chapter_005课件

CHAPTER 5,CHAPTER-SPECIFIC GUIDELINES (ICD-9-CM CHAPTERS 1-8),ICD-9-CM, Chapter 1,Infectious and Parasitic Diseases Divided based on etiology (cause of disease) Many combination codes Example: 112.0 candidiasis infection of mouth, which reports both organism and condition with one code,Multiple Codes,Sequencing must be considered UTI due to Escherichia coli 599.0 (UTI) etiology 041.4 (E. coli) organism 041 category is a secondary-code only,Section I.C.1.a,d,e Human Immunodeficiency Virus,Code HIV or HIV-related illness ONLY if stated as confirmed in diagnostic statement 042 HIV or HIV-related illness V08 Asymptomatic HIV status 795.71 Nonspecific HIV serology Once an HIV diagnosis cannot code V08,Section I.C.1.a.2.f. Previously diagnosed HIV-related illness,Code prior diagnosis HIV-related disease 042 (HIV) NEVER assign these patients to: V08 (asymptomatic) or 795.71 (Nonspecific serologic evidence of HIV),Section I.C.1.a.2. Selection and sequencing of HIV codes,If admitted for HIV-related illness (e.g., pneumonia) Code 042 (HIV) Followed by current illness (Pneumocystis carinii, 136.3) If admitted for other than HIV-related illness Code first-listed diagnosis Then 042 (HIV) (Contd),Section I.C.1.a.2. Selection and sequencing of HIV codes,(Contd) Sequence Reason most responsible for encounter, if HIV (042) Any additional diagnosis that impacts treatment,Section I.C.1.a.2.g. HIV infection in Pregnancy, Childbirth and the Puerperium,Exception to HIV sequencing During pregnancy, childbirth, or puerperium, code: 647.6X (Other specified infections and parasitic diseases) Followed by 042 (HIV) (stated diagnosis) Then any HIV-related illness (Contd),Section I.C.1.a.2.g. HIV and Pregnancy,(Contd) Asymptomatic HIV during pregnancy, childbirth, or puerperium 647.6X (Other specified infections and parasitic diseases) and V08 (Asymptomatic HIV infection status),Section I.C.1.a.2.e. Patients with inconclusive HIV serology,795.71 (Inconclusive serologic test for HIV),Section I.C.1.a.2.h. Encounters for testing for HIV,Code V73.89 (Screening for other specified viral disease) Patient in high-risk group for HIV V69.5 (Other problems related to lifestyle) Patients returning for HIV screening results = V65.44 (HIV counseling),Caution,Incorrectly applying these HIV coding rules can cause patient hardship Insurance claims for patients with HIV usually need patients written agreement to disclose,Section I.C.1.b. Septicemia, Septic Shock and SIRS,Septicemia: systemic disease of microorganisms or their toxins in the blood (blood poisoning) Septic shock: overwhelming infection due to severe sepsis SIRS: Systemic Inflammatory Response Syndrome is a systemic response to infection/trauma Sepsis refers to SIRS due to infection Severe sepsis is sepsis with acute organ dysfunction (Contd),Section I.C.1.b. Septicemia, Septic Shock and SIRS,(Contd) Code septicemia (038.XX) SIRS second (995.9X) If documented, septic shock (785.52) should be reported Sepsis and septic shock associated with OB codes, also use code 630-633, Ectopic and Molar Pregnancy Septic shock is never primary or first-listed diagnosis,Sepsis and Severe Sepsis not associated with noninfectious process,Infection resulting from Trauma, Other Serious Injury, Pancreatitis Code Trauma/Injury SIRS second (995.9X) Any acute organ dysfunctions,ICD-9-CM, Chapter 2 Neoplasm, Two steps for coding neoplasms: Index: Locate histologic type of neoplasm (e.g., sarcoma, melanoma) Review all instructions Locate code identified (usually in Neoplasm Table in Index) by body site Neoplasms Table divided into columns: Malignant (primary, secondary, ca in situ) Benign Uncertain behavior Unspecified,ICD-9-CM, Chapter 2 Neoplasm,Morphology Codes-Appendix A ICD-9-CM Codes are alpha numeric: M + 4 numeric characters, a slash, followed by 5th digit (indicates behavior) Assigned by tumor registry coder /0= Benign /1= Uncertain benign/malignant/borderline /2=Carcinoma in situ /3= Malignant, primary site /6= Malignant, secondary/metastatic site /9= Malignant, uncertain if primary/secondary site Not assigned in outpatient setting,Section I.C.2. Neoplasms,Treatment directed at malignancy: Neoplasm is first-listed diagnosis Except for chemotherapy or radiotherapy: Therapy (treatment) Neoplasm Chemotherapy: V58.11encounter for reason the patient presents for treatment, #1 diagnosis Radiotherapy: V58.0encounter for reason the patient presents for treatment, #1 diagnosis (Contd),Section I.C.2. Neoplasms,(Contd) Surgical removal of neoplasm and subsequent chemotherapy or radiotherapy Code malignancy as first-listed diagnosis Surgery to determine extent of malignancy Code malignancy as first-listed diagnosis Code neoplasm as long as patient is receiving treatment or medication following excision (Contd),Section I.C.2. Neoplasms,V10, “Personal history of malignant neoplasm” if Neoplasm was previously destroyed No longer being treated (Contd),Section I.C.2. Neoplasms,(Contd) If patient receives treatment for secondary neoplasm (metastasis): Secondary neoplasm is first-listed diagnosis Even though primary is known Code primary neoplasm as secondary diagnosis or if no longer treated code personal history of. (Contd),Section I.C.2. Neoplasms,(Contd) Admission for symptoms of primary or secondary neoplasm Malignancy first-listed diagnosis Do NOT code symptoms or signs First-listed is site receiving treatment If both primary and mets are treated, code primary as first-listed (Contd),Section I.C.2. Neoplasm,(Contd) Patient treated for anemia or dehydration due to neoplasm or therapy Code Anemia or dehydration Neoplasm Patient admitted for pain control due to neoplasm, 338.3 (Contd),Section I.C.2. Neoplasm,(Contd) Patient admitted to repair complication of surgery for an intestinal malignancy Complication first-listed diagnosis Complication is reason for encounter Malignancy secondary diagnosis (Contd),V Codes and Neoplasms,Patient receiving chemotherapy or radiotherapy post-op removal of neoplasm Code: Therapy Active neoplasm still being treated Do NOT report H/O (history of) neoplasm,ICD-9-CM, Chapter 3,Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders,Disorders of Other Endocrine Glands,Diabetes Mellitus 250 coded frequently Subterms often have two codes Example: Diabetic iritis 250.5X for diabetes (etiology) 364.42 for iritis (manifestation) Metabolic manifestation only one code assignment, e.g., diabetic ketoacidosis (250.1X) (Contd),Disorders of Other Endocrine Glands,(Contd) Fifth digit indicates type of diabetes Adult or juvenile 0, 2: Type II 0 Type II or unspecified type, not stated as uncontrolled 2 Type II or unspecified type uncontrolled 1, 3: Type I 1 Juvenile type, not stated as uncontrolled 3 Juvenile type, uncontrolled (Contd),Disorders of Other Endocrine Glands,Type IInsulin dependentpancreas does not function at all Type IInon-insulin dependent(can be on insulin) “Uncontrolled”must be documented by physician Can use “out of control” Cannot assign “uncontrolled” status when documentation states “poorly controlled” (Contd),Disorders of Other Endocrine Glands,(Contd) V58.67 in addition to diabetes code to indicate long-term use of insulin If type is not indicated, code Type II diabetes Patient with Type II diabetes can receive insulin Type I diabetic is insulin dependent,Other Metabolic and Immunity Disorders Section,Disorders such as gout and dehydration Disorders often have many names 242.0X Toxic diffuse goiter also known as: Basedows disease Graves disease Primary thyroid hyperplasia,ICD-9-CM, Chapter 4,Diseases of Blood and Blood-Forming Organs Short chapter with 10 sections Includes anemia, blood disorders, coagulation defects (Contd),Chapter 4,(Contd) Often used code, anemia Many different types of anemia: Hereditary hemolytic (282) Iron deficiency (280) Acquired hemolytic (283) Multiple coding often necessary Identify underlying disease condition (Contd),Chapter 4,(Contd) Two confusing anemias: anemia of chronic disease disease causing anemia is chronic Code 285.22 and then the appropriate code for the chronic disease chronic simple anemia Anemia (285.9), chronic simple (281.9),ICD-9-CM, Chapter 5, Mental Disorders,Includes codes for Personality disorders Stress disorders Neuroses Psychoses Sexual deviation/dysfunction, etc. Mental retardation (Contd),Chapter 5,(Contd) Fifth digit = status of episode Example: 304, Drug dependence has following fifth digits: 0: Unspecified (episode) 1: Continuous 2: Episodic 3: In remission,ICD-9-CM, Chapter 6,Diseases of Nervous System and Sense Organs Central Nervous System Peripheral Nervous System Disorders of Eye Diseases of Ear,Pain not elsewhere classified (338),Acute or chronic pain due to: Trauma Postoperative Neoplasm Psychosocial dysfunction NOT for generalized or localized pain First-listed/primary diagnosis When definitive diagnosis not established Pain management is reason for encounter/admission,ICD-9-CM, Chapter 7Diseases of Circulatory System,Three types of hypertension: Malignantaccelerated Benigncontinuous, mild (BP) controllable, no irreversible vascular changes UnspecifiedNOT indicated as either malignant or benign (.9) Hypertension table located in Index of ICD-9-CM Under “H”, Hypertension Locate now,Section I.C.7.a.1. Hypertension, Essential, or NOS,Assign hypertension arterial essential primary systemic NOS to 401 Fourth digit to indicate type, 401.X,Section I.C.7.a.2. Hypertension With Heart Disease,402 Category Certain heart conditions when stated “due to hypertension” or implied (“hypertensive”) Add fourth digit for type Use additional code to specify type of heart failure (428),Section I.C.7.a.3. Hypertensive Chronic Kidney Disease,Cause-and-effect relationship assumed in chronic kidney disease with hypertension Category 403, Hypertensive chronic kidney disease, used when following present: Chronic kidney disease (585.X) With 403 assign fifth digit 0 stage I-IV or unspecified and 1 for stage V or end stage renal disease,Section I.C.7.a.4. Hypertensive Heart and Chronic Kidney Disease,Assign 404 when both hypertensive chronic kidney disease and hypertensive heart disease stated Assume cause-and-effect relationship Assign fifth digit for mention of kidney, heart failure, and/or stages I-IV or end stage renal disease Use additional code from category 428, identifying type of heart disease,Stages of Chronic Kidney Disease,Stage I: Blood flow through kidney increases, kidney enlarges (585.1) Stage II: (mild) Small amounts of blood protein (albumin) leaks into urine (microalbuminuria) (585.2) Stage III: (moderate) Albumin and other protein losses increase. Patient may develop high BP and kidneys filter ability (585.3) Stage IV: (severe) Large amounts of urine pass through kidney, blood pressure increases (585.4) Stage V: Ability to filter waste nearly stops (585.5) End stage renal failure (585.6) When documentation indicates chronic renal disease (CKD) and ESRD, report ESRD Unspecified 585.9,Section I.C.7.a.5. Hypertensive Cerebrovascular Disease,Code: Cerebrovascular disease (430-438) first Type of hypertension (401-405) second,Section I.C.7.a.6. Hypertensive Retinopathy,Code: Hypertensive retinopathy first (362.11) Type of hypertension (401-405) second,Section I.C.7.a.7. Hypertension, Secondary,Hypertension caused by an underlying condition Code: Underlying condition first Type of hypertension (405) second,Section I.C.7.a.8. Hypertension, Transient,Transient hypertension: Temporary elevation of BP DO NOT assign 401-405 Hypertensive Disease Hypertension diagnosis NOT established Instead use: 796.2, Elevated blood pressure 642.3X, Transient hypertension of pregnancy,Section I.C.7.a.9. Hypertension, Controlled,Hypertension controlled by therapy Assign code from 401-405,Section I.C.7.a.10. Hypertension, Uncontrolled,Untreated hypertension Uncontrolled hypertension Assign code from 401-405,Section I.C.7.a.11. Elevated Blood Pressure,Elevated blood pressure coded 796.2 Elevated BP reading without hypertension is