History

The statistical study of disease began as early as the seventeenth century with the work of John Graunt. In 1837 William Farr urged the adoption of a uniform classification of causes of death. In 1893 a French physician, Jacques Bertillon, developed the Bertillon Classification of Causes of Death. The United States began using Bertillon’s classification system in approximately 1898. In 1938 the name was changed to International Classification of Diseases (ICD). With the publication of the ninth revision of the ICD in 1978, the words “Clinical Modification” (CM) were added to the title. This new title, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), is the one most recognized and used by coders today.

When it was published in 1978, the ICD-9-CM was a three-volume set compiled from the classifications that the World Health Organization (WHO) had established in 1977. However, since then, publishers have condensed the volumes into one book that contains either two or three of the volumes. Medical offices have the option of buying one book containing only the volumes that pertain to their particular practices or buying the complete three-volume set.

Purpose

The original purpose of the ICD system was to provide morbidity statistics for the WHO. Today medical offices use ICD-9-CM codes to provide information to substantiate the need for patient care or treatment and to provide statistics for analyzing the appropriateness of health care costs.

ICD coding translates written medical terminology or descriptions into codes that provide a universal language. Standard codes prevent the problems that arise when different terms are used for the same disease or condition. These standard codes are reported to insurance carriers with descriptions of the care or treatments patients received.

Coding Compliance

For many years, physicians were not required to give more than a simple descriptive phrase or perhaps the first three digits of the diagnosis code. Today, in order to have a profitable practice, a physician needs to understand the importance of coding and coding relationships. Federal agencies and most other insurance carriers require correct diagnosis coding. Coding has a direct impact on reimbursement to the practice.

Compliance with the rules for reporting codes is also important to correct coding. As you will see in this chapter, there are many guidelines (e.g., correct sequencing of codes) that must be followed for correct diagnostic coding. In most medical offices, a compliance plan covers the policies and procedures that must be followed. The compliance plan monitors the fulfillment of government regulations, especially in coding and billing.

Payers check the linkage between the condition and the care to determine if the services were medically necessary and should be reimbursed. Given the patient’s condition, a payer or insurance company will seek answers to such questions as the following:

In a medical office the chief source of ICD-9-CM codes should be the physician. The physician is the individual with the in-depth knowledge of the patient’s condition and appropriate medical terminology. Although it is the physician’s responsibility to advise staff concerning the patient’s diagnosis, office staff should have a working knowledge of the coding systems, diagnoses (ICD-9-CM), and procedures (CPT) to assist the physician in coding patient services.

One recommendation is to confer with the physician on an annual basis and review the diagnosis codes most often used in the practice. By having a complete list of these codes, the office staff can prevent costly delays and questions on future claims.

Contents of ICD-9-CM

Let’s begin our study by examining the design of ICD-9-CM and each of its three volumes to obtain a better understanding of the contents of each and how to apply them.

In the ICD-9-CM the way the text is printed is an important clue to the use of a particular code. In the introduction to each book, the publisher provides important facts and information to help the coder understand the basic uses of the ICD-9-CM. Each person involved in coding for the practice should read the introduction before beginning to code from that volume.

ICD-9-CM Code Format

In the diagnostic coding system, codes are broken down into a three-digit code category, or Rubric. Most of these three-digit codes are further broken down into a fourth-digit subcategory and a fifth-digit subclassification based on the descriptive terms needed to complete the diagnosis and achieve the highest degree of description, or specificity, for coding. However, not every code will require a fourth or fifth digit to be at its highest level of coding. There are a few codes that are at the highest level possible with only the three-digit number.

To understand how a code is built based on three, four, or five digits, let’s examine the code for diabetes mellitus (250).

Conventions of ICD-9-CM

To correctly apply the coding system, coders need to understand the various symbols, abbreviations, and other conventions that are used in ICD-9-CM. These descriptions and explanations are usually found in the introduction of the ICD-9-CM volume. With each new edition, publishers have deleted important definitions for some conventions. Let’s review some of the conventions pertinent to diagnostic coding.

Locating an ICD-9-CM Code

Table 1-1 contains the format and conventions used in the ICD-9-CM. Once we have reviewed these conventions, the next step is to learn how to locate a code. Coders must understand how each of the volumes (1 and 2) relates to the coding process.

Volume 1, often referred to as the Tabular List, is used as the final resource to apply the diagnosis, symptom, or condition. Because the Tabular List is in numerical order based on etiology instead of anatomy, it is difficult to find the correct code using this volume. When one is using the tabular listing, it is important to remember to always code to the highest level of the description. Use fourth and fifth digits only when they are applicable and are given in the coding sequence.

To solve the problem of finding the correct code, Volume 2, the Index, lists signs, symptoms, conditions, and so forth, in alphabetical order. The Index gives the coder an easy method of locating the correct code. It is important that you remember never to code directly from the Index. The Index is a reference tool to help locate the correct code in Volume 1. The Index might not list all the pertinent information for selecting the correct code.

Directions: Answer the following questions by giving the specified information. You might wish to list the ICD-9-CM page number for easy reference.

Example: Code 491 is assigned to chronic bronchitis. The complete code number for simple chronic bronchitis is as follows:

Page 131, _____________Volume 1,_______Answer: 491.0

Directions: Underline the main term in each coding problem. Locate the term in the Alphabetic Index. Record the page number and code.

Example: Irritable colon, Code 564.1, Page 430

TERM	CODE	PAGE
1. Diabetes insipidus	_______	_______
2. Yellow jaundice	_______	_______
3. Diverticulitis of colon	_______	_______
4. Major depression, single, mild	_______	_______
5. Tobacco dependence, continuous	_______	_______
6. Myocardial infarction with hypertension, initial episode of care	_______	_______
7. Bleeding peptic ulcer without obstruction	_______	_______
8. Actinic keratosis	_______	_______
9. Common migraine with blurred vision Only gold members can continue reading. Log In or Register to continue Share this: Click to share on Twitter (Opens in new window) Click to share on Facebook (Opens in new window) Like this: Like Loading... Related Related posts: Putting it All Together Accounts Receivable Insurance Claim Forms Service and Procedural Coding: Current Procedural Terminology (CPT) Stay updated, free articles. Join our Telegram channel Join Tags: Adams Coding and Reimbursement Dec 10, 2016 | Posted by admin in GENERAL SURGERY | Comments Off on Diagnostic Coding: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Full access? Get Clinical Tree Get Clinical Tree app for offline access Get Clinical Tree app for offline access %d