Some of the sneakiest rules in ICD-9-CM coding that get implemented each year do not involve new codes at all. Rather, these sneaky rule changes are simply changes made in the ICD-9-CM Alphabetical Index directing the coder to report some condition in a manner that’s different from how coders had been directed to report it in the past—and it’s not due to the creation of a new code. It’s just a change in the way the ICD-9-CM folks have decided they want a condition coded.

Most coders make note of new codes and codes that are being eliminated. But often coders overlook new guidance in the ICD-9-CM Alphabetical Index that instructs coders how to report a condition. This is especially true of coders who are so experienced that they simply have common conditions and codes memorized. For these common conditions, coders might not ever actually look in the Alphabetical Index and might not ever notice that the official instructions on how to code these conditions might have changed.

So here are a few of these new or revised coding instructions from the ICD-9-CM Alphabetical Index, for Fiscal Year 2009 (effective Oct. 1, 2008):

Again, none of these codes themselves are new for this year. These are simply new coding instructions.

Greg Schnitzer, RN, Six Sigma Black Belt, Coding Quality Expert