Intro to ICD-9 CodingNancy Clark, M.Ed.Director of Medical Informatics EducationFSU College of Medicine

Class Resources NeededICD-9 Coding bookPages refer to Medicode book. Page numbers may not match other books.A medical reference with ICD-9 codesOnline ICD-9 coder at CDC Wonder

PDA Coding ProgramsInfoRetrieverEpocrates ICDBluefish RX ICD and CPTCodeMeisterICD NotesPocket ICD/CPTStatICD, StatE&M, othersICD-9-CM pocket

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

International Classification of Disease, 9th Revision1948 - WHO developed to track diseases1977 - 9th revision published1988 - Congress passed Medicare Catastrophic Coverage Act requiring use of ICD-9 on all claims.1996 - mandated codes be of highest possible specificity.

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

HCFA GuidelinesCode 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 Do not code a diagnosis that is no longer applicable.

HCFA GuidelinesCode 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

HCFA GuidelinesCode 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.

Anatomy of ICD-9 Code

Organization of ICD-9 Volume 1001-139Infectious and Parasitic Diseases 140-239 Neoplasms240-279Endocrine, Nutritional and Metabolic Diseases280-289Diseases of the Blood and Blood-forming Organs290-319Mental Disorders320-389Diseases of the Nervous System and Sense Organs390-459Diseases of the Circulatory System460-519Diseases of the Respiratory System520-579Diseases of the Digestive System580-589Diseases of the Genitourinary System630-676Complications of Pregnancy, Childbirth, and the Puerperium680-709Diseases of the Skin and Subcutaneous Tissue

Organization of ICD-9 Volume 1710-739Diseases of the Musculoskeletal System & Connective Tissue740-759Congenital Anomalies760-779Certain Conditions Originating in the Perinatal Period780-799Symptoms, Signs and Ill-defined Conditions800-999Injury and PoisoningE800-E999Supplementary Classification of the External Causes of Injury and PoisoningV01-V82Supplementary Classification of factors influencing Health Status and Contact with Health Services

Key to SymbolsAdditional Digits RequiredNonspecific CodeNot a Primary DiagnosisNot Elsewhere ClassifiedNot Otherwise SpecifiedNECNOSEXCLUDESINCLUDESSymbols may vary with different books.Look for Key at beginning of Volume 1.

Volume 1 Structure

ICD-9 Volume 2 Section 1 - Alphabetic Index to DiseasesSection 2 - Table of Drugs and ChemicalsSection 3 - Index to External CausesHandy TablesHypertensionNeoplasms

Using BookLook up first 3 digits in Volume 2 IndicesPain, Chest 786.5

Using BookTurn to that ICD code in Volume 1

786.5Chest pain786.50Chest pain, unspecified786.51Precordial pain786.52Painful respirationPain:Pleurodyniaanterior chest wallpleuriticepidemic pleurodynia (074.1)786.59OtherDiscomfortPressurein chestTightnessEXCLUDES

New, Acute Problem, DiagnosableLook up diagnosis in Volume 2Go to Code # in Volume 1Pick specific location, type, severity, complication, and/or manifestationFind appropriate 4th and 5th digits

Bronchitis, acute, probably viral 466.0

New Acute or Chronic Problem that you cant diagnose this visitCode the symptom

Abdominal swelling or mass in epigastric area789.36Elevated blood pressure796.2

Check-up for Chronic Problem, Well Child, Well Adult with No Complaints, Sequelae, or ComplicationsUse a V Code and/or Code for Chronic ProblemLook up Examination in Volume 2

Well Child v20.2 (EPSDT different)General Physical v70.0Gynecological exam v72.3

More on Annual PhysicalsUse Family History of as second diagnosis when applicable to justify

Family History of colon cancer V16.0

Follow-up for Previous Acute Condition, with no problemsDont Code for the acute condition which no longer existsUse a V Code Look up History of or Aftercare unless it was an accident

Follow-up for pneumonia (fully healed) v12.6

Follow-up to Previous Acute Problem, there are complicationsLook up Late Effects or the specific condition(s)

Patient develops infection in wound on hand you sutured three days ago

906.1

Chronic Problems with SequelaeRequires two codes:Code the Chronic Problem firstCode the Complication second

Type 2 diabetic develops peripheral neuropathyType 2 DM with neurological manifestations 250.60 Peripheral neuropathy 337.1

Accidents, Suicides, Poisonings . . . External CausesUse E codes and/or Injury and PoisoningLook 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 845.01Fall on or from sidewalk curb E880.1

Drug Side-EffectsUse Section 2 of Volume 2, p353Will 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 penicillinAllergic urticaria 708.0Penicillin poisoning 960.0Therapeutic penicillin E930.0

Using IT Coding AidsOnline ICD-9 Search at CDC WonderInfoRetriever on PDA, desktop or onlineICD-9 Coding module5 Minute Clinical ConsultEncoder Pro and Code-it-FastFirst Consultonline

Other PDA coding softwareBluefish RX ICD and CPTCodeMeisterICD NotesPocket ICD/CPTStatICD, StatE&M, othersICD-9-CM pocket

References and ResourcesSulkes, S. Coding and Documenting for Reimbursement. In: Coleman, W. (2001) Family Focused Behavioral Pediatrics. Lippincott Williams & Wilkins, Philadelphia, PA. Available at Books@OVID

Look up some diagnoses