ICD-9-CM is the International Classification of Diseases Codes, 9th Revision, Clinical Modification. Developed and maintained by the World Health Organization, ICD-9-CM codes are used to describe illnesses, injuries and accidents for the purpose of
medical research and reporting. The ICD-9-CM system numerically classifies medical diagnosis by a code number, which provides need to use when processing claims. The ICD-9-CM includes diseases listed in both a tabular list and an alphabetic index.
Most insurance carriers, HMOs and Medicaid agencies require the use of ICD-9-CM codes in the billing format. There is adequate space for listing up to four codes on the standard CMS-1500 claim form. The primary diagnosis, the condition considered to
be the major health problem for which the particular treatment is provided, should be listed first. A secondary diagnosis is a medical condition which has manifested itself at the same time as the primary condition and alters the treatment required or
lengthens the expected recovery time of the primary condition. All diagnoses affecting the current treatment of the child should be included.
Benefit payments depend on accurate, precise, and meaningful coding techniques. Failure to provide an ICD-9-CM code, use of a code inconsistent with the service or a code which does not substantiate the need for the level of service provided, or use
of multiple diagnosis codes that confuse the claims examiner will cause payment problems. Confusion on the part of the payer can be avoided by including the ICD-9-CM code on each claim and limiting the codes used to those most pertinent and most clearly
medically related to the services provided.
For diagnostic codes, please refer to the ICD-9-CM code book available from local medical book stores or use an internet search for resources.