1. Identify the format of Volume 3, Tabular List and Alphabetic Index of Procedures 2. Apply the conventions and ICD-9-CM Official Guidelines for Coding and Reporting 4. Define significant procedures 5. Explain the surgical hierarchy 6. Explain when to code operative approaches and closures 7. Assign codes for canceled or converted to open procedures 8. Compare and contrast endoscopic versus open procedures 9. Discuss the importance of having a hospital policy regarding procedure code assignment The format of Volume 3, Alphabetic Index and Tabular List, follows the same format and conventions that are used in Volume 1, Tabular List of Diseases and Injuries, and Volume 2, Alphabetic Index of Disease and Injuries. These procedural codes are used to code hospital inpatient procedures. ICD-9-CM procedure codes are not used by hospital outpatient departments or by physician practices. Physicians and hospital outpatient services are coded using Current Procedural Terminology (CPT) for procedural coding. According to Coding Clinic (2008:1Q:p15),1 “The use of ICD-9-CM procedure codes is restricted to the reporting of inpatient procedures by hospitals.” This is in accordance with HIPAA regulations. A hospital may still collect ICD-9-CM procedural data but only for internal or non–claim-related purposes. ICD-10-PCS will only be required for inpatient billing by hospitals. At this time, CMS accepts six procedure codes on a hospital claim. They are considering increasing the number of procedure codes accepted upon conversion to ICD-10-PCS, which will not be used in physicians’ offices or other ambulatory settings; those providers will continue to use CPT and the Healthcare Common Procedure Coding System (HCPCS) for billing purposes. Volume 3 consists of 17 chapters (Table 6-1). Most of these chapters are classified by body system. It should be noted that Chapter 0 contains procedures and interventions that represent new technology. Table 6-1 Table of Contents for Volume 3, Procedures Omit code is an instructional note that is found only in the Alphabetic Index and Tabular List of Volume 3. This instruction denotes that no code is to be assigned. The omit code instruction is generally found under codes that are used for approaches and closures and therefore may be integral to the operative procedure (Figure 6-1). This convention is explained in further detail in this chapter under Operative Approaches and Closures. Example Aortocoronary bypass, (origin is the aorta with autologous left greater saphenous vein graft, which was harvested via percutaneous endoscopic approach) one coronary vessel with cardiopulmonary bypass, 36.11, 39.61 (Figure 6-2) (021009W, 06BQ4ZZ, 5A1221Z, 5A1935Z). Assign and sequence the following procedures using your ICD-9-CM code book. Please refer to the companion Evolve site for the most current guidelines. Under the specific chapter guidelines, there are only a few references to procedure codes. Chapter 11: Complications of Pregnancy, Childbirth, and the Puerperium (630-677)
General Coding Guidelines for Procedures in ICD-9-CM
Format of Volume 3, Tabular List and Alphabetic Index of Procedures
Omit Code
Code Also
Exercise 6-2
1. Partial left ventriculectomy with synchronous open mitral valve repair
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2. Total abdominal hysterectomy with bilateral salpingo-oophorectomy
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3. Laparoscopic cholecystectomy
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UHDDS Definitions
ICD-9-CM Official Guidelines for Coding and Reporting
