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ICD-9-CM

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International Classification of Diseases, 9th Revision, Clinical Modification - coding system used to report diagnoses and reasons for encounters, such as an annual physical examination, on outpatient and physician office claims. is updated once a year and updates are effective on October 1st.

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Advance Beneficiary Notice (ABN)

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is a form that the patient signs to acknowledge they are responsible for paying the bill if Medicare denies the claim.

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Adverse Effect

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also called adverse reaction; the appearance of a pathologic condition due to ingestion or exposure to a chemical substance properly administered or taken.

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Adverse Reaction

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see adverse effect

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Axis of Classification

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organizes entities, diseases, and other conditions according to etiology, anatomy, or severity (as in ICD-10-CM).

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Benign

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Not cancerous

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Carcinoma (Ca) in situ

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a malignant tumor that is localized, circumscribe, encapsulated, and noninvasive (has not spread to deeper or adjacent tissues or organs).

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Coding Conventions

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Rules that apply to the assignment of ICD-9-CM codes.

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Comorbidity

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secondary diagnosis or concurrent condition that coexists with the primary condition, has the potential to affect treatment of the primary condition, and is an active condition for which the patient is treated or monitored.

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Complication

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condition that develops subsequent to inpatient admission.

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Congenital Anomaly

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disorder diagnosed in infants at birth.

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E code

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are Supplementary Classification of External Causes of Injury and Poisoning; are use for environmental events, industrial accidents, or injuries inflicted by criminal activity.

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Encoder

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automates the coding process using computerized or Web-based software; instead of manually looking up conditions (or procedures) in the coding manual's index, the coder uses the software's search feature locate and verify diagnosis and procedure codes.

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Eponym

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are disease (or procedures) named for an individual (e.g., physician who originally discovered the disease, first patient diagnosed with the disease).

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First-Listed Diagnosis

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reported on outpatient claims (instead of inpatient principal diagnosis); it is determined in accordance with ICD-9-CM's coding conventions (or rules) as well as general and disease-specific coding guidelines.

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Late Effect

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is a residual effect or sequela of a previous acute illness, injury, or surgery.

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Malignant

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Cancerous

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Main Term

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(conditions) are printed in boldface type and are followed by the code number. they may or may not be followed by a listing of parentheical terms that serve as nonessential modifiers on the main term.

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Neoplasms

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are new growths, or tumors, in which cell reprodcution is out of control. should always be coded directly from a pathology report.

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Not Elsewhere Classifiable (NEC)

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identifies codes to be used when information needed to assign a more specific code cannot be located in the ICD-9-CM.

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Nonessential Modifier

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are supplementary words located in parentheses after a main term.

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Outpatient

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is a person treated in one of four settings: Ambulatory Surgery Center; lthcare provider's office; Hospital Clinic, Emergency department, outpatient department, same-day surgery unit; Hospital observation

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Principal Diagnosis

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as "the condition determined after study which resulted in the patient's admission to the hospital." the principal diagnosis code is reported in Form Locator 67 of the UB-04 (CMS-1450) claim.

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Principal Procedure

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is a procedure performed for definitive treatment rather than diagnostic purposes; one performed to treat a complication; or one that is most closely related to the principal diagnosis.

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Qualified Diagnosis

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is a working diagnosis that is not yet proven or established.

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Qualifiers

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are supplementary terms that further modify subterms and other qualifiers.

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Secondary Diagnosis

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include comorbidities and complications

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Secondary Procedure

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are additional procedures performed during the same encounter as the principal procedure.

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Subterms

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or essential modifiers; qualify the main term by listing alternate sites, etiology, or clincial status.

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Tabular List of Diseases (ICD-9-CM)

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are organized according to three-digit category codes for ICD-9-CM codes for Chapters 1-17 (codes 001-999.9)

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V Codes

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are located in the Tabular List of Diseases and are assigned for patient encounters when a circumstance other than a disease or injury is present.

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Volume 1

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Tabular List of Diseases (finish coding here)

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Volume 2

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Alphabetic Index to Diseases (start coding here)

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Volume 3

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Hospital Coding

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How many appendix are there?

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five appendies in the ICD-9-CM manual.

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Appendix D

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contains the Classification of Industrial Accidents According to Agency.

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Diagnosis Codes ranges from what?

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3-5 digits: First three digits refer to category; fourth digit refers to subcategory; fifth digit refers to subclassification

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What is indexing?

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is the process of cataloging diseases and procedures by code number.

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How many chapter of diseases and descriptions are there?

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17 chapters

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What does medical necessity require?

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requires diagnosis codes to be reported on submitted claims.

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Medical Necessity

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is to be sure to be clarify by the insurance companies (other than Medicare), because the definition can vary.

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What is an injury?

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is a traumatic wound or some other damage to an organ. ICD-9-CM, injuries are initially classified in the Injury and Poisoning chapter by type (e.g., all open wounds are classified in the same chapter).

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What is Medical Necessity?

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is the measure of whether a healthcare procedure or service is appropriate for the diagnosis and/or treatment of a condition.

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What does the MMA require?

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requires new, revised, and deleted ICD-9-CM codes to be implemented each October 1 and updated each April.

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Is cost-effective necessarily?

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no, it is not necessarily mean least expensive.

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What name did the CMS shorten?

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they shorten the name of the classification systems to International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System, abbrevating it as ICD-10-CM/PCS.

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What is being reviewing in the guidelines?

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Remember that the terms encounter and visit are used interchangeably in describting outpatient and physician office services.

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What is the outpatient first-listed diagnosis?

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was previously called the primary diagnosis.

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ICD-9-CM Classification of Drugs by AHFS list

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Appendix C of ICD-9-CM that contains the American Hospital Formulary services list number and its ID-equivalent code number; organized in numerical order according to AHFS list number

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ICD-9-CM Classification of Industrial Accidents According to Agency

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Appendix D of ICD-9-CM based on employment injury statistics adopted by the Tenth International Conference of Labor Statisticians

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computer- assisted coding (CAC)

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uses a natural language processing engine to "read) patient records and generate ICD-9-CM and HCPCS/CPT codes

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contiguous site

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also called overlapping site occurs when the origin of the tumor (primary site) involves two adjacent sites

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iatrogenic illness

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a disorder or symptom that occurs as a result of a medical or psychotherapeutic treatment

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ICD-9-CM coordination and Maintenance Committee

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Responsible for overseeing all changes and modifications to ICD-9-CM diagnosis (NCHS) and procedure (CMS) codes.

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ICD-9-CM Diagnostic Coding and Reporting Guidelines for Outpatient Services; Hospital-Based Outpatient Services and Provider-Based Office Visits

answer

Developed by the federal government for use in reporting diagnoses for claims submission.

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ICD-9-CM E code

answer

located in the supplementary classification of the ICD-9 tabular list of diseases they describe external causes of injury poisoning or other adverse reactions affecting a pt. health

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ICD-9-CM Index to Diseases (volume 2)

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is an alphabetical listing of main terms or conditions printed in boldfaced type that may be expressed as nouns, adjectives, or eponymous. The index contains three sections:injuries and diseases, drugs, external causes

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code in slanted brackets

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always reported as secondary codes because they are manifestations (results) of other conditions

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essential modifier

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subterms that are indented below the main term in alphabetical order except with or without clarifies the main term and must be contained in the diagnostic statement for the code to be assigned

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note

answer

contained in boxes to define terms clarify index entries, and list choices for additional digits

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qualifier

answer

supplementary term that further modifies sub terms and other qualifiers

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see-

answer

directs the coder to a more specific term under which the code can be found

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Chapter 6 A ICD-9-CM Coding – Flashcards

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