ICD-9-CM codes are 3 – 5 digit numeric and alphanumeric codes. These codes are used to describe diseases, conditions, symptoms, and other reasons for seeking healthcare services. Some codes are modified for special use in the DoD. The first three digits usually represent a single disease entity, or a group of similar or closely related conditions. The fourth digit subcategory provides more specificity or information regarding the etiology, site, or manifestation. In some cases, fourth-digit subcategories have been expanded to the fifth-digit level to provide even greater specificity.
V codes stands for –
ICD-9-CM codes beginning with the letter “V” are used when the patient seeks health care for reasons other than illness or injury. For example, well baby exam or a physical are reasons to contact health services without being “sick.” See para 2.2.7 in this chapter for more guidance.
E – codes External Causes of Injury
ICD-9-CM codes beginning with the letter “E” describe external causes of injury, poisoning and adverse reactions. They are used to describe where, why, and how an injury occurred.
E-Code as Principal Diagnosis
E codes describe the circumstances that caused an injury, not the nature of the injury, and therefore, are not used as a principal diagnosis. E-codes are all ICD-9-CM diagnosis codes that begin with the letter E. For a list of all E-codes, see “International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM), Volume I (Diseases).” Providers should review the medical record and/or fact sheet and enter the correct diagnosis before returning the bill.
The following error types will be rejected or returned to the provider for development. (Numbers correspond to the Non -OPPS OCE documentation.)
1. Invalid Diagnosis or Procedure Code
The OCE checks each diagnosis code against a table of valid ICD-9-CM diagnosis codes and each procedure code against a table of valid HCPCS codes. If the reported code is not in these tables, the code is considered invalid.
For a list of all valid ICD-9-CM codes see “International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), Volume I (Diseases),” The CMS approved ICD-9-CM addenda, and new codes are furnished by the A/B MAC (A) for each hospital. For a list of valid HCPCS codes see “Physicians’ Healthcare Current Procedural Terminology, 4th Edition, CPT” and “CMS Healthcare Common Procedure Coding System (HCPCS).” Providers should review the medical record and/or fact sheet and enter the correct diagnosis and procedure codes before returning the bill.
2. Invalid Fourth or Fifth Digit for Diagnosis Codes
The OCE identifies any diagnosis code that requires a fourth or fifth digit that is either missing or not valid for the code in question.
For a list of all valid fourth and fifth digit ICD-9-CM codes see “International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), Volume I (Diseases),” CMS approved ICD-9-CM addenda, and new codes furnished by the A/B MAC (A). Providers should review the medical record and/or fact sheet and enter the correct diagnosis before returning the bill.
