Home Health ICD-9/ICD-10 Alert

These coding basics can make or break your accuracy

The key to getting your diagnosis codes right is knowing the exact condition the patient has, identifying it in both the alphabetic index and tabular indexes, and selecting the most specific code possible.

Finding the right diagnosis code without following guidelines is like trying to put together an entertainment center without reading the directions, says Barbara Chiappini, CPC, an instructor with CRN Institute, an online coding certification training center based in Absecon, N.J.

"Most of us jump right in without reading the instructions and, hours later, we're bald from pulling our hair out, and we ended up with three screws, one nut and two bolts left over," Chiappini says. "If we take our time, read and follow the instructions, we'll end up with better results and have more hair left!"

Master the Manual
 
 Here's how to keep your diagnosis coding accurate.
 
1. Get familiar with your book

First of all, make sure you're using the right ICD-9 manual for your setting, says Gina Nuske, CPC, CMBS, with Hematology & Oncology Associates Inc. in Canton, Ohio. If you are a home health coder, you'll use Volumes 1, 2 and 3.
 
2. Scrutinize the medical record to find the information about the condition you're coding

You want to look for the reasons for the episode. If you are a coder and the clinician has not included a reason for the episode in the record or primary and secondary diagnoses, it's time to contact the clinician.

Word to the wise: You should not code conditions defined as "rule out," "suspected," "probable," "questionable," or "possible" in the home health setting.

3. Find the patient's condition in the Index to Diseases (Volume 2)

Always begin your code search from the index, says Joann Baker, CCS, CPC-H, CPC, CHCC, owner of Precision Coding and Compliance in Flanders, N.J. Starting with the index helps to ensure the highest level of specificity, which is your ultimate goal.

Coding example: One of the patient's diagnoses in this episode is residual dysfunction of the patient's left hand due to monoplegia after a stroke. She'll need additional help with medications because this is her dominant hand. 

You look up "cerebrovascular accident" in the index, and you find "cerebral - see condition."

Now what? Do you look up "condition"? No, but if you do, you won't be alone, Chiappini says. "We need to look up the problem [stroke], then code it to its highest level of specificity in relationship to the body organ or area [the hand]."

When you look up "stroke," you find "see also, Disease, cerebrovascular, acute, 436," and reading further down in the list you see "late effects - see Late effect(s) (of) cerebrovascular disease."

Turning to Late effects - still in the index - you find a list of codes falling under the 438 code. You scan this list and find "cerebrovascular disease with monoplegia of upper limb, affecting dominant side" and the code 438.31. Now you've solved the first piece of the code search puzzle, but you aren't through yet.

4. Locate your code in the Tabular List (Volume 1)

"Verifying your code in Volume 1 is an important step," Baker says. "There are additional notes, guideline boxes, and cross references that you should review prior to making your code selection."
 
5. Verify that you've got the most specific code for the condition

Your final task is to select the code with the highest level of specificity, which often includes assigning a fourth or fifth digit.

Coding example (next phase): You've coded to the fifth digit, but let's check it. Code 438.31 is under the subheading "438 Late effects of cerebrovascular disease," which is under the general heading "Cerebrovascular Diseases (430-438)."

You see that 438 (Late effects of cerebrovascular disease) has a required fourth-digit indicator. You look at  subheading "438.3 Monoplegia of upper limb," which notes that a fifth digit is required. You choose 438.31 (Monoplegia of upper limb affecting dominant side).

Quick tip: Although most ICD-9 codes have four or five digits, a select few codes have only three digits, Nuske says. "The ICD-9 book identifies valid three-digit codes in the three-digit code table located after Appendix E."