Q:When I started as a coder, I learned that the complication code, such as from ICD-9-CM series 998 or 999, takes precedence as the reason of admission when present with another contributing condition. Is this correct, and is there any written guidance from AHA Coding Clinic for ICD-9-CM/ICD-10-CM/PCS that discusses this?
A: First, refer to the code set’s alphabetic index and tabular list guidelines related to sequencing, with notes that instruct us to code first or code also. There are instructions within both the ICD-9-CM Official Guidelines for Coding and Reporting and the ICD-10-CMOfficial Guidelines of Coding and Reporting as to how to interpret the directional notes found here.
Coding Clinic also gives us guidance, however there is a hierarchy for which source of guidance supersedes the other. Follow first the instruction within the index and tabular list (coding conventions), followed by the Official Guidelines of Coding and Reporting, and lastly Coding Clinic advice.
The ICD-9-CM Official Guidelines of Coding and Reporting, related to this subject in particular state in Section II.G, Selection of Principal Diagnosis, Complications of surgery and other medical care:
When the admission is for treatment of a complication resulting from surgery or other medical care, the complication code is sequenced as the principal diagnosis. If the complication is classified to the 996-999 series and the code lacks the necessary specificity in describing the complication, an additional code for the specific complication should be assigned.
The ICD-10-CM Official Guidelines of Coding and Reporting give us the same instruction in the same section of the guidelines. The only difference is the code range:
When the admission is for treatment of a complication resulting from surgery or other medical care, the complication code is sequenced as the principal diagnosis. If the complication is classified to the T80-T88 series and the code lacks the necessary specificity in describing the complication, an additional code for the specific complication should be assigned.
Thus, your understanding of how these should be sequenced is absolutely correct, and now you are able to state where you accessed this instruction.
Editor’s note: Laurie Prescott, MSN, RN, CCDS, a CDI education specialist for HCPro, a division of BLR, in Danvers, Massachusetts, answered this question.This question and answer originally appeared on the Association of Clinical Documenation Improvement Specialists webstie.
This answer was provided based on limited information submitted to JustCoding. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
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