Introduction To ICD-9 Code Selection
Introduction To ICD-9 Code Selection
Code Selection
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Legal Stuff
The information provided here is personal opinion only and
should not be construed as legal advice. Each provider is
ultimately responsible for bills submitted under their NPI
numbers. For specific legal guidance on any billing issue,
consult with your Medicare Carrier and/or your health care
attorney.
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What is ICD-9?
- International Classification of Diseases, ninth
revision
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Reason for ICD-9
• Tracking of morbidity and mortality to assess international
health and disease trends
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Structure of ICD-9
There are 3 volumes of ICD-9 published each year.
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Appendices to Volume 1
Appendix A- Morphology of Neoplasm's
Appendix B- n/a
Appendix C- Classification of Drugs
Appendix D- Classification of Industrial Accidents
Appendix E- Listing of 3 digit ICD-9 codes
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Selecting an ICD-9 Code
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Identify the Reason
- Identify the reason for the patient’s visit. Sign, symptom,
diagnosis and/or condition to be coded
- 789.0 √ is what you will find the √ lets you know that
you need a fifth digit to use this code correctly
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Selecting a 5th digit
Volume 1 Tabular list states the following:
Using the “box” at the beginning of the 789. code set you need to select the specific location of the pain
0- unspecified site
1- right upper quadrant
2- left upper quadrant
3- right lower quadrant
4- left lower quadrant Example: 789.04 would
5- periumbilic be appropriate for
6- epigastric “abdominal pain in the
left lower quadrant
7- generalized
0- other specified site
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Exceptions
• As with anything there are exceptions to every rule.
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Instructional Notes
• Listed with each code are guidelines or “instructions” on
the use of the code
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Clinical Example
A patient presents for care with abdominal pain she has had
for 2 weeks. She has no history of a similar complaint. BS
done today indicates that her DMI is uncontrolled on insulin.
BP is well controlled on medication.
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Hypertension Table
• This table contains a listing of conditions that
are due to, or associated with hypertension
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Neoplasm Table
• This table is broken down into 4 categories
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Coding Neoplasm
- For a malignant neoplasm, determine the primary and
secondary sites but code the site being treated. (if the 2nd
location is the primary reason for care, select the code from
the secondary column and code it first)
- When information regarding primary site is unavailable use
199.1
Example:
A patient is treated for metastatic breast cancer of the left, lower-
outer quadrant that originated from the middle lobe of the lung.
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Table of Drugs and Chemicals
• This is a listing of specific types of agents that
can cause a reaction or poisoning if taken
incorrectly or in error
• Code first the identity of the manifestation
• The second code to identify the drug causing
the reaction
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Index to External Causes of Injuries
and Poisonings
• Used to classify environmental events,
circumstances, and other conditions as the
cause of injury or adverse effect
• E codes
– E850-E858 Accidental poisoning
– E930-E949 Therapeutic Use
– E950-E952 Suicide Attempt
– E960-E969 Assaults
– E980-E959 Undetermined
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Poisoning and Adverse Effect of Drugs
- When a prescription medication or drug is
taken as prescribed and the patient developed
a reaction
- Code the effect first, then the appropriate E
code
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Example of Drug Reaction
25y old female was given trimethobenzamide HC1
capsules for severe nausea and vomiting. She
developed dizziness and headache. Patient returned
to doctor for change in meds.
780.4 dizziness
339.3 Drug induced headache
E933.0 Anti-allergic and antiemetic drugs causing adverse effect
in therapeutic use
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Example of External Cause
35y old female falls through a plate glass window at
home and sustains a deep 4in laceration on upper
arm.
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V codes
Used when the circumstances of the encounter are due
to something other than a disease or injury.
Such as:
- Pt is not currently ill (wellness visit)
- Problem or circumstance that could influence the pt’s health
in the future (family history of colon cancer)
- Long term condition requiring continuous care (Coumadin
therapy)
- Newborns to indicate birth status
- Encounters for after care services (chemotherapy)
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V Codes Examples
1. V12.51 personal history of DVT
2. V07.4 Long term use of hormone therapy
3. V30.01 Single Live born, in hosp by C-section
4. V01.1 Exposure to TB
5. V04.81 Need for prophylactic , influenza
6. V09.0 Infection with penicillin resistance
(used in conjunction with the infection code)
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Diagnosis Coding
• Diagnosis coding does not drive the amount of
payment made by third party payors, however it
is used to determine if the service is payable, or
who may be responsible for payment.
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ICD-10 is coming
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Examples of ICD-10 codes
Examples:
M71.031 Abscess of bursa, right wrist
M71.032 Abscess of bursa, left hip
T50B96A Under-dosing of viral vaccine (1st encounter)
J10.81 Influenzal gastroenteritis
M12.152 Kaschin-Beck disease left hip
M12.151 Kaschin-Beck disease right hip
M32.11 Endocarditis in systemic lupus erythematosus
M32.12 Pericarditis in systemic lupus erythematosus
M32.13 Lung involvement is systemic lupus erythematosis
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Reminders
• Don’t code a diagnosis that has not been confirmed, for example: HIV
should not be coded unless it has been confirmed
• Hypertension and elevated blood pressure are not the same thing, one is a
confirmed disease and one is a condition that the patient may only have at
the moment
• When coding for obesity the BMI of the patient needs to be coded
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Sources
1 . “Deciphering Codes: Fraud & Abuse for Coders and Coding
Insight for Healthcare Lawyers”, 1st Edition, Editors: Rhonda
Buckholtz and Robert A Pelaia
3. www.cms.org
4. www.palmettogba.com
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Contact information
Laura A Sullivan, CPC
Coordinator
Corporate Compliance Auditing and Education
Room 2050
304-347-1374