Classification Systems
Catrina Lemus
American International University
April 3, 2011

Abstract The following paper will be discussing the 4 main steps to ensure that the ICD codes are accurate. This paper will also be discussing the four steps that are necessary to establish the proper ICD-9-CM code. There are many ways that this paper will explain what is right to do and gives you a good source through a book that you can just gather all your information from. Step-by Step Medical Code Book by Buck is such an incredible book to get your sources from.

ICD-9-CM code means International Classification of Disease, 9th edition. This is a standardized classification of disease, injuries and causes of death, by etiology and anatomic localization and anatomic localization and codified into a 6 digit number. When given any of these symptom assigned number’s this allows many clinicians and many involved people that have the same common language with in the medical field. The ICD-9-CM has been used in this country since 1973 for morbidity applications. This will help continue the hospital or anyone dealing with medical to be organized and just improve more and more. There are 8 steps to follow to have an accurate coding system. We are going to discuss the top 4 that are important. First one is to identify the main term in the diagnostic statements meaning you would to make sure that you have the correct code. Always do a double check when finding the correct code. The second step to an accurate code is you would need to locate the main term in the Alphabetic index. The Index book come in 3 volumes and it is so simple to look through and find the correct code. The third step to an accurate code is to make sure you verify the code correctly when you select it from the index in the Tabular list. You would really need to follow and read all the latest about the medical codes. It is important to use both the alphabetic index and the tabular list when locating and assigning a code. Because if you only use the alphabetic index or the tabular list this may lead to errors in code assignments and less specificity in code selection. The fourth step to an accurate code is that you must code the diagnosis until all elements are completely identified. There are many important steps to take when dealing with making sure your coding correctly. Again there are many steps to establish a proper ICD-9-CM code. I will be discussing the top four necessary proper ways to write the ICD-9-CM code. One is to have access to the rules. Which means that the coder must have access to the understanding of the federal, state and any private payer requirements? So when and if it comes down to it you can come up with a great explanation on why you made that decision about the code you picked. Two is to always base coding on medical record documentation. Meaning you would need to be dedicated about reviewing the documentation to be sure the record supports the codes that re selected. Important tip to all when you are coding make sure you have all the patients documentation in from of you so you can make the proper choices. Three is to keep up to date coding reference material. You need to be aware of any of the coding changes that are being made, there is so much information out there books, medical journals and even the internet is a very good key as well. The fourth on is never use abbreviated cheat sheets. No need to have cheat sheets your coding book will help you find all the right codes; this will make your job so much easier. In conclusion, knowing the ICD-9-CM can be a magic tool you have when learning the codes and having a good understanding you can make a difference in the medical field.

Reference
The free dictionary by farlex copyright 2011 farlex, Inc Retrieved from: http://medical-dictionary.thefreedictionary.com/ICD-9-CM
2010 Step-by-Step Medical Coding by Buck Publisher: Saunders Elsevier Copyright 2009, Elsevier, Inc. Chapter 2, 3, 4