聖功醫院 8-17演講資料劉明國

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ICD-9-CM 之年版更新概況與工具書使用介紹 Ming - Gwo Liu 劉明國 http://k76011@kmhk.kmu.edu.

1 ICD-9-CM 之年版更新概況與工具書使用介紹 Ming - Gwo Liu 劉明國 Department of Medical Records Kaohsiung Municipal Hsaio-Kang Hospital 1

2 大綱 ICD-9-CM CM 簡介國內使用 ICD-9-CM CM 沿革 ICD-9-CM CM 改版原因疾病與傷害分類代碼表列說明疾病字母代碼索引手術與處置表列說明與字母索引 ICD-9-CM CM Coding Guidelines 2

3 3

4 ICD-9-CM 簡介 1948 年 ICD-6 由 WHO 全權負責修訂, 並增加 Morbidity 及 Mortality 彙編, (The International Statistical Classification of Disease Injuries and Causes of Death) 1975 年 WHO 完成國際疾病分類第九版修訂版 ICD 年美國醫院協會 (AHA) 完成編訂 ICD-9 的臨床修訂版 ICD-9-CM ( Clinical Modification) 4

5 ICD-9-CM 簡介 1980 年 ICD-9-CM 代碼的修訂, 委由 The American Hospital Association ( AHA ) The American Health information Management Association ( AHIMA ) The Centers for Medicare and Medicaid Services ( CMS ) The National Center for Health Statistics( NCHS ) 負責每年代碼修訂工作 5

6 國內使用 ICD-9-CM 沿革 1991 年勞保局要求醫院住院費用申報疾病代碼使用 ICD-9-CM 編碼 1995 年健保局要求醫院住院案件申報診斷與處置代碼使用 ICD-9-CM ( 年版 ) 1999 年健保局要求醫學中心與區域醫院申報門, 住診案件診斷與處置代碼使用 ICD-9-CM ( 年版 ) 6

7 國內使用 ICD-9-CM 沿革 1999 年 7 月年 1 月 2006 年 1 月健保局要求地區醫院申報門, 住診案件診斷與處置代碼使用 ICD-9-CM ( 年版 ) 健保局要求基層診所申報健保費用案件診斷與處置代碼使用 ICD-9-CM ( 年版 ) 健保局要求各層級申報門住診案件診斷與處置代碼使用 ICD-9-CM ( 年版 ) 7

8 國內 ICD-9-CM 改版原因國內目前並無專責單位負責 ICD-9-CM 之修訂因醫療科技日新月異, 年版 ICD-9-CM 無法因應醫界實務需求修訂現行使用年版本為年版本更新目的, 是為解決醫療費用申報版本不一問題, 並建立代碼共同標準 8

9 ICD-9-CM 工具書架構國際疾病分類 - 第九版 - 臨床修訂版 International Classification of Disease-9 Revision -Clinical Modification 第一冊疾病代碼說明第二冊字母索引表第三冊手術處置分類碼和索引 9

10 第一冊疾病代碼說明 Volume 1 Tabular list of disease 1. 疾病與傷害碼詳細說明 (001~999) 2. 影響健康狀態和醫療服務利用情況補充分類代碼詳細說明 (V01 ~ V82) 3. 損傷及中毒外因碼詳細說明 (E800 ~ E999) 4. 腫瘤組織形態碼詳細說明 (M8000/0 ~ M9970/1) 10

11 第二冊字母索引表 Volume II Alphabetic Index of disease 第一部份 : 疾病傷害字母索引表疾病代碼 V-Code M-Code 第二部份 : 藥物化學物質一覽表疾病代碼 E-Code 第三部份 : 損傷和意外字母索引表 E-Code 11

12 第三冊手術處置分類碼和索引 Volume III Tabular list of procedures & Alphabetic index of procedures 第一部份 : 手術和處置分類詳細說明表第二部份 : 手術和處置字母索引表 12

13 第一冊疾病代碼說明 Infectious and Parasitic Diseases Neoplasm Endocrine, Nutritional, and Metabolic Diseases Diseases of the Blood-Forming Organs Mental Disorders Diseases of the Nervous System and Sense Organs 001~ ~ ~ ~ ~ ~389 13

14 第一冊疾病代碼說明 Diseases of the Circulatory System Diseases of the Respiratory System Diseases of the Digestive System Diseases of the Genitourinary System Complications, of Pregnancy, Childbirth, Puerperium Diseases of the Skin and Subcutaneous Tissue 390~ ~ ~ ~ ~ ~709 14

15 第一冊疾病代碼說明 Diseases of the Musculoskeletal System and Connective Tissue Congenital Anomalies Certain Conditions Originating in theperi-natal Period Symptoms, Signs, and Ill-Defined conditions Injury and Poisoning 710~ ~ ~ ~ ~999 15

16 第三冊手術處置代碼說明前 15 章依解剖部位分類第 16 章為診斷性及治療性處置第 1 章第 2 章第 3 章第 4 章第 5 章第 6 章神經系統處置內分泌系統處置眼處置耳處置鼻, 嘴及咽處置呼吸系統處置 01~05 06~07 08~16 18~20 21~29 30~34 16

17 第三冊手術處置代碼說明前 15 章依解剖部位分類第 16 章為診斷性及治療性處置第 7 章第 8 章第 9 章第 10 章第 11 章第 12 章循環系統處置血液及淋巴系統處置消化系統處置泌尿系統處置男性生殖系統處置女性生殖系統處置 35~39 40~41 42~54 55~59 60~64 65~71 17

18 第三冊手術處置代碼說明前 15 章依解剖部位分類第 16 章為診斷性及治療性處置第 13 章第 14 章第 15 章第 16 章產科處置骨骼肌肉系統處置皮膚系統處置其他診斷性及治療性處置 72~75 76~84 85~86 87~99 18

19 ICD-9-CM CM ( 年版 ) 新代碼說明 19

20 008.6 Enteritis due to specified virus Rotavirus Adenovirus Norwalk virus Other small round viruses(srv s) Calcivirus Astrovirus Enterovirus Other 20

21 042.0~ ~ ~044.9 Human immunodeficiency virus (HIV) 042 Human immunodeficiency virus (HIV) disease 重大傷病 21

22 Case study Pneumonia due to HIV disease

23 044.9 Human immunodeficiency virus infection, unspecified Positive (HIV) V08 Asymptomatic human immunodeficiency virus (HIV) infection status 23

24 795.8 Positive (HIV) Nonspecific serologic evidence of HIV Note:This code(795.71) is ONLY to be used when a test finding is reported as Nonspecific. Asymptomatic positive findings are coded to V08. If any HIV infection symptom or condition is present, see code 042. Negative findings are not coded. 24

25 070.2~070.3 Virus hepatitis B with or without hepatic coma 新增第五位碼 0 1 Acute or unspecified without or with of hepatitis delta 2 3 Chronic without or with of hepatitis delta 25

26 V02.6 Viral hepatitis carrier V02.60 Unspecified V02.61 Hepatitis B V02.62 Hepatitis C V02.69 Other viral hepatitis carrier 26

27 078.1 Viral warts Viral warts, unspecified Condyloma acuminatum Other specified viral warts 27

28 Other specified disease due to viruses and Chlamydiae 099.5x Other venereal diseases due to Chlamydia trachomatis ~

29 Candidiasis of other specified sites Candidal esophagitis Candidal enteritis 29

30 250.00~ Diabetes mellitus with or without complication, type II ~ Diabetes mellitus with or without complication, type I 第五位碼 0 2 Type II,(NIDDM).not stated as uncontrolled or uncontrolled 1 3 Type I,(IDDM).not stated as uncontrolled or uncontrolled 30

31 重大傷病

32 Case study Diabetes mellitus with nephrosis syndrome, adult-onset type

33 275.4 Disorders of calcium metabolism Unspecified disorder of calcium metabolism Hypocalcemia Hypercalcemia Other disorders of calcium metabolism 重大傷病 33

34 283.1 Non-autoimmune hemolytic anemia Non-autoimmune hemolytic anemia,unspecified Hemolytic-uremic syndrome Other non-autoimmune hemolytic anemia 34

35 285.9 Anemia,unspecified Chronic renal failure Anemia in end-stage renal disease 35

36 285.9 Anemia,unspecified + Malignant neoplasm Anemia,unspecified Anemia in neoplastic disease Anemia of other chronic illness 36

37 291.8 Other specified alcoholic psychosis Alcohol withdrawal Other specified alcoholic psychosis 37

305.1x Tobacco use disorder 305.10 Tobacco use disorder,unspecified 305.

38 305.1x Tobacco use disorder Tobacco use disorder,unspecified Tobacco use disorder,continuous Tobacco use disorder,episodic Tobacco use disorder,in remission Tobacco use disorder 38

39 342.9 Hemiplegia, unspecified 新增第五位碼 0 Affecting unspecified site 1 Affecting dominant site 2 Affecting nondominant site 39

40 344.0 Quadriplegia ~ 第五碼明示 C-Spine, 病灶的部分及嚴重度 0 Unspecified 1 C1-C4,complete 2 C1-C4,incomplete 3 C5-C7,complete 4 C5-C7,incomplete 40

41 414.0 Coronary atherosclerosis Of unspecified type of vessel, native or graft Of native coronary artery Of autologous biological bypass graft Of nonautologous biological bypass graft Of artery bypass graft Of unspecified type of bypass graft 41

42 Mechanical complication of cardiac device, implant,and graft,due to coronary bypass graft Of autologous biological bypass graft Of nonautologous biological bypass graft 42

43 Coronary atherosclerosis 414.0x Unspecified type of vessel, native or graft Native coronary artery Autologous vein bypass graft Nonautologous biological bypass graft Artery bypass graft Unspecified type of bypass graft 43

44 Vertebral Basilar artery insufficiency Multiple and bilateral occlusion 44

45 中風殘留症狀代碼 x 438.2x 438.3x 438.4x 438.5x 438.8x

46 Late effect of cerebrovasculardisease ( Old CVA) cognitive deficits 438.1x Speech and language deficit 438.2x Hemiplegia/ hemiparesis 438.3x Monoplegia of upper limb 438.4x Monoplegia of lower limb 438.5x Other paralytic syndrome 438.8x Other late effect of CVD Unspecified late effect of CVD 46

47 Case study Old CVA withhemiplegia Hemiplegia, affecting unspecified side 47

48 Case study Old CVA with residualquariplegia Other paralytic syndrome, bilateral 48

49 441.0 Dissecting aneurysm of aorta (any part) unspecified site thoracic abdominal thoracoabdominal 49

50 Iatrogenic hypotension Iatrogenic hypotension 50

51 466.1 Acute bronchiolitis due to respiratory syncytial virus (RSV) due to other infectious organisms 51

52 446.2 hypersencsitivity vasculitis Hypersensitivity angiitis, unspecified Goodpasture s syndrome Other specified hypersensitivity angiitis 重大傷病 52

53 482.8 Pneumonia due to other specified bacteria Anaerobes Escherichia coli Other Gramnegative bacteria Legionnaires' disease Other specified bacteria 53

54 483 Pneumonia due to other specified organism Mycoplasma pneumoniae Chlamydia Other specified organism 54

55 493 Asthma 494 Bronchiectasis 新增加 acute exacerbation 的描述 COPD with acute exacerbation Acute asthmatic bronchitis Chronic asthmatic bronchitis or asthmatic bronchitis with COPD Asthma with COPD Chronic asthmatic bronchitis with acute exacerbation Childhood asthma 493.x2 with acute exacerbation with acute exacerbation x 491.2x

56 997.3 or Due to operation, post operation Pneumothorax Iatrogenic pneumothorax 56

57 Case study Pneumothorax post a percutaneous needle biopsy Iatrogenicpneumothorax 57

58 58

59 Acute Respiratory failure Chronic respiratory failure Acute and chronic respiratory failure 59

60 519.0 Tracheostomy complication Unspecified Infection Mechanical complication Other complications 60

61 530.1 Esophagitis Unspecified Reflux esophagitis Other esophagitis 61

62 Case study Ulcerativeesophagitis Other esophagitis Esophagitis (acute)(alkaline)(chemical) (chronic)(infectional)(necrotic)(peptic) (postoperative)(regurgitant) specified NEC

63 Case study Gastroesophagealreflux disease (GERD) Reflux esophageal esophagitis gastroesophageal

64 536.8 Dyspepsia and other specified disorders of function of stomach Gastroparesis 64

65 997.4 Gastrointestinal complications Gastrostomy complication, unspecified Infection of gastrostomy Mechanical complication of gastrostomy Othergastrostomy complications 65

66 556 Idiopathic proctocolitis 重大傷病 Ulcerative (chronic)enterocolitis Ulcerative (chronic) ileocolitis Ulcerative (chronic) proctitis Ulcerative (chronic) proctosigmoiditis Pseudopolyposis of colon Left-sided ulceraive (chronic) colitis Universal ulcerative (chronic)colitis Other ulcerative colitis Ulcerative colitis, unspecified 66

67 569.6 Colostomy and enterostomy malfunction Colostomy and enterostomy complication, unspecified Infection of colostomy or enterostomy Mechanical complication of colostomy and enterostomy Other complication 67

68 574.0x Calculus of gallbladder with acute cholecystitis 574.3x + Calculus of bile duct with acutecholecystitis 574.6x Calculus of gallbladder and bile duct with acute cholecystitis 68

69 574.0x x x x 574.8x Calculus of gallbladder and bile duct with acute and chroniccholecystitis 69

70 575.0 Acutecholecystitis Othercholecystitis Acute and chronic cholecystitis 70

71 Neurogenic bladder Neurogenicbladder NOS 71

72 599.8 Other specified disorders of urethra and urinary tract Urethral hypermobility Intrinsic (urethral) sphincter deficiency (ISD) Urethral instability Other specified disorders of urethra Other specified disorders of urinary tract 72

73 600 Hyperplasia of prostate Hypertrophy (benign) of prostate Nodular prostate Benign localized hyperplasia of prostate Cyst of prostate Hyperplasia of prostate 73

74 Prolonged pregnancy 645.1x Post term pregnancy (Pregnancy over 40~42 weeks gestation) 645.2x Prolonged pregnancy (Pregnancy which has advanced beyond 42 weeks of gestation ) 74

75 無 677 Late effect of complication of pregnancy, childbirth, and the puerperium 75

76 Contact dermatitis and other eczema, due to other solar radiation Acute dermatitis due to solar radiation Actinicreticuloid and actinic granuloma Other chronic dermatitis due to solar radiation Disseminated superficial actinic porokeratosis (DSAP) 76

77 707.1 Ulcer of lower limbs, except decubitus Unspecified Thigh Calf Ankle Heel and midfoot Other part foot Other part of lower limb 77

78 288.3 Eosinophilia Myalgia and myositis, unspecified Eosinophilia myalgia syndrome 78

79 729.4 Fasciitis, unspecified Necrotizing fasciitis 79

80 752.5 Undescended testicle Undescended testis Retractile testis 80

81 752.6 Hypospadias and epispadias Hypospadias Epispadias Congenital chordee 81

82 780.0 Coma and stupor Coma Transient alteration of awareness Persistent vegetative state Other alteration of consciousness 82

83 558.9 Diarrhea Diarrhea, NOS 83

84 789.0 Abdominal pain Unspecified site Right upper quadrant Left upper quadrant Right lower quadrant Left lower quadrant Periumbilic Epigastric Generalized Other specified site 84

85 790.9 Other nonspecific findings on examination of blood Abnormal arterial blood gases Elevated prostate specific antigen(psa) Euthyroid sick syndrome Other nonspecific 85

86 Intracranial injury of other and unspecified Head injury, unspecified 86

87 V67.51 Following treatment with high-risk medication V58.61 Long-term (current) use of anticoagulants V58.62 Long-term (current) use of antibiotics V58.69 Long-term (current) use of other medications 87

88 V59.0 Donor, blood V59.01 Donors, blood, whole blood V59.02 Donors, blood, stem cells V59.09 Donors, blood, other 88

89 無 41.0x Bone marrow or hematopoietic stem cell transplant Autologous hematopoietic stem cell transplant without purging Allogeneic hematopoietic stem cell transplant without purging Cord blood stem cell kktransplant Autologous hematopoietic stem cell transplant with purging Allogeneic hematopoietic stem cell transplant with purging Autologous bone marrow transplant with purging 89

90 E884.2 Fall from chair or bed E884.2 Fall from chair E884.3 Fall from wheelchair E884.4 Fall from bed 90

91 E884.9 Other fall from one level to another E880.1 Fall on or from sidewalk curb E884.5 Fall from other furniture E884.6 Fall from commode 91

92 E885 Fall on same level from slipping, tripping, or stumbling E885.1 Fall from roller skates E885.2 Fall from skateboard E885.3 Fall from skis E885.4 Fall from snowboard E885.9 Fall from other. 92

93 無 Insertion of coronary artery stent(s) 93

94 39.59 Other repair of vessel Angioplasty or atherectomy of noncoronary vessel Insertion of non-coronary stentor stents 94

95 47.0 Appendectomy 47.1 Incidental appendectomy 47.0x or 47.1x 以第四位代碼表示手術方式 1 Laparoscopy 9 Other approach 95

96 60.2 Transurethral prostatectomy Transurethral guided laser induced prostatectomy Other transurethral prostatectomy 96

97 ICD-9-CM Coding 97

98 Coding Guidelines Code the primary diagnosis first, followed by the secondary, tertiary and so on. Code any coexisting conditions that affect the treatment of the patient for that visit or procedure as supplementary information. Do not code a diagnosis that is no longer applicable. 98

99 Coding Guidelines Code to the highest degree of specificity. Carry the numerical code to the 4th or 5th digit when necessary. Remember, there are only approximately 100 valid three digit codes; all other ICD-9 codes require additional digits 99

100 Coding Guidelines Identify each service, procedure, or supply with an ICD-9 code from through V82.9 to describe the diagnosis, symptom, complaint, condition, or problem Identify services or visits for circumstances other than disease or injury, such as follow-up care after chemotherapy, with V codes provided for this purpose. 100

101 Coding Guidelines Code a chronic diagnosis as often as it is applicable to the patient s treatment at this encounter. When only ancillary services are provided, list the appropriate V code first and the problem second. For surgical procedures, code the diagnosis applicable to the procedure. 101

102 Anatomy of ICD-9 Code First 3 digits describe the disease type or organ system (e.g.diseases of other endocrine glands ).In this case, 250 refers to Diabetes mellitus First digits after the decimal point specifies a subclassificationof the Main diagnosis, In this case, 0 without mention of complication. 1 with ketoacidosis. 2 with hyperosmolarity. Second digits after the decimal point specifies the diagnosis even further. In this case. a 0 NIDDM type. a 1 IDDM type. a 2 NIDDM type uncontrolled. a 3 IDDM type uncontrolled

103 Volume 1 Structure 103

104 Anatomy of ICD-9 Code Assign three-digit codes only if there are no four-digit codes within that code category. Assign four-digit codes only if there is no fifth-digit sub-classification for that category. Assign fifth-digit sub-classification code for those categories where it exists. 104

105 Combination Code A single code used to classify two diagnoses or a diagnosis with an associated secondary process (manifestation) or an Associated Complication is called a combination code. 105

106 Combination Code Malignant Benign Unspecified Hypertension with heart involvement with renal involvement due to polycystic kidney due to kidney stone due to ureter stone due to cushing s disease

107 Acute and Chronic conditions If the same condition is described as both acute ( subacute)and chronic, code both and sequence the acute(subacute ) code. 107

108 Late effect 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. Such as in cerebrovascular accident cases. 108

109 Prospective Payment System Important concepts for coders - Diagnosis Related Groups - Principal diagnosis - Comorbidities / Complications - Surgical procedures - Discharge status - Case mix index 109

110 Surgical Procedures --Not all procedures affect DRG assignment --Some procedures affect only specifiec DRGs --Some procedures only affect DRGs with specifiec principal diagnosis 110

111 Thanks for your listening 111

危疾指引這份指引可助您了解自己危疾保單內所承保的疾病及療程每種受保的危疾均會加以及我們更會扼要地列出各種除外責任及所須長短我們凡在這份指引中提及專科醫

危疾指引這份指引可助您了解自己危疾保單內所承保的疾病及療程每種受保的危疾均會加以及我們更會扼要地列出各種除外責任及所須長短我們凡在這份指引中提及專科醫危疾指引永明危疾保險驕陽永明, 人生更燦爛危疾指引這份指引可助您了解自己危疾保單內所承保的疾病及療程每種受保的危疾均會加以及我們更會扼要地列出各種除外責任及所須長短我們凡在這份指引中提及專科醫生, 皆指在所索