# Manifestation definition?



## lorrpb

Is there an "official" definition of a manifestion? As in, manifestation is an unacceptable principal dx, or, code first the underlying condition, sequence the manifestation 2nd. I've not been able to find one!

I teach coding at the college level and my students struggle with this concept...they take it "too far."  They want to apply it to every coding situation with more than one dx, regardless of other instructions in the Tabular List. For example, when coding a disease caused by an infectious organism, often the disease is first and the infectious organism is 2nd. Students think the infectious organism is the underlying disease and want to code it first. 

Any thoughts on how to help new coders understand the different clinical situations would be appreciated!  Thanks!

Lorraine


----------



## mitchellde

A manifestation is a condition that is an extension of the primary illness in question.  Such as the neuropathy is a manifestation of the diabetes, another way to say this is the neuropathy is due to the diabetes.  So if not for the diabetes the neuropathy could not "manifest".  which is why we sequence the primary illness first, the secondary condition would not be present without the existence of the primary.


----------



## Cuteyr

*Manifestation*

A manifestation code describes the manifestation(Sign or The display or disclosure of characteristic signs or symptoms of an illness) of an underlying disease, not the disease itself, and therefore, cannot be a principal diagnosis.

The best example is cataract.This is a manifestation.This may occur due to many reasons or etiology
if it occurs due to glaucoma -code glaucoma first(365.0-365.9) and then code cataract due to glaucome(366.31 )
If it occurs due to diabetes-code diabetes first(250.5x) and then code diabetic cataract(366.41)

Additional infos
Addendum E, pages E-39-41 in CMS manual contain listings of ICD-9-CM diagnoses identified as manifestation codes. 

[ ] Brackets are used in the tabular list to enclose synonyms, alternative wording or explanatory phrases. Brackets are used in the index to identify manifestation codes.

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions the ICD-9-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists there is a “use additional code” note at the etiology code, and a “code first” note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.
In most cases the manifestation codes will have in the code title, “in diseases classified elsewhere.” Codes with this title are a component of the etiology/ manifestation convention. The code title indicates that it is a manifestation code.

There are manifestation codes that do not have “in diseases classified elsewhere” in the title. For such codes a “use additional code” note will still be present and the rules for sequencing apply.


----------



## mflores

*diabetic cataract*

366.41 code first rule is not valid for a billable 1cid-9-cm medical claim
66984 cataract extraction should be coded with 366.41 as primary diagnosis  on a reimbursement claim
Medicare is establishing the following limited coverage for 66840, 66850, 66852, 66920, 66940, 66983, 66984:

Covered for:

365.51   Phacolytic glaucoma 
366.00   Nonsenile cataract, unspecified 
366.01   Anterior subcapsular polar cataract 
366.02   Posterior subcapsular polar 
366.03   Cortical, lamellar, or zonular cataract 
366.04   Nuclear cataract 
366.09   Other and combined forms of non-senile cataract 
366.10   Senile cataract, unspecified 
366.11   Pseudoexfoliation of lens capsule 
366.12   Incipient cataract 
366.13   Anterior subcapsular polar senile cataract 
366.14   Posterior subcapsular polar senile cataract 
366.15   Cortical senile cataract 
366.16   Nuclear sclerosis 
366.17   Total or mature cataract 
366.18   Hypermature cataract 
366.19   Other and combined forms of senile cataract 
366.20   Traumatic cataract, unspecified 
366.21   Localized traumatic opacities 
366.22   Total traumatic cataract 
366.23   Partially resolved traumatic cataract 
366.30   Cataracts complicata, unspecified 
366.31   Glaucomatous flecks (subcapsular) 
366.32   Cataract in inflammatory disorders 
366.33   Cataract with neovascularization 
366.34   Cataract secondary to ocular disorders 
366.41   Cataract associated with other disorders, diabetic cataract 
366.42   Tetanic cataract 
366.43   Myotonic cataract 
366.44   Cataract associated with other syndromes 
366.45   Toxic cataract 
366.46   Cataract associated with other disorders 
366.50   After-cataract, unspecified 
366.51   Soemmering's ring 
366.52   Other after-cataract, not obscuring vision 
366.53   After-cataract, obscuring vision 
366.8   Other cataract 
366.9   Unspecified cataract 
998.82   Cataract fragments in eye following cataract surgery 

Medicare is establishing the following limited coverage for 66982:

364.23   Lens induced iridocyclitis 
364.51   Essential or progressive iris atrophy  
364.55   Miotic cysts of the pupillary margin 
364.57   Degenerative changes of the ciliary body  
364.59   Other iris atrophy  
364.75   Pupillary abnormalities  
364.76   Iridodialysis  
364.8   Other disorders of iris and ciliary body 
364.9   Unspecified disorder of iris and ciliary body 
366.00   Non-senile cataract, unspecified 
366.01   Anterior subcapsular polar cataract 
366.02   Posterior subcapsular polar cataract 
366.03   Cortical, lamellar, or zonular cataract 
366.04   Nuclear cataract 
366.09   Other and combined forms of nonsenile cataract 
366.10   Senile cataract, unspecified 
366.11   Senile cataract, pseudoexfoliation of lens capsule 
366.13   Anterior subcapsular polar senile cataract 
366.14   Posterior subcapsular polar senile cataract 
366.16   Nuclear sclerosis 
366.17   Total or mature cataract  
366.18   Hypermature cataract  
366.19   Other and combined forms of senile cataract 
366.20   Traumatic cataract, unspecified 
366.21   Localized traumatic opacities 
366.22   Total traumatic cataract 
366.23   Partially resolved traumatic cataract 
366.30   Cataracta complicata, unspecified 
366.32   Cataract inflammatory conditions 
366.33   Cataract with neovascularization 
366.41   Diabetic cataract 
366.42   Tetanic cataract  
366.43   Myotonic cataract  
366.44   Cataract associated with other syndromes 
366.45   Toxic cataract 
366.46   Cataract associated with radiation and other physical influences 
379.32   Subluxation of the lens  
379.33   Anterior dislocation of lens  
379.34   Posterior dislocation of lens  
379.40   Abnormal pupillary function, unspecified 
379.41   Anisocoria 
379.42   Miosis (persistent), not due to miotics 
379.43   Mydriasis (persistent), dot due to mydriatics 
379.45   Argyll Robertson pupil, atypical 
379.46   Tonic pupillary reaction 
379.49   Other anomalies of pupillary function 
743.36   Anomalies of lens shape spherophakia  
743.37   Congenital ectopic lens  
743.45   Aniridia 
743.46   Other specified anomalies of the iris and ciliary body 

Diagnoses that Support Medical Necessity

As listed in the "ICD-9 Codes that Support Medical Necessity" section of this policy.

ICD-9 Codes that DO NOT Support Medical Necessity

Any diagnosis codes not listed in the "ICD-9 Codes that Support Medical Necessity" section of this policy.

Diagnoses that DO NOT Support Medical Necessity

Conditions not listed in the "ICD-9 Codes that Support Medical Necessity" section


----------



## mitchellde

mflores said:


> 366.41 code first rule is not valid for a billable 1cid-9-cm medical claim
> 66984 cataract extraction should be coded with 366.41 as primary diagnosis  on a reimbursement claim



I am not sure where you obtained your information, however 366.41 is NEVER allowed as a first listed code it is by definition a manifestation and a secondary only allowed code.  The notes in the code book that say code first the undlying condition can never be overlooked and must always be adhered to.  Also 366.41 is an italicized code and as such is secondary only allowed.


----------

