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Chapter 5 Powerpoint Notes

Notes

Chapter 5
CHAPTER-SPECIFIC GUIDELINES
(ICD-9-CM CHAPTERS 1-8)

ICD-9-CM, Chapter 1
• Infectious and Parasitic Diseases
– Divided based on etiology
(cause of disease)
– Many combination codes
– Example: 112.0 candidiasis infection of mouth, which reports both organism and condition with one code
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Multiple Codes
• Sequencing must be considered
– UTI due to Escherichia coli
• 599.0 (UTI) etiology
• 041.4 (E. coli) organism
– 041 category is a secondary-code only
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Section I.C.1.a,d,e Human Immunodeficiency Virus
• Code HIV or HIV-related illness ONLY if stated as confirmed in diagnostic statement
• 042 HIV or HIV-related illness
• V08 Asymptomatic HIV status
• 795.71 Nonspecific HIV serology
• Once an HIV diagnosis cannot code V08
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Section I.C.1.a.2.f. Previously
diagnosed HIV-related illness
• Code prior diagnosis HIV-related disease 042 (HIV)
• NEVER assign these patients to:
– V08 (asymptomatic) or
– 795.71 (Nonspecific serologic evidence
of HIV)
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Section I.C.1.a.2.
Selection and sequencing of HIV codes
• If admitted for HIV-related illness
(e.g., pneumonia)
– Code 042 (HIV)
– Followed by current illness
(Pneumocystis carinii, 136.3)
• If admitted for other than HIV-related illness
– Code first-listed diagnosis
– Then 042 (HIV)
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Section I.C.1.a.2.
Selection and sequencing of HIV codes
• Sequence
• Reason most responsible for encounter, if HIV (042)
– Any additional diagnosis that impacts treatment
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Section I.C.1.a.2.g. HIV infection
in Pregnancy, Childbirth and the Puerperium
• Exception to HIV sequencing
• During pregnancy, childbirth, or puerperium, code:
– 647.6X (Other specified infections and parasitic diseases)
– Followed by 042 (HIV) (stated diagnosis)
– Then any HIV-related illness
• Asymptomatic HIV during pregnancy, childbirth, or puerperium
– 647.6X (Other specified infections and parasitic diseases) and
– V08 (Asymptomatic HIV infection status)
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Section I.C.1.a.2.e.
Patients with inconclusive HIV serology
• 795.71 (Inconclusive serologic test
for HIV)
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Section I.C.1.a.2.h.
Encounters for testing for HIV
• Code V73.89 (Screening for other specified viral disease)
– Patient in high-risk group for HIV
– V69.5 (Other problems related to lifestyle)
• Patients returning for HIV screening results = V65.44 (HIV counseling)
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Caution
• Incorrectly applying these HIV coding rules can cause patient hardship
– Insurance claims for patients with HIV usually need patient’s written agreement to disclose
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Section I.C.1.b. Septicemia, Septic Shock and SIRS
• Septicemia: systemic disease of microorganisms or their toxins in the blood (blood poisoning)
• Septic shock: overwhelming infection due to severe sepsis
• SIRS: Systemic Inflammatory Response Syndrome is a systemic response to infection/trauma
• Sepsis refers to SIRS due to infection
• Severe sepsis is sepsis with acute organ dysfunction
• Code septicemia (038.XX)
• SIRS second (995.9X)
• If documented, septic shock (785.52) should be reported
• Sepsis and septic shock associated with OB codes, also use code 630-633, Ectopic and Molar Pregnancy
• Septic shock is never primary or first-listed diagnosis
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– Sepsis and Severe Sepsis not associated with noninfectious process
Infection resulting from Trauma, Other Serious Injury, Pancreatitis
– Code Trauma/Injury
– SIRS second (995.9X)
– Any acute organ dysfunctions

ICD-9-CM, Chapter 2 Neoplasm
• Two steps for coding neoplasms:
– Index: Locate histologic type of neoplasm (e.g., sarcoma, melanoma)
• Review all instructions
– Locate code identified (usually in Neoplasm Table in Index) by body site
• Neoplasms Table divided into columns:
– Malignant (primary, secondary, ca in situ)
– Benign
– Uncertain behavior
– Unspecified
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ICD-9-CM, Chapter 2 Neoplasm
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Section I.C.2. Neoplasms
• Treatment directed at malignancy: Neoplasm is first-listed diagnosis
– Except for chemotherapy or radiotherapy:
• Therapy (treatment)
• Neoplasm
• Chemotherapy: V58.11—encounter for reason the patient presents for treatment, #1 diagnosis
• Radiotherapy: V58.0—encounter for reason the patient presents for treatment, #1 diagnosis
• Surgical removal of neoplasm and subsequent chemotherapy or radiotherapy
– Code malignancy as first-listed diagnosis
• Surgery to determine extent of malignancy
– Code malignancy as first-listed diagnosis
– Code neoplasm as long as patient is receiving treatment or medication following excision
• V10, “Personal history of malignant neoplasm” if
– Neoplasm was previously destroyed
– No longer being treated
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Section I.C.2. Neoplasms
• If patient receives treatment for secondary neoplasm (metastasis):
– Secondary neoplasm is first-listed diagnosis
– Even though primary is known
– Code primary neoplasm as secondary diagnosis or if no longer treated code personal history of...
• Admission for symptoms of primary
or secondary neoplasm
– Malignancy first-listed diagnosis
– Do NOT code symptoms or signs
• First-listed is site receiving treatment
• If both primary and mets are treated, code primary as first-listed
• Patient treated for anemia or dehydration due to neoplasm or therapy
• Code
– Anemia or dehydration
– Neoplasm
• Patient admitted for pain control due to neoplasm, 338.3
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Section I.C.2. Neoplasm
• Patient admitted to repair complication of surgery for an intestinal malignancy
– Complication first-listed diagnosis
• Complication is reason for encounter
– Malignancy secondary diagnosis
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V Codes and Neoplasms
• Patient receiving chemotherapy or radiotherapy post-op removal of neoplasm
• Code:
– Therapy
– Active neoplasm still being treated
• Do NOT report H/O (history of) neoplasm
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ICD-9-CM, Chapter 3
• Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders
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Disorders of Other Endocrine Glands
• Diabetes Mellitus 250 coded frequently
– Subterms often have two codes
– Example:
– Diabetic iritis 250.5X for diabetes (etiology)
– [364.42] for iritis (manifestation)
• Metabolic manifestation only one code assignment, e.g., diabetic ketoacidosis (250.1X)
• Fifth digit indicates type of diabetes
– Adult or juvenile
0, 2: Type II
• 0 Type II or unspecified type, not stated as uncontrolled
• 2 Type II or unspecified type uncontrolled
1, 3: Type I
• 1 Juvenile type, not stated as uncontrolled
• 3 Juvenile type, uncontrolled
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Disorders of Other Endocrine Glands
• Type I—Insulin dependent—pancreas does not function at all
• Type II—non-insulin dependent—(can be on insulin)
• “Uncontrolled”—must be documented by physician
– Can use “out of control”
– Cannot assign “uncontrolled” status when documentation states “poorly controlled”
• V58.67 in addition to diabetes code to indicate long-term use of insulin
• If type is not indicated, code Type II diabetes
• Patient with Type II diabetes can receive insulin
• Type I diabetic is insulin dependent
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Other Metabolic and Immunity Disorders Section
• Disorders such as gout and dehydration
• Disorders often have many names
– 242.0X Toxic diffuse goiter also known as:
• Basedow’s disease
• Graves’ disease
• Primary thyroid hyperplasia
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ICD-9-CM, Chapter 4
• Diseases of Blood and Blood-Forming Organs
• Short chapter with 10 sections
• Includes anemia, blood disorders, coagulation defects
• Often used code, anemia
• Many different types of anemia:
– Hereditary hemolytic (282)
– Iron deficiency (280)
– Acquired hemolytic (283)
• Multiple coding often necessary
• Identify underlying disease condition
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Chapter 4
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ICD-9-CM, Chapter 5, Mental Disorders
• Includes codes for
– Personality disorders
– Stress disorders
– Neuroses
– Psychoses
– Sexual deviation/dysfunction, etc.
– Mental retardation
Fifth digit = status of episode
• Example: 304, Drug dependence has following fifth digits:
0: Unspecified (episode)
1: Continuous
2: Episodic
3: In remission
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ICD-9-CM, Chapter 6
• Diseases of Nervous System and Sense Organs
– Central Nervous System
– Peripheral Nervous System
– Disorders of Eye
– Diseases of Ear
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Pain not elsewhere classified (338)
• Acute or chronic pain due to:
– Trauma
– Postoperative
– Neoplasm
– Psychosocial dysfunction
• NOT for generalized or localized pain
• First-listed/primary diagnosis
– When definitive diagnosis not established
– Pain management is reason for encounter/admission

ICD-9-CM, Chapter 7—Diseases of Circulatory System
• Three types of hypertension:
– Malignant—accelerated
– Benign—continuous, mild (BP) controllable, no irreversible vascular changes
– Unspecified—NOT indicated as either malignant or benign (.9)
• Hypertension table located in Index
of ICD-9-CM
– Under “H”, Hypertension
– Locate now
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Section I.C.7.a.1.
Hypertension, Essential, or NOS
• Assign hypertension
– arterial
– essential
– primary
– systemic
– NOS to 401
• Fourth digit to indicate type, 401.X
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Section I.C.7.a.2. Hypertension With Heart Disease
• 402 Category
• Certain heart conditions when stated “due to hypertension” or implied (“hypertensive”)
• Add fourth digit for type
• Use additional code to specify type of heart failure (428)
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Section I.C.7.a.3. Hypertensive Chronic Kidney Disease
• Cause-and-effect relationship assumed in chronic kidney disease with hypertension
• Category 403, Hypertensive chronic kidney disease, used when following present:
– Chronic kidney disease (585.X)
• With 403 assign fifth digit 0 stage I-IV or unspecified and 1 for stage V or end stage renal disease
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Section I.C.7.a.4. Hypertensive Heart and Chronic Kidney Disease
• Assign 404 when both hypertensive chronic kidney disease and hypertensive heart disease stated
• Assume cause-and-effect relationship
• Assign fifth digit for mention of kidney, heart failure, and/or stages I-IV or end stage renal disease
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– Use additional code from category 428, identifying type of heart disease
Stages of Chronic Kidney Disease
• Stage I: Blood flow through kidney increases, kidney enlarges (585.1)
• Stage II: (mild) Small amounts of blood protein (albumin) leaks into urine (microalbuminuria) (585.2)
• Stage III: (moderate) Albumin and other protein losses increase. Patient may develop high BP and kidney’s filter ability (585.3)
• Stage IV: (severe) Large amounts of urine pass through kidney, blood pressure increases (585.4)
• Stage V: Ability to filter waste nearly stops (585.5)
• End stage renal failure (585.6)
– When documentation indicates chronic renal disease (CKD) and ESRD, report ESRD
• Unspecified 585.9
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Section I.C.7.a.5. Hypertensive Cerebrovascular Disease
Code:
• Cerebrovascular disease (430-438) first
• Type of hypertension (401-405) second
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Section I.C.7.a.6.
Hypertensive Retinopathy
Code:
• Hypertensive retinopathy first (362.11)
• Type of hypertension (401-405) second
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Section I.C.7.a.7.
Hypertension, Secondary
• Hypertension caused by an underlying condition
– Code:
– Underlying condition first
– Type of hypertension (405) second
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Section I.C.7.a.8. Hypertension, Transient
• Transient hypertension: Temporary elevation of BP
• DO NOT assign 401-405 Hypertensive Disease
– Hypertension diagnosis NOT established
– Instead use:
• 796.2, Elevated blood pressure
• 642.3X, Transient hypertension of pregnancy
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Section I.C.7.a.9. Hypertension, Controlled
• Hypertension controlled by therapy
– Assign code from 401-405
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Section I.C.7.a.10.
Hypertension, Uncontrolled
• Untreated hypertension
• Uncontrolled hypertension
• Assign code from 401-405
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Section I.C.7.a.11. Elevated Blood Pressure
• Elevated blood pressure coded 796.2
– Elevated BP reading without hypertension is diagnosis
– Hypertension NOT stated, NOT coded to 401 (essential hypertension)
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ICD-9-CM, Chapter 7—Diseases of Circulatory System
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Chapter 8, Diseases of Respiratory System
• Watch for: “Use additional code to identify infectious organism”
– Some codes indicate specific organism and do not need an additional code
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Respiratory Failure (RF) Sequencing
• If RF due to an acute condition (e.g., MI) or acute exacerbation of chronic condition (e.g., COPD)
• Per new guidelines, if there are no chapter-specific guidelines (OB, poisoning) regarding sequencing, either RF or acute condition may be first-listed diagnosis
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Acute Respiratory Infection Section
• Frequently used codes, such as:
– Common cold (460, acute nasopharyngitis)
– Sore throat (462, acute pharyngitis)
– Acute tonsillitis (463)
– Bronchitis (490-491)
– Acute upper respiratory infection (465.9, URI)
– Influenza (487, flu)
– Read Guidelines for Chapter 8 for specifics on coding COPD and asthma
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