Pathology/Lab Coding Alert

Question: I've been told that when we report ICD-9 diagnosis codes, we have to "code to the highest degree of specificity." What does that mean?

Missouri Subscriber

Answer: Coding to the "highest degree of specificity" means that you must assign the most precise ICD-9 code that explains the narrative description of the symptom or diagnosis. ICD-9 codes contain three, four or five digits. You should not submit a claim with a three-digit code if there are four-digit codes that further describe it. Nor should you submit a four-digit code if it is further subclassified into five-digit codes.

For example, if a patient is diagnosed with acute infectious dysentery caused by the genus Shigella, even if you do not know the species, you should not report the three-digit code 004 (Shigellosis). Rather, you should report 004.9 (Shigellosis, unspecified). Similarly, if you have a specific diagnosis such as enteropathogenic E. coli, you should report the most specific code (008.01, Enteropathogenic E. coli) rather than the less specific code (008.00, E. coli, unspecified).