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DIAGNOSIS CODING TIPS INDEX
Coding Tip Page
1. Diabetes 3
2. Asthma 3
3. Hypertention 3
4. Highest Specificity 5th Digit – Pain or Arthritis 3
5. Neoplasm 3
6. Chronic Pain 4
7. Depression with Anxiety 4
8. Fracture 4
9. Highest Specificity 4th and 5thDigits – Diabetes 4
10. Diabetes with Renal Manifestation 4
11. Sequencing of Codes 4
12. Non Specific Abnormal Findings 5
13. Osteoarthritis 5
14. Combination Codes – Hypertension 5
15. Allergic Rhinitis 5
16. BPH – Benign Prostatic Hypertrophy 6
17. Urinary System 6
18. Overweight and Obesity 6
19. Hypertensive Heart Disease 6
20. Contact Dermatitis 6
21. Combination Codes Used With Two Diagnoses 7
22. Coding Diabetes 4th and 5th Digit 7
23. Lipoid Metabolism 8
24. Ischemic Heart Disease 8
25. Chronic Ulcer of the Skin 8
26. Top Ten Diabetes manifestation Codes 8
27. Unspecified Code Usage 9
28. Diseases of the Endocardium 10
29. Proper documentation 10
30. Coding Fever 5th Digit 10
DIAGNOSIS CODING TIPS INDEX - Continued
32. Gout 11
33. Acute/chronic Venous embolism 11
34. Influenza 12
35. Voice and resonance disorders 13
36. Poisoning by psychotropic/psychostimulant agents 13
37. V-Code 14
38. Aortic Ectasia 15
39. Incontinence of Feces 15
Coding Tip #1
When coding Diabetes with a manifestation you need to use a separate code for the manifestation. For example Diabetes Type II with Retinopathy 250.50 and 362.01 for the retinopathy. Code the Diabetes first then the manifestation. These codes can be found in the ICD-9 CM book in the section on diabetes.
Coding Tip #2
According to the 2007 ICD9-CM coding book the code 496 (COPD) cannot be used with any code from categories 491-493. If you have a patient who has Asthmatic Bronchitis or Asthma with COPD there is a combination code 493.2* (requires fifth digit of 0-unsp, 1-w/status asthmaticus, 2-acute exacerbation).
Coding Tip #3
When coding hypertension there needs to be documentation that a blood pressure was taken and if the hypertension is benign (401.1) or malignant (401.0) this needs to be documented as well. Otherwise you should use the hypertension unspecified (401.9) or elevated blood pressure without a diagnosis of hypertension (796.2).
Coding Tip #4
When coding to the highest specificity the 5th digit is very important. When a patient
has pain or arthritis there are specific 5th digits that refer to different body areas. The
code range for these specific sub-classifications is 715-719. Here are the 5th digits and the body areas:
0= site unspecified 1= shoulder region 2= upper arm 3= forearm 4= hand
5= pelvic region and thigh 6= lower leg (knee)
7= ankle and foot 8= other specified sites 9= multiple sites
Coding Tip #5
V10.3 for a personal history of breast cancer. If there is definitive cancer diagnoses use the code range 140-199 with the appropriate 4th or 5th digit to define the location.
Coding Tip #6
There are new pain codes in the 2007 ICD-9 book for acute pain and chronic pain. They start with 338 and need to have 4th and/or 5th digits added depending on the cause of the pain. These are great codes to use for post-op pain or pain due to trauma, also chronic pain syndrome is included in this group of codes. The code for generalized pain (780.96) is still a good one to use if the pain is localized, and unspecified. Coding Tip #7
When coding a patient with a diagnosis of depression with anxiety use code 300.4 not the codes for major depressive disorder (296 series). There needs to be documentation that the patient has major depressive disorder and whether it is a single or recurrent event and also whether it is mild, moderate, severe in order for the 296 codes to be used.
Coding Tip #8
When coding a fracture only the initial provider who diagnoses the fracture can code it. All other visits related to the fracture are aftercare visits and the appropriate V code needs to be used depending on the location of the fracture. The V codes start with V54 and require two more digits, the fourth digit for traumatic or pathological fracture and the fifth digit for the actual location of the fracture.
Coding Tip #9
The 4th and 5th digits are very important when coding to the highest specificity. This is especially important with certain codes because it can mean the difference between Diabetes Type II, not juvenile (250.00), Juvenile Diabetes Type I (250.01) and Diabetes Type II, uncontrolled (250.02). Each of these 5th digits changes the definition of the
code.
Coding Tip #10
When coding diabetes with a renal manifestation a commonly missed manifestation code is Proteinuria (791.0), this code is not listed in the diabetes section of ICD-9-CM. Remember that if you use a diabetic code with a manifestation the manifestation code must be listed in addition to the diabetic code.
Coding Tip #11
When coding to the highest specificity the sequencing of codes is very important. For example Late Effects of a CVA (438) should be the first diagnosis followed by the late effect code. This would only be relevant for late effects that are not listed in a
that should be followed by a code for the type of paralytic syndrome such as locked in state (344.81). The other example would be the diabetic codes with manifestations, these would be listed first then the second code would be the manifestation.
Coding Tip #12
There are codes in the series 790-796 Nonspecific Abnormal Findings that are good to use when there is not a definitive diagnosis. For example (790.21) for impaired fasting glucose, or (796.2) elevated blood pressure reading without a diagnosis of hypertension. These codes are appropriate if the patient has not yet been diagnosed with diabetes or hypertension.
Coding Tip #13
When coding Osteoarthritis (715) the 4th and 5th digits are important to determine the subcategory and subclassification of the disease. The 4th digit will specify if the OA is
generalized (0), localized-primary (1), secondary (2) or unspecified (3), not generalized (8), or unspecified as to whether generalized or localized (9). The 5th digit will
determine the body area (s) affected: 0= site unspecified
1= shoulder region 2= upper arm 3= forearm 4= hand
5= pelvic region and thigh 6= lower leg (knee)
7= ankle and foot 8= other specified sites 9= multiple sites
Coding Tip #14
There are combination codes that can be used for a patient that have hypertension and another chronic illness. The hypertension codes are in the ICD-9 book under 401-405. These codes should be used if a patient has hypertensive heart disease (402) or
hypertensive chronic kidney disease (403), or hypertensive heart and CKD (404) and also secondary hypertension (405). There are 4th and 5th digits which clarify the chronic
illness as malignant, benign, unspecified and also the stage the illness is in and whether the patient has heart failure or not.
Coding Tip #15
When coding for Allergic Rhinitis use the codes from the category 477. There needs to be a 4th digit with this code to specify if the rhinitis is due to pollen (0), food (1), animal
since this code is for an allergic reaction or hypersensitivity which is unspecified, such as a localized reaction to a bug bite.
Coding Tip #16
When coding BPH-Benign Prostactic Hypertrophy (600.0*) the 5th digit states whether the patient has LUTS-lower urinary tract symptoms or not. If you use (600.00) then there are no LUTS but if you use (600.01) there is LUTS and an additional code will be needed to specify the symptom for example, urinary frequency (788.41) or urinary retention (788.20).
Coding Tip #17
There are some new codes in the category 788, symptoms involving the urinary system. One code is for urinary hesitancy (788.64) and the other for straining on urination
(788.65). Also in this section are the codes for urinary incontinence (788.3*) with a 5th
digit of (0) unspecified, (1) urge and (2) stress, male. If the patient has female stress incontinence the code is (625.6). There are codes for urinary frequency (788.41) and many other codes for a multitude of urinary symptoms.
Coding Tip #18
According to the ICD-9-CM coding book when coding for overweight and obesity category 278.0 you should use an additional code to identify the BMI-Body Mass
Index, if known, from the V codes V85.0-V85.54. The fifth digits in this section are (0) unspecified, (1) morbid, and (2) for overweight.
Coding Tip #19
According to the ICD-9-CM coding book when coding hypertensive heart disease and other chronic diseases you should include an additional diagnosis to specify the type of heart failure (428.0-428.43), or any other condition classifiable to (429.0-429.3, 429.8, 429.9) due to hypertension. For patients with hypertensive heart disease and chronic kidney disease use additional code to describe heart failure if known (428.0-428.43) and stage of chronic kidney disease (585.1-585.4, 585.9).
Coding Tip #20
When coding contact dermatitis (692.*) the 4th digit specifies what the dermatitis is due
to, such as detergents (0), oils and greases (1), solvents (2), drugs and medicines in contact with the skin (3), other chemical products (4), food in contact with the skin (5), plants [except food] (6), solar radiation (7) if using the 4th digit of seven you will need a
5th digit as well, such as unspecified due to sun (0), sunburn (1), due to solar radiation
radiation (2), metals (3), animal dander (4), other (9). Finally if there is no specific cause use 692.9.
Coding Tip #21
There are certain combination codes which encompass two diagnoses and do not need any other diagnosis codes. For example when coding COPD with asthma (493.20) you do not need to code COPD (496) since the combination code includes both. Another example would be diabetes with a manifestation such as (250.40) diabetes with a renal manifestation, you would not need to code diabetes (250.00) but you would need to code the manifestation. Last example is late effects of a CVA (438.**) just code the late effect, it is not necessary to also code (436) CVA.
Coding Tip #22
When coding Diabetes the 4th and 5th digits are very important. The 4th digit specifies if
there are any manifestations/complications of the Diabetes and the 5th digit specifies
whether or not the Diabetes is Type I or Type II and whether it is uncontrolled or not stated as uncontrolled. A common error is to use the 5th digit of (1) for a patient who is
an insulin dependent Type II diabetic. The 5th digit of (1) indicates the patient is a Type I (juvenile type diabetic) who is insulin dependent.
The 5th digits are as follows:
0 type II or unspecified type, not stated as uncontrolled-even if patient is insulin dependent
1 type I (juvenile type), not stated as uncontrolled
2 type II or unspecified type, uncontrolled-even if patient is insulin dependent 3 type I (juvenile type), uncontrolled
The 4th digit is important as well and they are as follows:
0 diabetes without mention of complication 1 diabetes with ketoacidosis
2 diabetes with hyperosmolarity 3 diabetes with other coma
4 diabetes with renal manifestation-use additional code for manifestation
Coding Tip #23
When coding disorders of lipoid metabolism category 272 the 4th digit is necessary to
specify the type of disorder, such as, hypercholesterolemia (0), hyperglyceridemia (1), mixed hyperlipidemia (2), hyperchlyomicronemia (3), unspecified hyperlipidemia (4), lipoprotein deficiencies (5), lipodystrophy (6), lipidoses (7), other disorder of lipoid metabolism (8), unspecified disorder of lipoid metabolism (9).
Coding Tip #24
There are some codes from the Ischemic Heart Disease Section (410-414) of ICD-9 that you may not be aware of, for example:
Angina, unstable (preinfarction) (411.1) this code is also used for ACS-acute coronary syndrome,
Old Myocardial Infarction (412), Angina Decubitus (413.0), Angina Pectoris (413.9),
CAD/ASHD (414.0*) the fifth digit specifies where but if unknown use (0), Chronic Ischemic Heart Disease (414.9).
The codes that begin with (410) Acute Myocardial Infarction need a 4th digit to describe where it occurred and a 5th digit to describe the episode of care-unspecified (0), initial
episode (1), subsequent episode (2). Coding Tip #25
When coding from the Chronic Ulcer of the Skin Section (707) the 4th digit of (0) is for decubitus ulcers and the 5th digit denotes the site such as; unspecified site (0), elbow (1), upper back (2), lower back (3), hip (4), buttock (5), ankle (6), heel (7), and other site (9). If the 4th digit is (1) this is for ulcer of lower limbs, except decubitus and the 5th
digits would be as follows; lower limb unspecified (0), thigh (1), calf (2), ankle (3), heel and midfoot (4), other part of foot (5), and other part of lower limb (9).
Coding Tip #26
When coding diabetes with a manifestation an additional code is needed for the manifestation here are the top ten manifestations based on frequency of use; Renal manifestations 250.4*
Chronic Kidney Disease-585.1-585.9 Nephropathy-583.81
Nephrosis-581.81 Proteinuria-791.0
Neurological manifestations 250.6* Peripheral neuropathy-337.1
Polyneuropathy-357.2 Gastroparesis-536.3
Peripheral circulatory disorders 250.7* Gangrene-785.4
Peripheral angiopathy-443.81
Please do not use the diabetes with unspecified manifestation (250.9*) unless the manifestation cannot be found in any of the other diabetes codes. Be sure if you use this particular code that there is a manifestation associated with diabetes coded on the same claim. There are additional codes in each category that are not listed here. The most important thing is that the manifestation code is used with the diabetes code. Coding Tip #27
Unspecified codes should be used when there is no specific code available or the specific diagnosis is not known at the time of the visit. For instance:
If insomnia (780.52) is the diagnosis do not use unspecified sleep disorder (780.50) since insomnia has its own code.
If a patient has a late effect of a CVA (438.**) don’t use 436 (CVA). Use the codes from the 438 series and if needed an additional code for the late effect. If a migraine (346.90) is documented don’t use the code for a headache (784.0). If a patient has abdominal pain (789.0*) the fifth digit will describe where the site
of the pain is:
(0) Unspecified
(1) Right upper quadrant (2) Left upper quadrant (3) Right lower quadrant (4) Left lower quadrant (5) Periumbilic
(6) Epigastric (7) Generalized
Coding Tip #28
Sections 424 (diseases of the endocardium) and 425 (cardiomyopathy) of the ICD9-CM book contain codes that are sometimes overlooked. Here are some of the most common codes from these two sections:
424.0- mitral valve disorders 424.1- aortic valve disorders 424.2- tricuspid valve disorders 424.3- pulmonary valve disorders 424.90- endocarditis, valve unspecified
424.91- endocarditis in diseases classified elsewhere (code underlying disease first) 425.0- endomyocardial fibrosis
425.1- hypertrophic obstructive cardiomyopathy 425.4- other primary cardiomyopathies
425.5- alcoholic cardiomyopathy
425.9- secondary cardiomyopathy, unspecified Coding Tip #29
Proper documentation is vital to coding correctly and to the highest specificity. If it isn’t documented it didn’t happen. During an audit the auditor will only look at the documentation for the date of service on the claim and if there are discrepancies
between diagnoses on the claim and what is documented in the medical record that will be counted as an error. Diagnosis coding is the wave of the future and will determine the HCC score of each individual patient and in turn affect payment.
Coding Tip #30
There are some new ICD9-CM codes for 2009 and the next few coding tips will
highlight these. For example, the code for a fever (780.6) now requires a fifth digit; the additional digit will cover a broader range of temperature regulation disturbances. If the fifth digit is:
(0) fever, unspecified
(1) fever presenting with conditions classified elsewhere-code underlying condition first
(2) postprocedural fever (3) postvaccination fever (4) chills (without fever)
Coding Tip #31
Section 249 of the ICD-9-CM book is new codes for secondary diabetes mellitus. The fourth digits are the same as for the codes in section 250 the difference with the
secondary diabetes codes are the fifth digits; there are only two of them, and the definition.
Secondary diabetes includes diabetes mellitus (due to), (in), (secondary), (with): drug -induced or chemical -induced infection
The fifth digit:
(0) not stated as uncontrolled, or unspecified (1) uncontrolled
249.0 Secondary diabetes mellitus w/o mention of complication 249.1 Secondary diabetes mellitus with ketoacidosis
249.2 Secondary diabetes mellitus with hyperosmolarity 249.3 Secondary diabetes mellitus with other coma
249.4 Secondary diabetes mellitus with renal manifestations
249.5 Secondary diabetes mellitus with ophthalmic manifestations 249.6 Secondary diabetes mellitus with neurological manifestations 249.7 Secondary diabetes mellitus with peripheral circulatory disorders 249.8 Secondary diabetes mellitus with other specified manifestations 249.9 Secondary diabetes mellitus with unspecified complication Coding Tip #32
Category (274) gout had some new codes added in the 2010 ICD-9 book, here they are: 274.00 gout arthropathy
274.01 Acute gouty arthritis
274.02 Chronic gouty arthropathy w/o tophus (tophi) 274.03 Chronic gouty arthropathy w/tophus (tophi) Coding Tip #33
In the 2010 ICD-9 book there were a few new categories added:
(453.5*) Chronic Venous Embolism and thrombosis of deep vessels, lower extremity 453.50 Chr. Venous embolism and thrombosis of unsp deep vessels
453.51 Chr. Venous embolism and thrombosis of unsp deep vessels, of proximal 453.52 Chr. Venous embolism and thrombosis of unsp deep vessels, distal
(453.7*) Chr. Venous embolism and thrombosis of other specified vessels
453.71 Chr. Venous embolism and thrombosis of of superficial veins of upper extremity
453.72 Chr. Venous embolism and thrombosis of unsp deep veins of upper extremity
453.73 Chr. Venous embolism and thrombosis of upper extremity, unsp 453.74 Chr. Venous embolism and thrombosis of axillary veins
453.75 Chr. Venous embolism and thrombosis of subclavian veins 453.76 Chr. Venous embolism and thrombosis of internal jugular veins 453.77 Chr. Venous embolism and thrombosis of other thoracic veins 453.79 Chr. Venous embolism and thrombosis of other specified veins
(453.8*) Acute Venous embolism and thrombosis of superficial veins upper extremity
453.81 Acute Venous embolism and thrombosis of superficial veins upper ext 453.82 Acute Venous embolism and thrombosis of deep veins upper extremity 453.83 Acute Venous embolism and thrombosis of upper extremity, unsp 453.84 Acute Venous embolism and thrombosis of axillary veins
453.85 Acute Venous embolism and thrombosis of subclavian veins 453.86 Acute Venous embolism and thrombosis of internal jugular veins 453.87 Acute Venous embolism and thrombosis of other thoracic veins 453.89 Acute Venous embolism and thrombosis of other specified veins Coding Tip #34
There are new influenza codes in the 2011 ICD-9 book they are:
488.01 Infuenza due to identified avian influenza virus w/pneumonia
488.02 Influenza due to identified novel H1N1 influenza virus w/other respiratory manifestations
488.09 Influenza due to identified avian influenza virus w/other manifestation
There are also new influenza codes in the 2012 ICD-9 book they are:
488.81 Influenza due to identified novel influenza A virus w/pneumonia
Coding Tip #35
There are some new codes for category (784.4) Voice and resonance disorders in the 2010 ICD-9 book. Also some changes were made to the definitions for a few existing codes.
784.40 (change) voice and resonance disorder, unspecified 784.41 (same) aphonia (loss of voice)
784.42 (new) dysphonia (hoarseness) 784.43 (new) hypernasality
784.44 (new) hyponasality
784.49 (change) other voice and resonance disorders (change in voice) Also category (784.5) other speech disturbance
784.51 (new) dysarthria
784.59 (new) other speech disturbance (dysphasia, slurred speech) Coding Tip #36
In the 2010 ICD-9 book there are some new codes for category (969) Poisoning by psychotropic agents. They are as follows:
969.00 antidepressant, unspecified
969.01 monoamine oxidase inhibitors (MAOI)
969.02 selective serotonin and norepinephrine reuptake inhibitors (SSNRI) 969.03 selective serotonin reuptake inhibitors (SSRI)
969.04 tetracyclic antidepressants 969.05 tricyclic antidepressants 969.09 other antidepressants
Also category (969.7*) poisoning by psychostimulants 969.70 psychostimulant unspecified
969.71 caffeine
969.72 amphetamines (methamphetamines) 969.73 methylphenidate
Coding Tip #37
When using a V-code it is vitally important to refer to the tabular list in the ICD-9-CM book to check if the diagnosis is a primary (highlighted in green) or a secondary
(highlighted in purple) code. If the diagnosis is primary, it must appear in the diagnosis list in the first position only and consequently if it is a secondary diagnosis it cannot be listed in the first position. Some examples of primary and secondary only codes are as follows: Primary DX only V20.0-V20.32 V22.0 and V22.1 V24.0-V24.2 V26.81 V30.**-V39.** V56.0 V57.0-V57.9 V58.11 and V58.12 V59.0-V59.9 V70.0-V70.9 V71.0*-V71.9 Secondary DX only V14.0-V14.9 V15.01-V15.89 V21.0-V21.9 V22.2 V26.51 and V26.52 V27.0-V27.9 V42.0-V42.9 V43.0 and V43.1 V43.21 V43.3-V43.5 V43.6-V43.69 V43.7 V43.8-V43.89 V44.0-V44.9 V45.00-V45.69 V45.61 and V45.69 V45.81-V45.89 V58.61-V58.69 V62.21-V62.29 V62.3-V62.9 V64.00-V64.43 V85.0 and V85.1 V85.21-V85.54
Coding Tip #38
In the 2011 ICD 9 book there are some new codes for Aortic ectasia (447.7*), they are as follows:
447.70 aortic ectasia, unspecified site 447.71 thoracic aortic ectasia
447.72 abdominal aortic ectasia
447.73 thoracoabdominal aortic ectasia Coding Tip #39
In the 2011 ICD 9 book there are some new codes for Incontinence of feces (787.6*), they are as follows:
787.60 full incontinence of feces 787.61incomplete defecation 787.62 fecal smearing
787.63 fecal urgency Coding Tip #40
In the 2011 ICD 9 book there are some new codes for Signs and symptoms involving cognition (799.5*), they are as follows:
799.51 Attention or concentration deficit 799.52 cognitive communication deficit 799.53 visuospatial deficit
799.54 psychomotor deficit
