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Medical Coding News Archives

Updated ICD-9-CM Guidelines Released

September 10, 2009:

The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS) released updated guidelines for ICD-9-CM coding which were created on 8/27/2009 and are effective as of 10/01/2009. The Official Guidelines for ICD-9-CM coding are approved by the Cooperating Parties for ICD-9-CM: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and NCHS. These guidelines are included in the official government version of the ICD-9-CM and are also published by the AHA in the Coding Clinic for ICD-9-CM.

The revised guidelines clarify that the official conventions and instructions provided within the ICD-9-CM classification itself take precedence over the official guidelines. Updated categories and codes that are exempt from the Present on Admission (POA) reporting requirement were included; however, the POA examples have been removed from the guidelines.

Other revisions included in the updated guidelines are:

  • The General Coding Guidelines section includes new guidance for coding syndromes. Coders should follow the Alphabetic Index guidance when coding syndromes; however, if the index does not provide specific guidance, coders are instructed to assign codes for the documented manifestations of the syndrome.
  • The guidelines for coding and sequencing of complications were expanded to clarify correct coding of anemia associated with malignancy. If both anemia in neoplastic disease and anemia due to antineoplastic chemotherapy are documented, code 285.22 Anemia in neoplastic disease, and code 285.3 Antineoplastic chemotherapy induced anemia, may both be assigned.
  • Instructions for coding only confirmed cases of influenza due to certain identified viruses were revised to include new codes 488.0 Influenza due to identified avian influenza virus, and code 488.1 Influenza due to novel H1N1 influenza virus (swine flu).
  • Guidelines for selecting the principal diagnosis when a delivery occurs were revised. The principal diagnosis should correspond with the main circumstances or complication of the delivery. For cesarean deliveries, the principal diagnosis should be the condition established after study that was responsible for the patient’s admission. For example, if the patient is admitted with a condition that results in a cesarean section being performed, that condition should be selected as the principal diagnosis. If the reason for the admission/encounter was unrelated to the condition resulting in the cesarean delivery, the condition related to the reason for the admission/encounter should be reported as the principal diagnosis.
  • Instructions for coding puerperal sepsis are among the revisions to the guidelines. A code from category 038 Septicemia, should not be used for puerperal sepsis. Do not assign code 995.91 Sepsis, because code 670.2x describes the sepsis. Puerperal sepsis, code 670.2x, should be reported first followed by a secondary code to identify the causal organism. Additional codes to identify severe sepsis (995.92) and any associated acute organ dysfunction may be reported when applicable.
  • Clarification that fifth digit assignments for abortion categories 634–637 are based on the status of the patient at the beginning of the encounter.
  • Patient encounters for routine, screening (i.e., in the absence of any signs, symptoms, or diagnosis) laboratory or radiology testing may be reported with codes V72.5 and V72.62.
  • The list of V codes/categories that may only be reported as the principal/first-listed diagnosis was updated to include code V26.82 Encounter for fertility preservation procedure.
  • E code coding guidelines were updated with instructions for reporting the new activity codes (categories E001–E030) and external cause status codes (category E000). A code from category E001–E030 should be reported to describe the activity that caused or contributed to the injury or other health condition. Activity E codes may be assigned to indicate a health condition (not just injuries) resulted from an activity, or the activity contributed to the condition. A code from category E000 is reported to indicate the work status of the person at the time the event occurred. Do not assign code E000.9 Unspecified external cause status, if the status is not stated. The external cause status codes and the activity codes are not applicable to poisonings, adverse effects, misadventures, or late effects.
  • Additional guidance was provided for situations where the reporting format limits the number of E codes that can be reported. In these cases, coders should report the code for the cause/intent most related to the principal diagnosis, and additional E codes for the cause/intent (e.g., medical misadventures) should be reported instead of the codes for place, activity, or external status.

The updated Official Guidelines for ICD-9-CM coding effective as of 10/01/2009 can be found at: http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide09.pdf

Sarah A. Serling, CPC, CPC-H, CPC-I, CCS-P, CCS
Clinical Technical Editor


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