CHAPTER 5,CHAPTER-SPECIFIC GUIDELINES (ICD-9-CM CHAPTERS 1-8),ICD-9-CM, Chapter 1,Infectious and Parasitic Diseases Divided based on etiology (cause of disease) Many combination codes Example: 112.0 candidiasis infection of mouth, which reports both organism and condition with one code,Multiple Codes,Sequencing must be considered UTI due to Escherichia coli 599.0 (UTI) etiology 041.4 (E. coli) organism 041 category is a secondary-code only,Section I.C.1.a,d,e Human Immunodeficiency Virus,Code HIV or HIV-related illness ONLY if stated as confirmed in diagnostic statement 042 HIV or HIV-related illness V08 Asymptomatic HIV status 795.71 Nonspecific HIV serology Once an HIV diagnosis cannot code V08,Section I.C.1.a.2.f. Previously diagnosed HIV-related illness,Code prior diagnosis HIV-related disease 042 (HIV) NEVER assign these patients to: V08 (asymptomatic) or 795.71 (Nonspecific serologic evidence of HIV),Section I.C.1.a.2. Selection and sequencing of HIV codes,If admitted for HIV-related illness (e.g., pneumonia) Code 042 (HIV) Followed by current illness (Pneumocystis carinii, 136.3) If admitted for other than HIV-related illness Code first-listed diagnosis Then 042 (HIV) (Contd),Section I.C.1.a.2. Selection and sequencing of HIV codes,(Contd) Sequence Reason most responsible for encounter, if HIV (042) Any additional diagnosis that impacts treatment,Section I.C.1.a.2.g. HIV infection in Pregnancy, Childbirth and the Puerperium,Exception to HIV sequencing During pregnancy, childbirth, or puerperium, code: 647.6X (Other specified infections and parasitic diseases) Followed by 042 (HIV) (stated diagnosis) Then any HIV-related illness(Contd),Section I.C.1.a.2.g. HIV and Pregnancy,(Contd) Asymptomatic HIV during pregnancy, childbirth, or puerperium 647.6X (Other specified infections and parasitic diseases) and V08 (Asymptomatic HIV infection status),Section I.C.1.a.2.e. Patients with inconclusive HIV serology,795.71 (Inconclusive serologic test for HIV),Section I.C.1.a.2.h. Encounters for testing for HIV,Code V73.89 (Screening for other specified viral disease) Patient in high-risk group for HIV V69.5 (Other problems related to lifestyle) Patients returning for HIV screening results = V65.44 (HIV counseling),Caution,Incorrectly applying these HIV coding rules can cause patient hardship Insurance claims for patients with HIV usually need patients written agreement to disclose,Section I.C.1.b. Septicemia, Septic Shock and SIRS,Septicemia: systemic disease of microorganisms or their toxins in the blood (blood poisoning) Septic shock: overwhelming infection due to severe sepsis SIRS: Systemic Inflammatory Response Syndrome is a systemic response to infection/trauma Sepsis refers to SIRS due to infection Severe sepsis is sepsis with acute organ dysfunction (Contd),Section I.C.1.b. Septicemia, Septic Shock and SIRS,(Contd) Code septicemia (038.XX) SIRS second (995.9X) If documented, septic shock (785.52) should be reported Sepsis and septic shock associated with OB codes, also use code 630-633, Ectopic and Molar Pregnancy Septic shock is never primary or first-listed diagnosis,Sepsis and Severe Sepsis not associated with noninfectious process,Infection resulting from Trauma, Other Serious Injury, Pancreatitis Code Trauma/Injury SIRS second (995.9X) Any acute organ dysfunctions,ICD-9-CM, Chapter 2 Neoplasm, Two steps for coding neoplasms: Index: Locate histologic type of neoplasm (e.g., sarcoma, melanoma) Review all instructions Locate code identified (usually in Neoplasm Table in Index) by body site Neoplasms Table divided into columns: Malignant (primary, secondary, ca in situ) Benign Uncertain behavior Unspecified,ICD-9-CM, Chapter 2 Neoplasm,Morphology Codes-Appendix A ICD-9-CM Codes are alpha numeric: M + 4 numeric characters, a slash, followed by 5th digit (indicates behavior) Assigned by tumor registry coder /0= Benign /1= Uncertain benign/malignant/borderline /2=Carcinoma in situ /3= Malignant, primary site /6= Malignant, secondary/metastatic site /9= Malignant, uncertain if primary/secondary site Not assigned in outpatient setting,Section I.C.2. Neoplasms,Treatment directed at malignancy: Neoplasm is first-listed diagnosis Except for chemotherapy or radiotherapy:Therapy (treatment)Neoplasm Chemotherapy: V58.11encounter for reason the patient presents for treatment, #1 diagnosis Radiotherapy: V58.0encounter for reason the patient presents for treatment, #1 diagnosis (Contd),Section I.C.2. Neoplasms,(Contd) Surgical removal of neoplasm and subsequent chemotherapy or radiotherapy Code malignancy as first-listed diagnosis Surgery to determine extent of malignancy Code malignancy as first-listed diagnosis Code neoplasm as long as patient is receiving treatment or medication following excision (Contd),Section I.C.2. Neoplasms,V10, “Personal history of malignant neoplasm” if Neoplasm was previously destroyed No longer being treated(Contd),Section I.C.2. Neoplasms,(Contd) If patient receives treatment for secondary neoplasm (metastasis): Secondary neoplasm is first-listed diagnosis Even though primary is known Code primary neoplasm as secondary diagnosis or if no longer treated code personal history of. (Contd),