Medical coding

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Medical coding

• Applications of Health Informatics

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History

• John Graunt began the statistical study of
  disease in the early 17th century
• 1837 William Farr wanted adoption of a uniform
  classification of causes of death
• In 1893 Jacques Bertillon developed the Bertillon
  classification of Causes of Death and the U.S.
  began using that system around 1898
• The name was changed in 1938 to International
  classification of Diseases (ICD)

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• In 1978, the ninth edition of the classification
  system was published and included Clinical
  Modification (CM) to its title. The new name
  International Classification of diseases, Ninth
  Revision, Clinical Modification (ICD-9-CM) is the
  one still used today although transition is
  beginning for the 10th (ICD-10-CM) edition now.
• Originally it was a 3-volume set, established by
  the WHO in 1977, but has now been condensed into
  1 book that contains either two or three of the
  volumes giving offices the choice of buying one
  book containing the volume specific to its need

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purpose

• Originally, the purpose of the ICD system was to
  provide morbidity statistics for the WHO (World
  Health Organization)
• Today, all medical offices use the coding system
  to provide information to verify the need for
  patient care/treatment and to provide statistics
  for analysis of health care costs
• ICD coding translates written medical terminology
  into codes using a universal language
• Payers check the condition to the care provided
  to determine if the services are medically
  necessary and, therefore, reimbursable

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compliance

• In the beginning, physicians were only required
  to give simple descriptive phrases or 1st
  3-digits of the diagnosis, but today, Federal
  agencies and most payers require correct
  diagnosis coding and reimbursement which are
  directly impacted on those codes. Now, 5-6 digits
  are required for more specific diagnosis
  treatments
• Coding must meet federal guidelines

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ICD-9 contents

• The introduction to each book provides important
  information to help coders understand the basic
  uses of the ICD-9-CM books

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Format of Icd-9-cm

• In the diagnostic coding system, codes are broken
  down into a 3-digit category,
• Ex code 250 diabetes mellitus
• then broken down further into a 4th digit
  subcategory to give info about patient condition
• Ex code 250.0 diabetes mellitus without
  mention of complication
• And a 5th digit sub-classification based on
  descriptive terms needed to complete the
  diagnosis, or specificity, for coding.
• Ex code 250.00 diabetes mellitus without
  mention of complication, type 1 insulin
  dependent IDDM type juvenile type or
  unspecified type, not stated as uncontrolled

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Volume understanding

• Volume I
• tabular list numerical listing of
  diseases/injuries and contains 17 chapters groups
  by etiology (cause) or anatomical (body) site.
• Volume II
• Alphabetic index listing of codes to assist in
  locating the complete code in volume I
• Volume III
• Tabular alphabetical and numerical listing used
  mostly by hospitals. It includes a tabular list
  of procedures by anatomical site, miscellaneous
  diagnostic and therapeutic procedures and an
  alphabetical index

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conventions

• To use the coding system, coders need to
  understand the symbols, abbreviations and other
  conventions used within the ICD-9-CM
• These are usually found in the introduction of
  the volume. These are some of the conventions
  that are important to diagnostic coding
• Print type
• Bold face
• Volume I - All title and codes are printed in
  bold type
• Volume II main term is printed in bold face

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• Italics
• Both volumes use italics to highlight all
  exclusion notes and to identify codes that should
  NOT be used as the primary code
• Ex code 359.5, myopathy in endocrine disease
  classified elsewhere
• In this case, the code is written in italics with
  the instruction to code first the underlying
  disease, such as Addisons disease, 255.4 because
  Addisons is the primary diagnosis followed by
  the myopathy (manifestation) or secondary
  diagnosis.
• Primary dx 255.4 Addisons disease
• Secondary dx 395.5 myopathy in endocrine disease
  classified elsewhere

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How to find icd-9-cm code

• Have good research habits ?
• 5 basic steps to finding the correct code
• Correctly identify the main term/condition
• Use the index to locate the condition/problem
• Review information given following all
  instructions
• Locate and confirm the correct code in the
  tabular list and select the correct code
• Put codes in correct sequence when using multiple
  diagnoses
• Main/primary diagnosis should be coded as the
  condition or reason that patient sought medical
  care
• Ex patient with a history of ulcers (533.9) was
  seen for acute pharyngitis (462).

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Other icd-9-cm elements

• An important factor in coding is reading the
  notes and other instructions provided with a code
• V-codes are supplemental classification codes for
  factors that influence a patients care
• May be used with a patient sees the doctor
  without a complaint or problem (sports exam,
  etc.) or to describe conditions that could
  influence patient care (allergies, etc.). There
  are 3 main categories
• Problems something that could affect overall
  health
• Services patient returns for a
  problem/treatment
• Factual findings description of facts for
  statistics

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• E-codes are optional codes that describe the
  following
• Events or circumstances
• Causes of injury or poisoning
• Other adverse effects
• Should never be used as a primary or stand-alone
  code
• Its function is to provide details of an incident
  or injury and help identify the following
• Automobile accident liability
• Worker compensation situations
• Third-party insurance liability

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Icd-10-cm preview

• Newest version was actually released by the WHO
  in 1992, but the U.S. has yet to implement the
  system because the NCHS (National Center for
  Health Statistics) determined the new version was
  not sufficiently detailed for use within the
  national health care system.
• In the new version, volumes 1 and 2 will be
  completely replaced by ICD-10-CM and volume 3,
  used by hospitals will be replaced by ICD-10-PCS
  which is developed by the Centers for Medicare
  and Medicaid Services (CMS)

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• The objectives of the ICD-10-CM coding system is
  to offer
• Completeness unique code for each illness or
  disease
• Expandability new injuries or disease can be
  incorporated easily into the existing structure
• Standardization terminology will be defined for
  standardization with each term being assigned a
  specific meaning

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comparison

• Icd-10-cm

• Icd-9-cm

• Tabular
• Alphabetic index
• Procedures
• 22 chapters
• Alpha-numerical code system
• 6th and 7th digit specificity
• Limited use of unspecified codes
• Supplementary class for V and E codes
• New chapters for disease of eye and ear instead
  of inclusion in nervous system

• Tabular
• Alphabetic index
• Procedures
• 17 chapters
• Numerical code system
• 4th and 5th digit specificity
• Category for unspecified codes
• Supplementary class for V and E codes

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Putting it all together
Need Worksheet 1 Worksheet 2 Worksheet for V
E codes ICD-9-CM all volumes
Adams, W. (2004). Coding and Reimbursement A
simplified approach. Mosby, Inc. St. Louis
Missouri.