When it comes to choosing diagnosis codes, donít forget to give details about location
by Tamra McLain, CPC, CPC-H, CMC
Published in the April 2004 issue of Today's Hospitalist
In last monthís column, I discussed the importance of providing details so you or your coders can choose the most specific ICD-9 codes possible to best reflect your patientsí severity of illness.
Using the most specific codes possible affects not only your reimbursement, but it gives anyone reviewing your utilization data the most complete picture. Neglect to include codes showing just how sick a patient is, for example, and you may appear to be using too many diagnostic tests or other procedures in that patientís care.
To make the most of diagnosis codes, you need to specify the location of patient conditions and problems. If coders donít know exactly where a patient had a contusion or was experiencing pain, they will have a tough time choosing the most accurate diagnosis code.
Coders can use an unspecified code when they donít have location information, but you and your hospital will be missing out. Information about location is particularly important when it comes to contusions, hematomas, trauma, injuries, burns and pain.
To help illustrate the different codes that can be used to indicate the location of an illness or condition, Iíll focus on information for four common conditions seen by hospitalists: cellulitis, superficial injuries, contusions and pain.
The following charts provide a sample listing of several types of ICD-9 codes that can specify location. Even if you donít do your own coding, the charts will help you realize the areas where the people doing your coding need detailed information from you.
Location codes: cellulitis
Cellulitis includes areas with abscess. The coder would use an additional code to identify an organism such as staphylococcus (041.1).
Upper arm/forearm 682.3
Hand, except fingers/thumb 682.4
Leg, except foot 682.6
Foot, except toes 682.7
Other specified sites 682.8
Unspecified site 682.9
Location codes: superficial injuries
A common condition that requires location codes is superficial injuries or insect bites. If youíre treating an insect bite, you must also specify if there are signs of infection.
No infection Infection
Face, neck, scalp 910.4 910.5
Trunk 911.4 911.5
Shoulder/upper arm 912.4 912.5
Elbow, forearm, wrist 913.4 913.5
Hand, except finger 914.4 914.5
Finger 915.4 915.5
Hip, thigh, leg and ankle 916.4 916.5
Foot/toes 917.4 917.5
unspecified sites 919.4 919.5
Location codes: contusions
Contusions with intact skin surfaces can be found in the category range of 920 through 924 in the ICD-9 manual. This includes areas of bruised skin without fractures or open wounds. It excludes crushing injuries.
Face, scalp and neck 920
Eye and adnexa 921
Black eye 921.0
Eyelids/periocular area 921.1
Orbital tissue 921.2
Chest wall 922.1
Intrascapular region 922.33
Genital organs 922.4
Multiple sites of trunk 922.8
Unspecified part 922.9
Upper limb 923
Upper arm 923.03
Multiple sites of upper arm 923.09
Multiple sites of upper arm 923.8
Unspecified part of upper limb 923.9
Lower limb 924
Lower leg 924.10
Multiple sites of lower limb 924.4
Unspecified part of lower limb 924.8
Unspecified site 924.9
Location codes: patient pain
The ICD-9 manual does not provide a good code for chronic pain syndrome. As a result, you should refer to the body area that is most affected by the diagnosis. For generalized pain, use ICD-9 code 700.99.