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Thread: ICD-9-CM Code acute or chronic first?

  1. #1
    Join Date
    Apr 2007
    Milwaukee Chapter

    Default ICD-9-CM Code acute or chronic first?

    Your coding an office visit and you have 2 different/ unrelated diseases to ICD-9 code. One diasnosis is acute and the other is a nonacute diagnosis. The chronic diagnosis is coded first and the acute diagnosis is coded 2nd. Is there a rule that acute conditions are coded before chronic conditions for physician services? If this is true, can you site source?

  2. #2
    Join Date
    Apr 2007


    I could be wrong but I believe you code the acute first, if that is why they are being seen, therefore it is the principal diagnosis. Then you can add the chronic condition. Without further details that's the best I can do....

  3. #3


    I am not aware of any other criteria other than ICD-9-CM Coding Guidelines Section II [Selection of Principal Diagnosis] B, C, and D (Coding Guidelines Page 26 of 2010 Ingenix Volumes 1 & 2).

  4. #4


    Premature post - I missed including reference to ICD-9-CM Sect. I.B.10 when referencing the SAME condition (pg 4).

  5. #5
    Join Date
    Apr 2007
    Bangor, Maine


    Acute and chronic condition - guidelines
    ******Coding Clinic

    Acute and Chronic Condition

    When a particular condition is described as both acute or subacute and chronic, code according to the Alphabetic Index subentries (including those enclosed in parentheses) for that condition, such as:

    · Whenever separate subentries for acute (subacute) and chronic are listed, code both and sequence the acute condition first.

    · When there are no subentries for acute (subacute) or chronic, disregard these modifiers in coding the particular condition.

    · When the Index does not provide a subentry for a condition described as subacute, code the condition as acute.


    · Acute and chronic appendicitis, 540.9 and 542

  6. #6


    Listed in the ICD-9 coding guidelines Section I. Conventions, General Coding Guidelines...B. General Coding Guidelines, #10 Acute & chronic conditions

    If the same condition is described as both acute (subacute) & chronic, and separate subentries exist in the alphabetic index at the same indentation level, code both and sequence the acute (subacute) code first.

    Hope this helps,
    Anthony McCallum, CPC, CIRCC, CPC-I, CCS

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