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Use these tips to improve ICD-9-CM coding accuracy

HIM Connection, July 25, 2006

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Use these tips to improve ICD-9-CM coding accuracy

Deborah Grider, CPC, CPC-H, CPC-P, CCS, CCS-P, president of Medical Professionals, Inc., in Indianapolis recommends the following strategies to improve the accuracy of ICD-9-CM diagnosis coding:

Tip #1: Review the official ICD-9-CM guidelines for coding and reporting at least annually. These guidelines often give the coder official guidance when the code description in the ICD-9-CM Manual does not, Grider says. Find the guidelines at www.cdc.gov/nchs/data/icd9/icdguide.pdf.

For example, the guidelines offer the following instructions for sequencing diabetes:

When assigning codes for diabetes and its associated conditions, the codes from category 250 must be sequenced before the codes for the associated conditions. The diabetes codes and the secondary codes that correspond to them are paired codes that follow the etiology/manifestation convention of the classification. Assign as many codes from category 250 as needed to identify all of the associated conditions that the patient has.

The guidelines also offer the following instruction on coding diabetes mellitus with the use of insulin:

For type II patients who routinely use insulin, code V58.67, Long-term (current) use of insulin, should also be assigned to indicate that the patient uses insulin. Code V58.67 should not be assigned if insulin is given temporarily to bring a type II patient's blood sugar under control during an encounter.

Tip #2: Use both the alphabetic index and tabular list together. Never code from just the alphabetic index. "I've made mistakes doing this," Grider says. Use the alphabetic index as a guidebook, and then consult the tabular list for greater specificity.

Tip #3: List first the basis for the visit: condition, symptom, or other reason. This is defined as the reason why the patient is at the facility (e.g., why he or she is being treated, what is the definitive diagnosis). Then list other conditions describing coexisting conditions managed by the physician.

Some physicians list all of the patient's ailments "and they want to get credit for it, but physicians should only list those conditions that they're managing on a diagnostic coding basis, unless it's a coexisting condition or a manifestation of that condition," Grider says.

Tip #4: Always code to the highest level of specificity (fourth and fifth digits). Doing so not only provides more specific information, Grider says, but it also helps coders and physicians prepare for ICD-10-CM. Since ICD-10-CM codes have up to seven digits of specificity, coding to the highest degree now can encourage physicians to improve their documentation habits and strengthen coders' ability to derive codes from the record when the system becomes mandatory (possibly by 2009, Grider estimates).

Tip #5: Code chronic conditions when treated or that affect the patient's treatment today. "Don't code conditions that affected the patient six months ago," Grider says.

Editor's Note: This article was adapted from the HCPro newsletter Briefings on Coding Compliance Strategies.

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