Thursday, 2 March 2017

DIAGNOSIS CODING

The ICD-9-CM codes have been available for use since 1977. However, only since 1989 have the ICD- 9-CM codes been required for physician professional services. In the spring of each year, diagnosis codes are reviewed and new codes are created. At the same time, other diagnosis codes are revised to reflect the diseases and conditions physicians are treating. The new, revised and deleted code changes are published in the spring and are implemented for coding on Oct. 1 of each year. ICD-9 and ICD-10 coding guidelines are similar. The system has been changed to allow more diagnosis codes for specific diseases, to give more options for tracking morbidity and mortality for the Center of Disease Control and to have continuity with the World Health Organization. There is more flexibility with ICD-10 since there are more codes to choose as the appropriate diagnosis. Since the coding guidelines are similar for ICD-9 CM, emphasis will be placed on learning the new ICD-10CM codes, which will become the standard coding system for use in physician practices.

ICD-10-CM coding system is arranged in the same format as the ICD-9CM book with the book divided into two sections: the index − an alphabetical list of terms and their corresponding code − and the tabular section − a sequential alphanumeric list of codes divided into chapters based on body system or condition. The Alphabetical Index is arranged with an index to Disease and Injuries, The Neoplasm Table, Table of Drugs and Chemicals and the Index to External Causes and injuries. The Tabular list contains categories and subcategories of codes. The format for the codes is alphanumerical, with each code beginning with an alpha character and then having a mix of alpha and numerical characters for each code. A valid code may range from three to seven characters.

These diagnosis codes are divided into chapters, sections, subsections and subcategories. The list below gives you a look at the code breakdown:

• First character of a three character category is a letter 
• Second and third characters may be numbers or alpha characters 
• Fourth and fifth characters define subcategories and also may be either alpha or numerical characters 
• Sixth and seventh characters also may be either numerical or alphabetical. These characters are further divisions of the subcategories described in the first through fifth position of the ICD- 10CM codes. 

Unique to the ICD-10CM coding system is the use of the letter “X” as a placeholder when the diagnostic code needs to be expanded but there isn’t a number or letter appropriate to use to complete the code expansion for a specific place. For example, an initial encounter for a scorpion sting would be coded as T63.2X1. The “x” is required to enable the expansion of the code to the seventh place to complete the code.

The Alphabetical Index section of the ICD-10CM books is arranged in the same manner as the ICD- 9 CM book, with the exception that it lacks a hypertension table. The alphabetical section also has a guide to indicate with a √ when the code will need an additional digit to make for a complete code. The alphabetical section is considered the index for the numerical section of the book and should be used as a person would use any other index, as a beginning point to determine where to find the correct code. Behind the alphabetical section is the Neoplasm Table. The Neoplasm Table list contains diagnosis codes for malignant primary, malignant secondary, Ca in situ, benign, uncertain behavior, and unspecified behavior neoplasms. Some of these codes may require additional digits not shown in the Index. Again, to code completely, the codes will need to be selected from the Tabular section of the ICD- 10CM book to verify laterality as well as specificity for the code. The third index in the alphabetical section is the Table of Drugs and Chemicals and the last index is the Table of External Cause or Accident Codes. Again, the appropriate manner for coding would be to use these sections as indexes and determine the appropriate code from the tabular section of the book.  

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