Federal Register 65, no. May 29, Testimony by Dr. The current ICDCM diagnosis codes do not provide sufficient clinical specificity to describe the severity or complexity of the various disease conditions. In particular, the codes for healthcare encounters for other than disease V codes do not provide enough specificity. Consequently, there are increasing requirements for submission of additional documentation in order to support claims. The exchange of meaningful healthcare data with healthcare organizations and professionals around the world is hindered by the fact that many countries are presently using ICD or a clinical modification of it Australia and Canada, for example, have modifications.
Even in the US, mortality statistics information on death certificates have been collected using ICD since The current ICDCM system is ineffective for effectively monitoring utilization of resources, measuring performance, and analyzing healthcare costs and outcomes. There are many uses of coded data, including: Designing payment reimbursement systems with emphasis on the processing of claims specifically for reimbursement, Measuring the safety, quality, and efficacy of medical care, Designing delivery systems and setting healthcare policy, Monitoring the utilization of resources while improving financial, clinical, and administrative performance, Providing healthcare consumers with data regarding the cost and outcome s of various treatment options, Identifying, tracking, and managing public health risks and disease processes, Recognizing and identifying abusive or fraudulent reimbursement practices and trends, and Conducting healthcare research and clinical trials and participating in epidemiological studies.
ICDCM offers the addition of information relative to ambulatory and managed care encounters. In ICDCM, some three-character categories are not used in order to allow for revisions and future expansion. Instead of grouping by categories of injury or type of wound, ICDCM groups injuries by site of the injury and then the type.
Excludes notes were expanded in order to provide guidance on the hierarchy of the chapters and to clarify priority of code assignment. Some conditions with a new treatment protocol or perhaps a recently discovered or new etiology have been listed in a more appropriate chapter.
Combination codes are used for both symptom and diagnosis, and etiology and manifestations-for example K Codes for postoperative complications have been expanded. Also a distinction has been made between intraoperative complications and post-procedural disorders-for example, K91 Intraoperative and postprocedural complications and disorders of digestive system, NEC.
This may have been accomplished by means of movement from one chapter to another or one section to another. More complete descriptions-In ICDCM, the subcategory titles are usually complete so that the coder does not have to read previous codes to understand the meaning of the code. Fifth and sixth characters-Fifth and sixth characters are incorporated into the code listing rather than having common fifth digits listed at the beginning of a chapter, section, or category.
Laterality-ICDCM incorporates laterality of conditions or injuries at the fifth or sixth character level.
If you do, you more than likely have some experience in the medical billing and coding profession. The next question would be; do you know the answer to this question? What are these things? ICDCM is the official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States.
The ICD-9 was used to code and classify mortality data from death certificates until , when use of ICD for mortality coding started. Skip directly to site content Skip directly to page options Skip directly to A-Z link. National Center for Health Statistics. The fifth digit describes the type of diabetes and its level of control.
To correctly code an encounter with a patient who has uncontrolled type 1 diabetes complicated by ketoacidosis, you should use all five digits. Here's another example: You see a patient for follow-up of benign essential hypertension.
The proper code would be If, however, the patient also had benign hypertensive heart disease, then you would include a fifth digit: The proper code would be The point is that you must always code to the highest number of digits that best describe your patient's condition.
To be certain you're using the correct number of digits, review the codes in a given category and choose the highest-level code that most specifically describes your patient's condition. Many payers, including Medicare, will deny or delay payments if you fail to do so.
The list includes many of the ICD-9 codes family physicians use most often, organized alphabetically within categories of diseases and body systems.
A version of the list printed on cardstock, designed to be carried with you as you see patients or to be placed in each exam room, is available from the AAFP Order Department at Ask for item number A for two copies or A for 10 copies. Daugird, D. October — Choosing the most specific code means coding only what you know to be a fact. Patients often have ill-defined complaints, such as back pain. While you may suspect a specific condition —perhaps a herniated disc or a urinary tract infection — and then order lab tests to confirm the diagnosis, you should code only the sign or symptom that brought the patient in to see you until you receive the test results or otherwise make a definitive diagnosis.
If you don't, you may inadvertently label the patient with an incorrect diagnosis and, as a result, the patient may have difficulty obtaining health and disability insurance or may end up paying higher insurance premiums in the future. Use ICD-9 codes to to describe symptoms, signs and ill-defined conditions that aren't linked to a specific disease.
But be aware that some body-system categories of codes include codes for nonspecific conditions. When you need to list more than one diagnosis for your patient, prioritize them: Code the primary diagnosis first followed by the next most important and so on. The primary diagnosis should be the one that receives the most attention during the patient visit.
For example, if a patient you're treating for hypertension presents with an upper respiratory infection, the infection would be considered the primary reason for the visit and should be listed first, followed by hypertension. For example, you're treating a patient with poorly controlled diabetes, hypertension and coronary artery disease. Because you see the patient most often for blood-glucose monitoring, the primary diagnosis would be diabetes followed by hypertension and coronary artery disease unless the patient had active signs or symptoms related to one of the other conditions.
And here's a related tip: Don't code a diagnosis that doesn't affect your care of the patient. For example, if your patient with diabetes is also being treated by an orthopedist for a broken arm, don't code the fracture since it doesn't affect the care you're providing.
Evaluate your coding skills by choosing the correct ICD-9 code s for the following two patient visits. The answers and explanations appear below. A patient complains of epigastric pain. You suspect reflux esophagitis and order an upper GI series. What ICD-9 code s would you submit for this visit? A female patient complains of dysuria and increased frequency.
A microscopic exam performed in your office reveals the presence of bacteriuria, and you order a culture. During the visit, the patient also asks you for a refill of Synthroid.
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