As part of the work-up that day, you perform an ECG in your office. On your claim form, however, you list only the ICD-9 code for diabetes. In all likelihood, the insurer won't pay for the ECG because it's not clear from the claim form why the test was medically necessary.
The ICD-9 code for chest pain or angina pectoris should also have been listed to indicate the medical necessity for the ECG. Code to the highest degree of specificity. Carry the code to the fourth or fifth digit when possible. Link the diagnosis code ICD-9 to the service code CPT on the insurance claim form to identify why the service was rendered, thereby establishing medical necessity.
Assign the applicable code for the sign or symptom that is the reason for the patient visit. Code the primary diagnosis first, followed by the secondary, tertiary, etc. The primary diagnosis is the main reason for the patient visit. Code coexisting conditions that affect the patient's treatment in that visit.
Code chronic conditions when they apply to the patient's treatment. Don't code diagnoses that are no longer being treated or that don't affect your care of the patient. Volume I is a numeric listing of the roughly 12, diagnostic codes and descriptions give or take a few!
Volume II is an alphabetic index of terms and the codes that correspond to them; its more than , entries direct you to the codes you need by linking them to a variety of terms. Volume III contains a tabular list and alphabetic index of procedural codes and descriptions and is intended for use only by hospitals.
Always look in the index first and then turn to the numeric listing for a complete description of the condition. Never code solely from the index. ICD-9 codes may have three to five digits depending on their category although only a few diagnoses have valid three-digit codes.
Each digit provides important information about the patient's condition. For example, consider the following codes in the diabetes mellitus category:.
The three-digit code in this case, represents the diagnostic category. The fourth digit identifies complications associated with diabetes e. The fifth digit describes the type of diabetes and its level of control.
To correctly code an encounter with a patient who has uncontrolled type 1 diabetes complicated by ketoacidosis, you should use all five digits. Here's another example: You see a patient for follow-up of benign essential hypertension. The proper code would be If, however, the patient also had benign hypertensive heart disease, then you would include a fifth digit: The proper code would be The point is that you must always code to the highest number of digits that best describe your patient's condition.
To be certain you're using the correct number of digits, review the codes in a given category and choose the highest-level code that most specifically describes your patient's condition.
Many payers, including Medicare, will deny or delay payments if you fail to do so. The list includes many of the ICD-9 codes family physicians use most often, organized alphabetically within categories of diseases and body systems. A version of the list printed on cardstock, designed to be carried with you as you see patients or to be placed in each exam room, is available from the AAFP Order Department at Ask for item number A for two copies or A for 10 copies.
Daugird, D. October — Choosing the most specific code means coding only what you know to be a fact. Patients often have ill-defined complaints, such as back pain. While you may suspect a specific condition —perhaps a herniated disc or a urinary tract infection — and then order lab tests to confirm the diagnosis, you should code only the sign or symptom that brought the patient in to see you until you receive the test results or otherwise make a definitive diagnosis.
If you don't, you may inadvertently label the patient with an incorrect diagnosis and, as a result, the patient may have difficulty obtaining health and disability insurance or may end up paying higher insurance premiums in the future. Use ICD-9 codes to to describe symptoms, signs and ill-defined conditions that aren't linked to a specific disease.
But be aware that some body-system categories of codes include codes for nonspecific conditions. When you need to list more than one diagnosis for your patient, prioritize them: Code the primary diagnosis first followed by the next most important and so on. The primary diagnosis should be the one that receives the most attention during the patient visit. For example, if a patient you're treating for hypertension presents with an upper respiratory infection, the infection would be considered the primary reason for the visit and should be listed first, followed by hypertension.
For example, you're treating a patient with poorly controlled diabetes, hypertension and coronary artery disease. Once the medical practitioner finds out the disease, it assigns a diagnosis code that can be found in the ICD codebook. It is a set of manual codes used by medical coders and billers to denote the various medical procedures. Codes in this book describe the service given by doctors during consultation. Category I is further divided into six sub-categories. It has a code made up of 5 digit numeric codes.
These categories include code for anesthesia, surgery, radiology , pathology and laboratory, medicine, and evaluation and management.
Category II codes are made by combining 4 numeric digits and one alphabet in the end. It consists of 11 codes. This category of codes is used for clinical components used for medical services and evaluation and management of medical procedures. These codes are copyrighted material of the American Medical Association, but still, it is mandatory for almost all health insurance payment and information systems.
The users of this code have to pay the license fee to access these codes. Volume three is usually sold separately. Your office will only need to replace the ICD-9 codebook every 10 to 15 years since these codes change infrequently.
Conversely, the CPT book is a listing of descriptive terms and identifying codes for reporting medical services and procedures performed by doctors. The purpose of the terminology is to provide a uniform language that will accurately describe treatment and diagnostic services, thus providing a uniform method of communicating between doctors, insurance companies and patients. The CPT codebook should be updated every years. In a concise statement, ICD-9 is the code used to describe the condition or disease being treated, also known as the diagnosis.
CPT is the code used to describe the treatment and diagnostic services provided for that diagnosis.
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