Chapter-Specific Guidelines

Front 1

Etiology/manifestation convention(“code first”, “use additional code” and “in diseases classified elsewhere” notes)

Back 1

ICD-9-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a “use additional code” note at the etiology code, and a “code first” note at the manifestation code.

“In diseases classified elsewhere” codes are never permitted to be used as first listed or principal diagnosis codes.

Front 2

With

Back 2

The word “with” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List.

Front 3

“See” and “See Also”

Back 3

The “see” instruction following a main term in the index indicates that another term should be referenced. It is necessary to go to the main term referenced with the “see” note to locate the correct code.

Front 4

Late Effects

Back 4

A late effect is the residual effect (condition produced) after the acute phase of an illness or injury has terminated. There is no time limit on when a late effect code can be used. The residual may be apparent early, such as in cerebrovascular accident cases, or it may occur months or years later, such as that due to a previous injury. Coding of late effects generally requires two codes sequenced in the following order: The condition or nature of the late effect is sequenced first. The late effect code is sequenced second.

An exception to the above guidelines are those instances where the code for late effect is followed by a manifestation code identified in the Tabular List and title

Front 5

Impending or Threatened Condition

Back 5

If it did occur, code as confirmed diagnosis.
If it did not occur, reference the Alphabetic Index to determine if the condition has a subentry term for “impending” or “threatened” and also reference main term entries for “Impending” and for “Threatened.”
If the subterms are listed, assign the given code.
If the subterms are not listed, code the existing underlying condition(s) and not the condition described as impending or threatened

Front 6

Long-term insulin use

Back 6

For patients who routinely use insulin, code V58.67, Long-term (current) use of insulin,

Front 7

Assigning and sequencing secondary diabetes codes and associated conditions

Back 7

When assigning codes for secondary diabetes and its associated conditions (e.g. renal manifestations), the code(s) from category 249 must be sequenced before the codes for the associated conditions.

Front 8

Secondary diabetes mellitus due to pancreatectomy

Back 8

assign code 251.3, Postsurgical hypoinsulinemia. Assign a code from subcategory 249, Secondary diabetes mellitus and a code from subcategory V88.1, Acquired absence of pancreas as additional codes. Code also any diabetic manifestations

Front 9

Anemia of chronic disease

Back 9

When using a code from subcategory 285 it is also necessary to use the code for the chronic condition causing the anemia.

Front 10

Anemia in chronic kidney disease

Back 10

When assigning code 285.21, Anemia in chronic kidney disease, it is also necessary to assign a code from category 585, Chronic kidney disease, to indicate the stage of chronic kidney disease.

Front 11

Anemia in neoplastic disease

Back 11

When assigning code 285.22, Anemia in neoplastic disease, it is also necessary to assign the neoplasm code that is responsible for the anemia. Code 285.22 is for use for anemia that is due to the malignancy, not for anemia due to antineoplastic chemotherapy drugs.

Front 12

Hypertensive Cerebrovascular Disease

Back 12

First assign codes from 430-438, Cerebrovascular disease, then the appropriate hypertension code from categories 401-405.

Front 13

Hypertensive Retinopathy

Back 13

Two codes are necessary to identify the condition. First assign the code from subcategory 362.11, Hypertensive retinopathy, then the appropriate code from categories 401-405 to indicate the type of hypertension.

Front 14

Hypertension, Transient
Elevated blood pressure

Back 14

Assign code 796.2, Elevated blood pressure reading without diagnosis of hypertension, unless patient has an established diagnosis of hypertension. Assign code 642.3x for transient hypertension of pregnancy.

Front 15

Cerebral infarction/stroke/cerebrovascular accident (CVA)

Back 15

The terms stroke and CVA are often used interchangeably to refer to a cerebral infarction. The terms stroke, CVA, and cerebral infarction NOS are all indexed to the default code 434.91, Cerebral artery occlusion, unspecified, with infarction