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CODING UPDATE:

DON'T LET SPECIAL WORD MEANINGS THROW THE BOOK AT YOUR CLAIMS

Published on Tue Apr 26, 2005

Small words give quick guidance - if you understand them.

You may think you know what "and" means - but you may be surprised.

The Centers for Medicare & Medicaid Services and the National Center for Health Statistics released an update to the official guidelines for ICD-9-CM coding - effective April 1 - including many clarifications that can make your job as a coder easier.

The guidelines were approved by the four organizations that make up the "Cooperating Parties" for the ICD-9-CM: the American Medical Association, the American Health Information Management Association, CMS and NCHS.

Some of the changes apply to specific conditions, such as diabetes. Others are general conventions that apply to all codes. Paying attention to coding conventions is crucial for correct coding, says Sue Bowman, director of coding policy and compliance with the Chicago-based American Health Information Management Association.

One addition to coding conventions defines the words "and," "with," "see" and "see also." Understanding how to interpret these words as you determine what code to use will improve your accuracy, experts say. 

  • "And" should be interpreted to mean "and" or "or" when it appears in a title, the revised official guidelines state.
     
    Example: 513 (Abscess of lung and mediastinum) applies to the lung and/or the mediastinum. The fourth digit denotes which of these conditions the patient has.
     
  • "With" in the alphabetical index is sequenced immediately following the main term, not in alphabetical order, the new guidelines explain.

    Example: If you are looking for "adenocarcinoma with squamous metaplasia," you will find it directly under the title entry for "Adenocarcinoma," not later in the three columns of terms under Adenocarcinoma, following the sub-term "water-clear cell."
     
  • "See" following a main term in the index means that another term should be referenced. You must go to the main term the "see" note indicates to find the correct code, the guidelines say.

    Example: If your patient has dementia from Alzheimer's disease, and you look in the index under the main term "Dementia," you will be told to "see Alzheimer's dementia." When you refer to "Alzheimer's dementia," the index directs you to both the 331.0 code (Alzheimer's disease) and the 294.1x code (Dementia in conditions classified elsewhere) for the manifestation and the fifth digit choice - with or without behavioral disturbance.
     
  • "See also" after a main term in the index indicates there is another main term you can look at that may provide additional useful index entries. But if the main term you are already referencing provides the code you need, you do not have to check the other entry, the guidelines tell you.

    Example: For a patient with viral pneumonia, you might first look in the index under "Virus, viral." The entry includes codes for viral infection NEC and viral septicemia. It also states "see also condition." This tells you to look for "Pneumonia" instead, where you will find codes for various viral pneumonia diagnoses. 

    Editor's Note: The revised ICD-9 guidelines are at     www.cdc.gov/nchs/data/icd9/icdguide.pdf.

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