Home Health ICD-9/ICD-10 Alert

Published on Sun Jan 01, 2006 PDF

Risk coding errors if you ignore subterms.

Searching the index like you do a dictionary could make your coding take twice as long.

If you're tired of locating a term in the alphabetic index of your ICD-9 coding manual only to be told "see condition," you can save time and make your searches more productive by getting to know the manual's conventions and quirks.

Example: Your patient has benign hypertrophy of the prostate, and you look up "prostate" in the alphabetic index. Rather than a code, you find "see condition." You try "benign hypertrophy," but here you are greeted with "see also condition," along with a few codes that don't match your patient's diagnosis. Finally, you try looking under "hypertrophy," and you find the code you were searching for: 600.00 (Hypertrophy, prostate, benign). 

"Finding a code in the alphabetic index can be confusing. The investigative process begins with figuring out what to look under. Like any investigator, it helps to think deductively," says Keith Nielsen, RN, HCS-D, PPS/OASIS coordinator with Great Lakes Home Healthcare in Erie, PA.

"The main terms in the index are set flush with the left margin of each column and are in boldface type. They represent diseases, such as 'pneumonia;' conditions, such as 'fracture;' nouns, such as 'syndrome;' and adjectives, such as 'large,'" says Ann Zeisset, RHIT, CCS, CCS-P with the American Health Information Management Association in Chicago, IL. Keep these categories in mind as you begin your search to narrow down your options from the start.

Search tips: 

•  Look for the noun. For example, with benign prostatic hypertrophy, both "benign" and "prostatic" are adjectives that describe the noun, "hypertrophy." 

•  Save body parts for later. Never start your search by looking under the body part, or you will be advised to "see condition." 

• Try conditions or symptoms. Search for the condition or symptom that caused or contributed to the diagnosis you are looking for, says Nielson. Other helpful terms you may consider when searching the alphabetic index include "complication," "disease," "abnormal" or "injury," he suggests. 

Example: Your patient has chronic obstructive pulmonary disease (COPD). If you search under "pulmonary" or "chronic," you will only find the dreaded "see condition." Which term is the condition or symptom? 

"The clue is in the diagnosis itself; this is an obstructive disorder," explains Nielson. If you search under the term "obstruction, obstructed, obstructive" you will find several disorders listed as subterms, but the subterm "pulmonary" doesn't give you the code you are seeking. 

Don't throw in the towel yet; be persistent and use your powers of deduction. "Ask yourself which other terms you could look under instead of "pulmonary," advises Nielson. The terms "lung" and "respiratory" should come to mind. When you look for either of these subterms under the "obstruction" category, you will find the code 496 (Chronic airway obstruction, not elsewhere classified).

Tip: Another way to search for this code is to look under the term "disease," subterms "lung," "pulmonary," or "respiratory," says Nielson.

Found Your Term? Keep Reading

Once you locate your term, be sure to review all of the indented sub-terms below it for more specificity, advises Zeisset. 

Example: If you stop your search for female stress incontinence once you locate code 788.30 (Incontinence), you'll assign an incorrect code. Look under the sub-term "stress," and you'll find the correct code is 625.6 (Stress incontinence, female).