HIPAA requires compliance with ICD-9-CM guidelines

Key Takeaway:

ICD-9-CM guidelines have been issued to bring about standardization and uniformity in the use of medical codes. Adherence to this guideline is a requirement under Health Insurance Portability and Accountability Act (HIPAA).

The International Classification of Diseases, 9th Revision, Clinical Modification, more popularly known as ICD-9-CM, is a set of guidelines issued by two departments within the Department of Health and Human Services (DHHS): The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS).

The ICD-9-CM guidelines provide healthcare professionals with the knowledge of how to code and report diseases, which has to be in accordance with this instrument. The ICD-9-CM guidelines are meant for accompanying and supplementing the extant official conventions and instructions that the ICD-9-CM has already provided.

Facts about the ICD-9-CM guidelines

  • These ICD-9-CM guidelines are to be used by healthcare coders when allocating ICD-9-CM diagnosis and procedure codes
  • Adherence to these guidelines is a requirement under HIPAA
  • These, however, are guidelines, and hence are subservient to the more clear-cut conventions and instructions that the classification has
  • Although ICD-9-CM guidelines provide additional instruction; instructions on how to code and sequence diseases, as set out in Volumes I, II and III of ICD-9-CM, are the guiding document

ICD-9-CM guidelines on general inpatient coding

ICD-9-CM guidelines have full details of how medical coders have to go about general inpatient coding. These are some of the general areas in which ICD-9-CM guidelines have to be adhered to:

  • Use of both alphabetic index and tabular list
  • Level of specificity in coding
  • Not Elsewhere Classified (NEC) or Not Otherwise Specified (NOS) code titles
  • Conditions that are classified as being both acute and chronic
  • Code relating to combinations
  • Tabular list
  • Multiple coding of diagnoses
  • Late effect, meaning residual effect or condition produced
  • ICD-9-CM guidelines when diagnosis is uncertain
  • o ICD-9-CM guidelines on impending or threatened condition
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