# ICD9 Coding Question (Axis 3)



## jessv1910 (Sep 4, 2009)

Hello. I'm a new CPC and I'm currently coding for a psychiatric hospital. The face sheet from where I'm coding has 5 parts - Axis 1 to Axis 5. The doctor wrote on Axis 3 (arrow going down) and TSH (Thyroid stimulating hormone). My question is: Is this the same as Hypothyroidism? Or, maybe I should use code 246.9? Thanks so much for your help!


----------



## kevbshields (Sep 4, 2009)

I'd be reluctant to code from arrows at all--regardless of IP or OP setting.

The other thing:  did the Psychiatrist treat, manage or observe the Axis III condition or was it simply mentioned in passing and noted from lab values that were "borrowed" into the multi-axial system?

Psych hospitals (regardless of independent policy and per HIPAA) are to use ICD-9 as the official reporting system.  What this means is, you have to use ICD-9 guidelines for coding--regardless of the providers' use of DSM-IV in their narrative diagnostic reporting.  ICD requires a condition factor in medical decision making before there can be justified inclusion for coding purposes.

Make sense?


----------



## jessv1910 (Sep 4, 2009)

Thanks Kevin. And, WOW to all your certifications!! 

I'm sorry but I don't really understand what you are saying about the DSM-IV   - And now I'm scare of coding. What they told me to do is to code Axis I, Axis II, and Axis III, except when is "hx" or "s/p" - This is my first job coding and I'm not really sure about a lot of things.  Can you kindly suggest a reference book that I could use? Thanks.


----------



## kevbshields (Sep 7, 2009)

It's nothing to be scared of--the coding, I mean.

Absolutely, there's a Federal Register from around the HIPAA implementation dates that might be of help to you.  There was a discussion between the Federal level HIPAA experts and the mental health community over whether "coding was in DSM or ICD-9".  This Federal Register established that ICD-9 is the official reporting system--per HIPAA Uniform Data Set.  Guidance in ICD supersedes any "coding" done in DSM-IV.

*Federal Register, November 15, 2004.*

Essentially, providers diagnose patients in DSM-IV.  Coders are supposed to code in ICD-9-CM.  Although there is probably more agreement between the two systems than disparity, there are differences that may very well effect that final codes listed or collected for reporting.  A coder should always follow and be familiar with the rules and guidelines in ICD, as that's how he or she will report the the diagnoses.

ICD-9 establishes that secondary codes (e.g., those listed on Axis III) are only to be reported if they were treated, factored into medical decision making, observed, assessed or otherwise monitored.  That rule would distinguish what (if anything) is coded off Axis III.  Psychiatrists do not always treat chronic conditions like COPD, hyperlipidemia and CAD.  Those would be collected on Axis III, but it'd be up to the coder (and possibly the provider in query situations) to establish that those were actually relevent to the encounter.

Good luck to you.  I wrote an article on this topic in September, 2007 Coding Edge.  You may want to read that for any clarification.


----------



## mitchellde (Sep 7, 2009)

That was an excellent article!  I was very helpful to me and I refer to it a lot.  I did not realize you wrote it, so kudos to you!


----------



## jessv1910 (Sep 7, 2009)

Kevin, thanks so much for all your help!


----------

