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Chapter 3
ICD-9-CM Official Guidelines (Section I): General Rules
McGraw-Hill/Irwin Copyright 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
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LEARNING OUTCOMES
After studying this chapter, you should be able to:
1. 2. 3. 4. 5. Understand the content and source of ICD-9-CM General Coding Guidelines. Describe how the correct coding process uses both the Alphabetic Index and the Tabular List to assign codes. Apply the coding guidelines on the level of detail. Explain the coding of conditions that are an integral part of the disease process. Explain the coding conditions that are not an integral part of the disease process.
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KEY TERMS
Acute Causal condition Chapter-specific guidelines Chronic Code first notes Combination code Impending Integral Late effect Mandatory multiple coding Neoplasm Table Residual condition Sign Specificity Symptom Threatened
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General
Coding Guidelines:
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ICD-9-CM Diagnosis Codes Composed of either three, four, or five digits, with three digits always before the decimal point. Typically, the fourth and fifth digit provide additional specificity regarding the type of disease, the cause of the disease, or the site of disease.
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Coding Decisions for Signs, Symptoms, and Integral Conditions Step 1: Determine the patients signs and symptoms. Step 2: Determine the medical condition of the patient. Step 3: Are the signs and symptoms integral to the medical condition?
YES = Do not code the sign/symptom separately NO = Assign the separate code for the sign/symptom
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Coding Decisions
(Conditions that are an integral part of a disease process)
The coding rule states that codes for signs and symptoms that are INTEGRAL to the disease should not be assigned. EX: Pneumonia
TYPICAL SIGNS AND SYMPTOMS
fever, cough SIGN (easily measured and objective) Dyspnea - SYMPTOM (not easily measured and subjective)
Cough, fever, and dyspnea are integral to pneumonia, so only pneumonia would be coded)
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Coding Decisions
(Conditions that are not integral part of a disease process)
Additional signs and symptoms that may not be associated with a disease process should be coded when present. Ex: Cirrhosis of the Liver (symptoms of ascites not routinely associated with Cirrhosis of the Liver)
Since ascites is not integral to Cirrhosis of the Liver, ascites must be coded also.
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Combination Codes
Combination code is one code that classifies: two diagnoses a diagnosis with an associated manifestation a diagnosis with an association complication
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Note Use the following fifth-digit subclassification with category 574: 0 without mention of obstruction 1 with obstruction
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with
cholecystitis 574.1 acute 574.0 chronic 574.1
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Late Effects
A late effect is the residual effect (condition produced) after the acute phase of an illness or injury has been terminated. A late effect generally requires two codes, with the code or condition or nature of the late effect (code the condition/residual) listed first, followed by the code for the late effect (code using the main term late).
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hernia see Hernia, by site with gangrene hospital noma 528.1 intestine, intestinal (acute) (hemorrhagic) (massive) 557.0 with hernia see Hernia, by site with gangrene mesentric embolism or infarction 557.0 laryngitis 464.00 There is no subterm for impending in the Alphabetic Index. Therefore, the code for gangrene would not be assigned, and the decubitus ulcer would be coded as document (707.03).
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