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Thread: Manifestation definition?

  1. #1

    Default Manifestation definition?

    Is there an "official" definition of a manifestion? As in, manifestation is an unacceptable principal dx, or, code first the underlying condition, sequence the manifestation 2nd. I've not been able to find one!

    I teach coding at the college level and my students struggle with this concept...they take it "too far." They want to apply it to every coding situation with more than one dx, regardless of other instructions in the Tabular List. For example, when coding a disease caused by an infectious organism, often the disease is first and the infectious organism is 2nd. Students think the infectious organism is the underlying disease and want to code it first.

    Any thoughts on how to help new coders understand the different clinical situations would be appreciated! Thanks!

    Lorraine

  2. #2
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    A manifestation is a condition that is an extension of the primary illness in question. Such as the neuropathy is a manifestation of the diabetes, another way to say this is the neuropathy is due to the diabetes. So if not for the diabetes the neuropathy could not "manifest". which is why we sequence the primary illness first, the secondary condition would not be present without the existence of the primary.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3

    Default Manifestation

    A manifestation code describes the manifestation(Sign or The display or disclosure of characteristic signs or symptoms of an illness) of an underlying disease, not the disease itself, and therefore, cannot be a principal diagnosis.

    The best example is cataract.This is a manifestation.This may occur due to many reasons or etiology
    if it occurs due to glaucoma -code glaucoma first(365.0-365.9) and then code cataract due to glaucome(366.31 )
    If it occurs due to diabetes-code diabetes first(250.5x) and then code diabetic cataract(366.41)

    Additional infos
    Addendum E, pages E-39-41 in CMS manual contain listings of ICD-9-CM diagnoses identified as manifestation codes.

    [ ] Brackets are used in the tabular list to enclose synonyms, alternative wording or explanatory phrases. Brackets are used in the index to identify manifestation codes.

    Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions the 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. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.
    In most cases the manifestation codes will have in the code title, “in diseases classified elsewhere.” Codes with this title are a component of the etiology/ manifestation convention. The code title indicates that it is a manifestation code.

    There are manifestation codes that do not have “in diseases classified elsewhere” in the title. For such codes a “use additional code” note will still be present and the rules for sequencing apply.

  4. #4

    Talking diabetic cataract

    366.41 code first rule is not valid for a billable 1cid-9-cm medical claim
    66984 cataract extraction should be coded with 366.41 as primary diagnosis on a reimbursement claim
    Medicare is establishing the following limited coverage for 66840, 66850, 66852, 66920, 66940, 66983, 66984:

    Covered for:

    365.51 Phacolytic glaucoma
    366.00 Nonsenile cataract, unspecified
    366.01 Anterior subcapsular polar cataract
    366.02 Posterior subcapsular polar
    366.03 Cortical, lamellar, or zonular cataract
    366.04 Nuclear cataract
    366.09 Other and combined forms of non-senile cataract
    366.10 Senile cataract, unspecified
    366.11 Pseudoexfoliation of lens capsule
    366.12 Incipient cataract
    366.13 Anterior subcapsular polar senile cataract
    366.14 Posterior subcapsular polar senile cataract
    366.15 Cortical senile cataract
    366.16 Nuclear sclerosis
    366.17 Total or mature cataract
    366.18 Hypermature cataract
    366.19 Other and combined forms of senile cataract
    366.20 Traumatic cataract, unspecified
    366.21 Localized traumatic opacities
    366.22 Total traumatic cataract
    366.23 Partially resolved traumatic cataract
    366.30 Cataracts complicata, unspecified
    366.31 Glaucomatous flecks (subcapsular)
    366.32 Cataract in inflammatory disorders
    366.33 Cataract with neovascularization
    366.34 Cataract secondary to ocular disorders
    366.41 Cataract associated with other disorders, diabetic cataract
    366.42 Tetanic cataract
    366.43 Myotonic cataract
    366.44 Cataract associated with other syndromes
    366.45 Toxic cataract
    366.46 Cataract associated with other disorders
    366.50 After-cataract, unspecified
    366.51 Soemmering's ring
    366.52 Other after-cataract, not obscuring vision
    366.53 After-cataract, obscuring vision
    366.8 Other cataract
    366.9 Unspecified cataract
    998.82 Cataract fragments in eye following cataract surgery

    Medicare is establishing the following limited coverage for 66982:

    364.23 Lens induced iridocyclitis
    364.51 Essential or progressive iris atrophy
    364.55 Miotic cysts of the pupillary margin
    364.57 Degenerative changes of the ciliary body
    364.59 Other iris atrophy
    364.75 Pupillary abnormalities
    364.76 Iridodialysis
    364.8 Other disorders of iris and ciliary body
    364.9 Unspecified disorder of iris and ciliary body
    366.00 Non-senile cataract, unspecified
    366.01 Anterior subcapsular polar cataract
    366.02 Posterior subcapsular polar cataract
    366.03 Cortical, lamellar, or zonular cataract
    366.04 Nuclear cataract
    366.09 Other and combined forms of nonsenile cataract
    366.10 Senile cataract, unspecified
    366.11 Senile cataract, pseudoexfoliation of lens capsule
    366.13 Anterior subcapsular polar senile cataract
    366.14 Posterior subcapsular polar senile cataract
    366.16 Nuclear sclerosis
    366.17 Total or mature cataract
    366.18 Hypermature cataract
    366.19 Other and combined forms of senile cataract
    366.20 Traumatic cataract, unspecified
    366.21 Localized traumatic opacities
    366.22 Total traumatic cataract
    366.23 Partially resolved traumatic cataract
    366.30 Cataracta complicata, unspecified
    366.32 Cataract inflammatory conditions
    366.33 Cataract with neovascularization
    366.41 Diabetic cataract
    366.42 Tetanic cataract
    366.43 Myotonic cataract
    366.44 Cataract associated with other syndromes
    366.45 Toxic cataract
    366.46 Cataract associated with radiation and other physical influences
    379.32 Subluxation of the lens
    379.33 Anterior dislocation of lens
    379.34 Posterior dislocation of lens
    379.40 Abnormal pupillary function, unspecified
    379.41 Anisocoria
    379.42 Miosis (persistent), not due to miotics
    379.43 Mydriasis (persistent), dot due to mydriatics
    379.45 Argyll Robertson pupil, atypical
    379.46 Tonic pupillary reaction
    379.49 Other anomalies of pupillary function
    743.36 Anomalies of lens shape spherophakia
    743.37 Congenital ectopic lens
    743.45 Aniridia
    743.46 Other specified anomalies of the iris and ciliary body

    Diagnoses that Support Medical Necessity

    As listed in the "ICD-9 Codes that Support Medical Necessity" section of this policy.

    ICD-9 Codes that DO NOT Support Medical Necessity

    Any diagnosis codes not listed in the "ICD-9 Codes that Support Medical Necessity" section of this policy.

    Diagnoses that DO NOT Support Medical Necessity

    Conditions not listed in the "ICD-9 Codes that Support Medical Necessity" section
    Last edited by mflores; 08-09-2010 at 04:45 PM. Reason: better explanation on code first rule-icd-9-cm vol 2 manifestation could be use as primary. for billing med claim

  5. #5
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    Quote Originally Posted by mflores View Post
    366.41 code first rule is not valid for a billable 1cid-9-cm medical claim
    66984 cataract extraction should be coded with 366.41 as primary diagnosis on a reimbursement claim
    I am not sure where you obtained your information, however 366.41 is NEVER allowed as a first listed code it is by definition a manifestation and a secondary only allowed code. The notes in the code book that say code first the undlying condition can never be overlooked and must always be adhered to. Also 366.41 is an italicized code and as such is secondary only allowed.

    Debra A. Mitchell, MSPH, CPC-H

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