# ICD-9 "code first underlying disease" examples



## brenda Shafer (Apr 1, 2009)

For ICD-9 336.3 Myelopathy in other diseases classified elsewhere. Indicates, "Code first underlying disease, as: myelopathy in neoplastic disease (140.0-239.9), and also indicates exclusions. 
With this manifestation, are the codes they specify in the ICD-9 book the only codes that this manifestation can be coded with?
If you have an reference that speaks to this it would be helpful. No where have I found, that it states other codes could be used, other than the ones indicated.
Thanks, Brenda


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## luz.buenaventura (Apr 1, 2009)

found one.
Spinal cord injury from a pathological compression deformity of T8 with identified vertebral body metastatic carcinoma. This is coded 733.13, pathological fracture of vertebrae (principal diagnosis), 336.3, myelopathy in other diseases classified elsewhere, and 198.5, secondary malignant neoplasm of other specified sites, bone and bone marrow. (See Coding Clinic, third quarter 1999, page 5.)


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## 007CPC (Apr 1, 2009)

*Underlying=etiology*

Hi Brenda,

One way to determine the difference between underlying/etiology and manifestation codes/conditions is to ask yourself one question: what condition caused the other. You can answer this question by what the Medical Director writes on paper, and from that dictated information you have to abide by AHA guidelines while being very mindful about your facility, clinic, and/or payer rules.  I do know there are specific ICD-9 books that distinguish what codes are principal from secondary, etiology from manifestation.

You might want to disclose your coding method so other coders know how to approach your question. A word of advice in particular setting could mean nothing in another.

Maybe someone else could explain the answer to your question more transparently.


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## brenda Shafer (Apr 1, 2009)

*Code first underlying disease*

My real question is; Is myelopathy in neoplastic disease, Codes 140.0-239.9 the only underlying diseases that can be coded with 336.3 Myelopathy in other disease classified elsewhere. 
Brenda


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## 007CPC (Apr 1, 2009)

*yes*

Oh.   Yes, you can code other underlying conditions that aren't 140.0-239.9. The only trick to arriving at the correct code is being able to fathom and follow conventions and instructional notes. The only situation that would require you to disregard conventions and instructional notes is if you recieved specific orders from your boss or payer saying this is the way they want you to medical code.


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## pamtienter (Apr 7, 2009)

Brenda,
The codes listed for the diseases and manifestations are just some of them and usually the most commonly found, not an all encompassing list.


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