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Follow these steps when researching an ICD-9-CM coding question:
- Start with the ICD-9-CM Manual. You can resolve many ICD-9-CM coding questions by carefully studying the ICD-9-CM Manual itself, paying particular attention to typographical conventions and the various notes included throughout the Manual.
- Review the official guidelines. The Public Health Service and CMS jointly publish the Official ICD-9-CM Guidelines for Coding and Reporting. The following organizations helped develop and approve these guidelines:
- American Hospital Association (AHA)
- AHIMA
- CMS
- National Center for Health Statistics
- Review Coding Clinic. Coding Clinic is a newsletter published by the AHA. Representatives from the four organizations listed above review and approve each issue of Coding Clinic. You can order a subscription or back issues of Coding Clinic from the AHA by calling 800/AHA-2626.
This tip was adapted from the handbook, Coding and You: What Every Healthcare Professional Should Know. For ordering information, visit the HCMarketplace.
Q: A patient undergoes outpatient surgery and is subsequently admitted due to acute blood loss anemia with hemorrhage and low hematocrit and hemoglobin caused by Plavix®. A physician had instructed the patient to discontinue this medication 10 days before surgery. However, the patient admits after surgery that he or she stopped taking the drug only two days before surgery.
What ICD-9 code(s) should I report for this scenario? Read More→
The following ICD-9-CM codes denote acute respiratory failure (ARF):
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518.81, ARF
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518.82, other pulmonary insufficiency, not elsewhere classified (includes acute respiratory distress, acute respiratory insufficiency, and adult respiratory distress syndrome NEC)
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518.84, acute and chronic respiratory failure
Check out Coding Clinic, fourth quarter 1998 and first quarter 2005, for more information about when ARF should be the principal diagnosis, as well as documentation requirements.
The sequencing of respiratory failure depends on the reason for admission. When respiratory failure from an underlying condition causes the inpatient admission, the failure becomes the principal diagnosis; when the patient develops respiratory failure after admission, it is the secondary diagnosis and should be coded as such.
Q: What does an incidental pregnancy (code V22.2) mean? Is it related at all to an ectopic pregnancy (code 633.11)? Should I report the two together?
A: Coding Clinic, fourth quarter 1996, p. 50–51, states that code V22.2 is a secondary code only for use when the pregnancy is in no way complicating the reason for the visit. Otherwise, coders should report a code from the obstetric chapter.
For routine outpatient prenatal visits when no complications are present, report codes V22.0 (supervision of normal first pregnancy) and V22.1 (supervision of other normal pregnancy) as the first-listed diagnoses. Do not report these codes in conjunction with Chapter 11 codes. For more information, see Chapter 11 (Pregnancy/Childbirth) of the ICD-9-CM Official Guidelines for Coding and Reporting that took effect October 1, 2008.
Editor’s note: Alison Stangeby, RHIA, CCS, CPC, senior consultant at BKD, LLP in Little Rock, AR, answered this question that originally appeared in the August 2009 issue of Briefings on Coding Compliance Strategies.
CMS recently posted a fact sheet regarding ICD-10 that summarizes structural differences between the new system and its predecessor, ICD-9. It also explains how organizations and facilities should plan for the change and provides a list of helpful Web sites.
IPPS final rule published in Federal Register
On August 27, the inpatient prospective payment system (IPPS) final rule for FY 2010 was published in the Federal Register (74 FR 43754). It was previously available as a display copy.
Join MedicareFind today for a direct link to this and all the documents in our regulatory database.
The next Hospital & Hospital Quality Open Door Forum (HODF) is scheduled for Wednesday, August 26, 2009, at 2 p.m. Eastern. To participate, dial 800/837-1935 and reference conference ID 22153872.
MedicareFind subscribers and free trial users can access transcripts and audio of past HODF conference calls.
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