What is coding?

• Transformation of verbal descriptions into numbers

• Describes: Diseases Injuries Procedure

INTRODUCTION TO ICD-9-CM

Official Guidelines for Coding and Reporting Appendix I Used by ALL healthplans Volumes 1-2

Cover diseases, injuries, impairments Cover other health problems Cover Causes of injury and disease

Volume 3 covers procedures or other actions taken for disease, injury, or impairments

HCPCS and CPT-4 are used for physicians and other healthcare services (i.e. ambulance, tests, therapy)

Official Guidelines

Classifications of Diseases and Injuries Supplementary Classifications ( V and E ) Appendices 17 Chapters/categories Volume 1

Sections (groups of 3 digits) Single disease or group of similar conditions

Categories (3 digit) More specific than sectionsSubcategories (4th digit) More specific re:signs,

symptoms, secondary illness)

Tabular List

Fifth digit – Even greater specificity. ◦ (See page 5 in your book)

Includes notes – further defines or provides an example.

Excludes notes – directs you to look elsewhere

Two supplementary classifications• V Codes – Factors influencing Health Status and

contact with Health Services• E Codes – External Cause of Injury and Poisoning

Tabular List (cont)

Appendix A: Morphology of Neoplasms• M code

Appendix B: Abbreviations Appendix C: Mocroorganisms Appendix D: Commonly Used Drugs Appendix E: Morphology Terminology Appendix F: Sample Billing Forms Appendix G: Ethics in Coding Appendix H: Data Quality Appendix I: Previous slide - Guidelines

Appendices

Index to Diseases and Injuries• Main terms- boldface type• Subterms- indented (modifiers) affect selection• Carryover lines- needed to fit long term onto

another line• Nonessention modifiers- in parentheses- no effect

on selection• Eponyms – named after discovering physician, etc.• Not all terms are in Tabular list that are in

Alphabetic Index• Cross-reference – item states see to send to

alternate term. Direction must be followed. See also requires viewing another main term for best info.

Alphabetic Index

Table of Drugs and Chemicals

Alphabetic Index to External Causes of Injury and Poisoning (E codes)

Alphabetic Index (cont)

Mandatory Multiple Coding – need to use more than one code to fully identify a given condition; includes “due to”, “secondary to”, or “with” – these may require multiple codes. When no combination codes available – use multiple codes. AVOID indiscriminate multiple coding.

Not Elsewhere Classifiable• Use with ill-defined terms• More precise info is not available

Not Otherwise Specified (Unspecified) Symbols • Lozenge – square IDs code as unique to US• Parentheses – enclose words or info that may or

may not b present in statement of diagnosis• Square brackets – enclose alternate words or

phrases.

Volume 3 – includes Tabular and Alphabetic Combines with HCPCS Connecting words – subterms with as, by, or

with Code also – reminder to code additional

procedures when they have been performed Omit code – only used in volume 3 – no

code is to be assigned Code incomplete procedures Code failed procedures

Procedures

Principal procedure – was performed for definitive treatment rather than for diagnosis or exploratory purposes or for treatment of a complication

Procedures (cont)

Minimum core data needed for payment:• Personal ID – number assigned to patient• DOB Sex Race Ethnicity Residence• Hospital ID – assigned to physician• Disposition of patient – to home, AMA, another

hospital, long-term, short-term, deceased• Principal diagnosis – condition established after

study to be chiefly responsible for the admission of patient

• Other diagnosis – All must be listed• Complication Comorbidity (preexisting)• Procedures w/dates - significant or principal

Uniform Hospital Discharge Data Set (UHDDS)

Principal Diagnosis: selection depends on the circumstances of admission, diagnostic tests, studies, symptom or illness could be changed after admission.

Pages 51-55 CAREFULLY read the guidelines for principal diagnosis

Guidelines