ICD-9 codes are used to describe a patient's diagnosis including symptoms, diseases or disorders. In a medical office, ICD-9 codes are used to establish medical necessity for patient visits as well as communicate to insurance companies the reason for a patient visit.
It is important for ICD-9 codes to be accurate for the quality of patient care, to prevent medical malpractice and for the medical office to receive proper insurance reimbursement. Proper ICD-9 coding requires anUs understanding of how ICD-9 codes are used, how to use the ICD-9 manual, and the importance accuracy in ICD-9 coding.
1. What are ICD-9 codes?
ICD-9 ....
- usually referred to as diagnosis codes
- stands for International Classification of Disease, Ninth Revision
- coding is a universal or standard system used for the purpose of identifying diseases
- are three, four or five digit codes
- can desribe the reason for the visit, the illness or injury, or supplemental information
- can be numerical or alphanumerical
- must be coded to the highest level of specificity
- are listed on billing claim forms, CMS-1500 and UB-04
2. Using the ICD-9 coding manual
ICD-9 coding can be confusing enough, but can be more frustrating if you don't have a full understanding of how to use the ICD-9 Manual. The ICD-9 manual has three volumes. Volume 1 and 2 contain diagnostic information used for physician and hospital billing and are in the same manual; Volume 3 contains procedural information used for hospital billing only and is in a separate manual.
3. Using the ICD-9 coding manual: Volume 1
- The numerical listing of ICD-9 codes
- Located at the back of the manual
- Codes are listed by category, subcategory and subclassifications
- Each category starts with a three digit code, each digit beyond three adds more detail
- A decimal and a fourth digit starts a subcategory
- A fifth digit is the subclassification and most likely the code of highest specificity
4. Using the ICD-9 coding manual: Volume 2
- The alphabetical listing of ICD-9 codes
- Located at the front of the manual
- Has the same list of diseases as found in Volume 1
5. Using the ICD-9 coding manual: Volume 3
- Features alphabetical and numerical listing of procedural codes
- Each category starts with a two digit code, each digit beyond two adds more detail
- A decimal and a third digit starts a subcategory
- A fourth digit is the subclassification and most likely the code of highest specificity
- Lists DRG (Diagnosis Related Groups) for inpatient coding by category
6. Using the ICD-9 coding manual: Formatting
The ICD-9 coding manual uses special formatting to help you properly identify and use the correct codes. This formatting structure is referred to as conventions.
Abbreviations
- NEC: Not Elsewhere Classifiable
- NOS: Not Otherwise Specified
Color Codes
- Blue: cannot be used as the primary diagnosis, describes a condition caused by another condition
- Yellow: used when there is not enough information to choose a more specific code; ends in 8, 9 or 0
- Gray: refers to "Other" codes that do not have a more specific code to describe a condition
Text Format
- Bold type for main terms
- Brackets identify synonyms/alternate words
- Colons indicate the use of the following modifiers
- Indentation to identify subterms
- Italics to identify supplemental codes
7. Using the ICD-9 coding manual: Symbols
- Bullet points indicate a new code
- A triangle pointing upwards indicates a revised code
- Text enclosed in triangles pointing inwards indicate revised text
- A white N inside a yellow box indicates Newborn
- A white P inside a yellow box indicates Pediatric Age
- A white M inside a yellow box indicates Maternity Age 12 - 55
- A white A inside a yellow box indicates Adult Age 15 - 124
- A check in front of 4th enclosed in a red box indicates a fourth digit is required
- A check in front of 5th enclosed in a red box indicates a fifth digit is required
- A white H inside a blue box indicates a Hospital Acquired Condition
