, The Tabular List

Used to research the specific code Punctuation has various meanings.

– A colon : is used after an incomplete phrase or when a modifier is needed.

– Square brackets, [ ], are used to enclose synonyms, alternate wordings, or explanations.




Volume 1, The Tabular List

Punctuation has various meanings.– Parentheses () are used to enclose

supplementary words that may be present or absent in a statement of disease without affecting the code assignment




Three Steps for Accurate Coding

1. Determine the reason for the encounter.

2. Locate the term in alphabetic index Volume 2.

3. Verify the code in the tabular list (Volume 1).




Key Coding Guidelines

Code the primary diagnosis first, followed by current coexisting conditions.

Code to the highest level of certainty. Code to the highest level of specificity.




Code to the Highest Level of Certainty

Code condition of encounter. Sign: Objective Symptom: Subjective Signs, symptoms, ill-defined conditions Use Volume 2, alphabetic index, for sign

or symptom Use Volume 1, Chapter 16, to verify




Code to Highest Degree of Specificity

Assign three-digit codes if there are no four-digit codes in the category.

Assign four-digit codes if there are no five-digit codes in the category.

Claims submitted with three- or four-digit codes will be returned if four- to five-digit codes are available.




Proper Order for Coding

Main reason for encounter Any current coexisting condition Do not code conditions that were

previously treated and no longer exist.




Subsequent Coding

Surgical coding: Diagnosis for which surgery is performed

Late effects/residual effects: Condition that remains after an acute illness or injury

Acute and chronic conditions Combination codes




Subsequent Coding

V codes: Supplemental code that describes problems, services, or facts

E codes: Supplemental classifications of external causes of injuries and poisonings




Nine Steps of Accurate ICD-9-CM Coding

Locate main term in the diagnostic statement.

Locate the main term in Volume 2, the alphabetic index.

Refer to all notes under the main term. Use instructions in any notes appearing in a box after the main term.





Examine any modifiers. Note any subterms that provide greater

specificity.





Follow any cross-reference instructions. Confirm the code selection in the tabular

list (Volume 1). Follow the instructional terms in Volume 1. Assign the correct code number.

chapter 4 icd-9-cm medical coding

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