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Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

ICD-9 Notes

These were notes I took while going through the Official ICD-9-CM Offical Guidelines for Coding and Reporting.  [If this is inaccessible, try the guidelines from the National Center for Health Statistics (NCHS) Web site.  To find this exact sub-file, go to the 2004 directory, and download the file you want - DTAB is the Tabular List of Diseases, i.e. Diagnosies, and PTAB is the Tabular List of Procedures.]

V30 codes are used only at the place where born or initial "admission" - NOT for followup!
V29 can be used following V30 codes
V29 is ONLY for healthy newborns and infants w/no other diagnoses
V codes are not used if there are any other problems present!
E codes for external causes when the baby has a problem???

NEC - "NOt elsewhere classifiable" - This abbreviation in the tabular represents "other specified"  When a specific code is not available for a
condition the tabular includes an NEC entry under a code to identify the code as the "other specified".
NOS "Not otherwise specified" This abbreviation is the equivalent of unspecified. see "Unspecified" codes)

"Other specified" codes - the terms are a list of the various conditions assigned to that code.  The inclusion terms are not necessarily exhaustive.
Additional terms found only  in the index may also be assigned to a code.

"Other" codes - Codes titled "other" or "other specified" are for use when the information in the medical record provides detail for which a specific
code does not exist.

"Unspecified" codes are for use when the information in the medical record is insufficient to assign a more specific code. [NEVER the case for me!]

Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable when a related definitive diagnosis has not been established
(confirmed) by the physician.  Chapter 16 contains many codes for symptoms.

Signs and symptoms that are integral to the disease process should not be assigned as additional codes.

Additional signs and symptoms that may not be associated routinely with a disease process should be coded when present.

C11 - A5 - The fifth-digits for a single item should all be the same for a single item?
 A8 - V codes should not be used in conjunction with chapter 11 codes.
B1 - When no delivery occurs, the principal diagnosis should correspond to the principal complication of the pregnancy, which necessitated the
encounter.  Should more than one complication exist, all of which are treated or monitored, any of the complications codes may be sequenced first.
B2 - When a delivery occurs, the principal diagnosis should correspond to the main circumstances or complication of the delivery.
B5 - "Fetal Conditions Affecting the Management of the Mother" Codes 655 and 656 are assigned only when the fetal condition is actually
responsible for modifying the management of the mother, i.e. by requiring diagnostic studies, additional observation, special care.  The fact that a
fetal condition exists does not justify assigning a code from this series to the mother's record.
E1 - Code 650 is for use in cases when a woman is ADMITTED for a full-term normal delivery and delivers a single, healthy infant without any
complications antepartum, during the delivery, or postpartum during the delivery episode.
E2 - Code 650 may be used if the patient had a complication at some point during her pregnancy but the complication is not present at the time of
the admission for delivery.
E3 - Code 650 is always a principal diagnosis.  Not to be used with any other code from chapter 11 is needed.  Additional codes from other
chapters may be used w/650 if that are not related to or are in any way complicating the pregnancy.
F4 - Postpartum complications that occur during the same admission as the delivery are identified with a fifth digit of "2". Subsequent
admissions/encounters for postpartum complications should be identified with a fifth digit of "4".

C15 - Newborn (Perinatal) Guidelines
Birth through the 28th day following birth.
A - General Perinatal Rule - All clinically significant conditions noted on routine newborn examination should be coded.  A condition is clinically
significant if it requires:
clinical evaluation; or
therapeutic treatment; or
diagnostic procedures; or
extended length of hospital stay; or
increased nursing care and/or monitoring; or
has implications for future health care needs.

B - Codes V30-39 is assigned as a principal diagnosis, and assigned only once to a newborn at the time of birth.

E - "Maternal Causes of Perinatal Morbidity" Codes from 760-763 are assigned only when the maternal condition has actually affected the fetus or
newborn.

G - "Coding of Additional Perinatal Diagnoses"
G1 - Assign codes for conditions that require treatment or further investigation, prolong the length of stay, or require resource utilization.
G2 - Assign codes for conditions that have been specified by the physician as having implications for future health care needs.
G3 - Assign a code for Newborn conditions originating in the perinatal period (760-779), as well as complications arising during the current episode
of care classified in other chapters, only if the diagnoses have been documented by the responsible physician at the time of transfer or discharge as
having affected the fetus or newborn.
[For homebirth, these codes would only be used at followup appointments?  Not sure.]

RE: "V codes"
2 - When a person with a resolving disease or injury, or a chronic, long-term condition requiring continuous care, encounters the health care system
for specific aftercare of that disease or injury.  A diagnosis/symptom code should be used whenever a current, acute diagnosis is being treated or a
sign or symptom is being studied.

Re: Newborn screen and other screening codes:
A screening code may be a first listed code if the reason for the visit is specifically the screening exam.  It may also be used as an additional code if
the screening is done during an office visit for other health problems.

V28 Antenatal screening

V24 is a followup code, meaning the birth didn't happen in this episode of care?!?

V25.09 Other general counseling and advice for contraceptive management
for six-week visit and 10-day visit???

V20.2 Routine infant or child health check - Developmental testing of infant or child

Outpatient Coding

In the outpatient setting, the term first-listed diagnosis is used in lieu of principal diagnosis.  [Now they tell me!]

Specific coding conventions of specific codes take precedence over the outpatient guidelines.  [Phew!]

List first the diagnosis, condition, problem or other reason for encounter that is chiefly responsible for the services provided.  List additional codes
that describe any coexisting conditions.

Do not code diagnoses as "probable", "rule out", etc.
Rather code to the highest degree of certainty, such as symptoms, signs, abnormal test results, or other reason for the visit.

Code all documented conditions that coexist at the tie of encounter/visit and require or affect patient care treatment or management.  Do not code
conditions that were previously treated and no longer exist.

V22.0 and V22.1 should not be used in conjunction with Chapter 11 codes!!