The 2012 Coding Manual Collection SaMple pageS ICD-9-CM Manual, Volumes 1, 2 & 3 (Hospital Edition) ICD-9-CM Manual, Volume 1 & 2 (Professional Edition) HCPCS Level II Manual The following 10 sample pages are from HCpro’s 2011 ICD-9-CM Coding Manual, Volumes 1, 2 & 3 SaMple pageS ICD-9-CM Manual, Volumes 1, 2 & 3 (Hospital Edition) 2011 ICD-9-CM Conventions HCPro’s ICD-9-CM manuals include all the symbols and conventions Please note: Certain categories of codes only consider a particular set of found in the government’s official version (see Preface and ICD-9-CM fifth digits to be a CC condition. Official Guidelines for Coding and Reporting). In addition, HCPro’s ICD- • For example: 9-CM manuals include the following icons and color-coded conventions: Category 403.9x. CC 1 ✓4 TH Fourth digit required. In order to accurately assign a diagnosis This means that ICD-9 code 403.90 is not considered a CC condition, but from this category, it requires the assignment of a fourth digit. 403.91 is designated as a CC condition. • For example: Category 465.x requires a fourth digit of a 0, 8, or 9 to be assigned an accurate code. MCC Major Complication and Comorbidity. This diagnosis is considered a major complication and/comorbidity. Assignment of these ✓5 TH Fifth digit required. In order to accurately assign a diagnosis from diagnoses as an additional code may impact DRG assignment. this category, it requires the assignment of a fifth digit. • For example: 585.6 (End stage renal disease) is • For example: Category 642.0x requires a fifth digit of a 0, 1, 2, 3, or designated as an MCC. 4 to be assigned an accurate code. HIV HIV-related condition. This diagnosis code has been designated Unspecified This diagnosis code is designated as “unspecified.” It as an HIV-related condition. Based on the Official Guidelines, when is advisable to determine if a more specific code can be assigned to admission occurs for an HIV-related condition the principal diagnosis appropriately describe the condition. will be assigned code 042 (Human Immunodeficiency Virus Disease) • For example: followed by any HIV-related diagnoses. 585.9 (Chronic kidney disease, unspecified) • For example: Pneumocystis carinii pneumonia (PCP) due to HIV disease. Code 042 would be reported as the principal diagnosis and Manifestation Code This diagnosis is considered a manifestation of 136.3 would be reported as an additional diagnosis. an underlying disease and should not be assigned as a first listed or principal diagnosis. Codes designated as a manifestation code should H Hospital Aquired Condition. This condition has been identified always be assigned as an additional diagnosis only. In the Alphabetic as a hospital acquired condition (HAC). Per the Deficit Act of 2005, index, the manifestation code will be listed next to the underlying CMS designates certain conditions that when assigned with a present disease code in italicized slanted brackets. This convention indicates on admission (POA) indicator of “N” (which signifies not present on mandatory multiple coding in the order listed. In the Tabular index, the admission), will not yield the case into a higher-paying DRG if this is the code description will be written in italics. The instructional note “Code only condition identified as a CC/MCC. first underlying condition, cause or disease” will generally appear under • For example: the manifestation code. H 925.2 Crushing injury of neck CC • For example: 484.3 Pneumonia in whooping cough INCLUDES: An includes note identifies particular diagnoses considered to be classified to a particular code series. CC CC Condition. Codes are designated as CCs or MCCs if their • For example: presence would significantly increase hospital resources. These 598 (Urethral stricture) INCLUDES: pinhole meatus resources may include such services as intensive monitoring, complex stricture of urinary meatus services, or extensive care from multiple caregivers. A complication is a condition that develops that is not considered an expected outcome. ExCLUDES: An excludes note identifies particular diagnoses that would A comorbidity is a condition that co-exists with the primary condition not classify to a particular code series. For specific code assignment, during the specific encounter/admission. another series of codes may need to be referenced in lieu of or in • Complication example: addition to that code. PostoperativeTake hemorrhage a look (998.11) at our (CC Condition) CC • Comorbidity example: • For example: 598 (Urethral stricture) Atrial referenceflutter – 427.32 (CC guide condition) to the CC ExCLUDES: Congenital stricture of urethra and urinary conventions meatus (753.6) that appear in the ICD-9-CM Manual, Volumes 1, 2, & 3 ICD-9-CM MANUAL 2011 2011 ICD-9-CM CONVENTIONS vii ICD9_2011_Preface.indd 7 8/16/10 10:09:16 PM 2011 ICD-9-CM Conventions Valid OR Procedure This procedure has been designated as a valid OR New Code. This code is new for the current year. procedure that can affect DRG assignment. • For example : • For example: 237.73 Schwannomatosis 00.66 (Percutaneous transluminal coronary angioplasty [PTCA] or coronary atherectomy) Revised Code Title. This code title has been revised for the current year. • For example: Non OR Procedure This procedure has been designated as a non OR 307.0 Adult onset fluency disorder procedure and generally does not affect DRG assignment unless used in conjunction with a valid OR procedure. ♦ Revised Text ♦. Codes identified as having revised text have had • For example: additions or deletions to their inclusion notes, example conditions, or 36.06 (Insertion of non-drug-eluting coronary artery stent(s)) non-essential modifiers. • For example: Please note code 36.06 used in conjunction with 00.66 may affect DRG 564.0 Constipation assignment. ExCLUDES: ♦fecal impaction (560.32)♦ ❖ New Line. This icon designates a new line in the Alphabetic index. • For example: ❖ Arcuate uterus 752.36 ▲ Revised Text ▲. Revisions made to the alphabetic index in Volume 2 are also indicated. • For example: Arcuatus uterus ▲752.36 ▲ Appendix F provides a complete list of current CC Exclusions. Take a look at our reference guide to the conventions that appear in the ICD-9-CM Manual, Volumes 1, 2, & 3 viii 2011 ICD-9-CM CONVENTIONS ICD-9-CM MANUAL 2011 ICD9_2011_Preface.indd 8 8/16/10 10:09:18 PM Index to Diseases and Injuries Fracture Fracture osteoporotic—see Fracture, pathologic multiple sites 813.07 Note—Use the following fifth-digit subclassification palate (closed) 802.8 open 813.17 with categories 800, 801, 803, and 804: open 802.9 neck 813.06 0 unspecified state of consciousness paratrooper—see Fracture, tibia, lower end open 813.16 1 with no loss of consciousness parietal bone—see Fracture, skull, vault open 813.17 2 with brief [less than one hour] loss of parry—see Fracture, Monteggia’s specified site NEC 813.07 patella (closed) 822.0 open 813.17 consciousness open 822.1 ramus 3 with moderate [1–24 hours] loss of pathologic (cause unknown) 733.10 inferior or superior (with visceral injury) consciousness ankle 733.16 (closed) 808.2 4 with prolonged [more than 24 hours] loss femur (neck) 733.14 open 808.3 of consciousness and return to pre-existing specified NEC 733.15 ischium—see Fracture, ischium conscious level fibula 733.16 mandible 802.24 5 with prolonged [more than 24 hours] loss of hip 733.14 open 802.34 consciousness, without return to pre-existing humerus 733.11 rib(s) (closed) 807.0 Yellow-shadedradius (distal) 733.12 conscious level specified site NEC 733.19 Use fifth-digit 5 to designate when a patient call-outtibia 733.16 boxes Note—Use the following fifth-digit subclassification is unconscious and dies before regaining ulna 733.12 with categories 807.0–807.1: consciousness, regardless of the duration of the vertebraedescribe (collapse) the 733.13 0 rib(s), unspecified loss of consciousness wristfifth-digit 733.12 1 one rib 6 with loss of consciousness of unspecified duration pedicle (of vertebral arch)—see Fracture, vertebra, by site 2 two ribs 9 with concussion, unspecified subclassifications.pelvis, pelvic (bone(s)) (with visceral injury) (closed) 808.8 3 three ribs multiple swith disruption of pelvic circles 808.43 4 four ribs with open 808.53 5 five ribs contusion, cerebral 804.1 open 808.9 6 six ribs epidural hemorrhage 804.2 rim (closed) 808.49 7 seven ribs extradural hemorrhage 804.2 open 808.59 hemorrhage (intracranial) NEC 804.3 peritrochanteric (closed) 820.20 8 eight or more ribs intracranial injury NEC 804.4 open 820.30 9 multiple ribs, unspecified laceration, cerebral 804.1 phalanx, phalanges, of one subarachnoid hemorrhage 804.2 foot (closed) 826.0 with flail chest (open) 807.4 subdural hemorrhage 804.2 with bone(s) of same lower limb 827.0 open 807.1 open 804.5 open 827.1 root, tooth 873.63 with open 826.1 complicated 873.73 contusion, cerebral 804.6 hand (closed) 816.00 sacrum—see Fracture, vertebra, sacrum epidural hemorrhage 804.7 with metacarpal bone(s) of same hand 817.0 scaphoid extradural hemorrhage 804.7 open 817.1 ankle (closed) 825.22 hemorrhage (intracranial) NEC 804.8 distal 816.02 open 825.32 intracranial injury NEC 804.9 open 816.12 wrist (closed) 814.01 laceration, cerebral 804.6 middle 816.01 open 814.11 subarachnoid hemorrhage 804.7 open 816.11 scapula (closed) 811.00 F subdural hemorrhage 804.7 multiple sites NEC 816.03 acromial, acromion (process) 811.01 vertebral column with other bones, except skull open 816.13 open 811.11 or face bones (sites classifiable to 805 or 806 open 816.10 body 811.09 proximal 816.01