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ICD-9 Coding Overview

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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
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