OASIS Alert

If you're tired of locating a term in the alphabetic index of your ICD-9 coding manual only to be told "see condition," you can save time and make your searches more productive by getting to know the manual's conventions and quirks.

Example: Your patient has benign hypertrophy of the prostate, and you look up "prostate" in the alphabetic index. Rather than a code, you find "see condition." You try "benign hypertrophy," but here you are greeted with "see also condition," along with a few codes that don't match your patient's diagnosis. Finally, you try looking under "hypertrophy," and you find the code you were searching for: 600.00 (Hypertrophy, prostate, benign).

"Finding a code in the alphabetic index can be confusing. The investigative process begins with figuring out what to look under.  Like any investigator, it helps to think deductively," says Keith Nielsen, RN, HCS-D, PPS/ OASIS coordinator with Great Lakes Home Healthcare in Erie, PA.

"The main terms in the index are set flush with the left margin of each column and are in boldface type. They represent diseases, such as 'pneumonia;' conditions, such as 'fracture;' nouns, such as 'syndrome;' and adjectives, such as 'large,'" says Ann Zeisset, RHIT, CCS, CCS-P with the American Health Information Management Association in Chicago, IL. Keep these categories in mind as you begin your search to narrow down your options from the start.

Many conditions are in multiple locations in the alphabetic index, Zeisset says. Use these expert tips to streamline your next coding search:

1. Look for the noun. For example, with benign prostatic hypertrophy, both benign and prostatic are adjectives that describe the hypertrophy.

2. Save body parts for later. Never start your search by looking in the index under the body part, or you will be advised to "see condition."

3. Try conditions or symptoms. Search for the condition or symptom that caused or contributed to the diagnosis you are looking for, says Nielsen. Other helpful terms you may consider when searching the alphabetic index include "complication," "disease," "abnormal" or "injury," he suggests. 

4. Don't stop too soon. Once you locate your term, be sure to review all of the indented sub-terms below it for more specificity, Zeisset recommends.

Example: If you stop your search for female stress incontinence once you locate code 788.30 (Incontinence), you'll assign an incorrect code. Look under the sub-term "stress," and you'll find the correct code is 625.6 (Stress incontinence, female).

5. Follow cross-references. In the index, notes such as "see" or "see also" and explanatory notes in the "injury" and "fracture" sections help guide you to the correct code assignment, Zeisset advises.

6. Expect to find exceptions. V code 58.83 (Encounter for therapeutic drug monitoring) isn't listed under "encounter," "therapeutic," "drug" or "monitoring." Instead, it is listed under "Admission for" or "Test," points out Melinda Gaboury with Healthcare Provider Solutions in Nashville, TN.

7. Names matter. If the condition is named after a person, like Lou Gehrig's disease, look under the name. 

8. Look for complications. To find the code for an infected joint prosthesis search under "complications" then "infection/inflammation."

9. Know your alternatives. You can find complications of medical or surgical care under the main term "complications" and under the name of the condition. Conditions that include the term disease or syndrome in the title may be found under "disease" or "syndrome," as well as under the disease or syndrome's name, Zeisset says.