Billing for patient encounters and other procedures must be accompanied by ICD-9 diagnosis codes. This coding system uses three- to five-digit codes to classify diseases, conditions, symptoms, complaints or problems by diagnosis. It was first initiated by an international panel but then modified by the United States National Center for Health Statistics Council on Clinical Classification. It is the official system in the US for recording all diseases, injuries, impairment, symptoms, and causes of death since 1977. A 10th revision was introduced in Europe and is being implemented in the US. Volume 1 of the ICD-9 contains three sections: tabular listing of classification of diseases and injuries; supplementary classifications of factors influencing health status (V codes) and of external causes of injury and poisoning (E codes); and appendices for morphology of neoplasms, glossary of mental disorders, drug list numbers, industrial accidents, and three-digit categories. Volume 2 is the alphabetical index of diseases and injuries, and volume 3 is a procedure code list for hospital use only. Annual updates include new codes, delete old ones, and revise descriptors. ICD-9 codes do not affect reimbursement. The diagnosis that is chiefly responsible for the encounter or procedure should be listed first. Physicians should code for documented diagnoses only and should not code suspected (rule out) diagnoses but rather the symptom or problem; the medical record reflects that services were provided for the suspected condition. The physician should code to the highest level of specificity (otherwise called �truncated� coding), and list coexisting or chronic conditions only if applicable to the patient�s treatment. The fourth digits .8 and .9 are used to indicate �not elsewhere classified, (NEC)� and �not otherwise specified, (NOS)�, respectively; it is necessary to limit the use of unlisted diagnoses. Conditions that no longer exist should not be coded and if the diagnosis changes following a procedure, the new diagnosis should be coded. If a patient has acute and chronic problems, the code for the acute condition should be listed first. If multiple injuries or burns exist, the severest one is listed first, and for inpatients, external cause codes should be listed. Special instructions may be indicated for certain conditions, such as �use additional code,� �code first underlying disease,� and �mandatory codes.� If the patient receives only ancillary services, the V code is listed first followed by the diagnosis code.

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