3. For diagnosis qualified as "due to" or "secondary to" alcoholism, both the disease
condition and alcohol use (category (33) will be coded; for example, pancreatitis due
to alcoholism will be coded 577. and 33.9. Use the same principle if disease
condition is "due to" or "secondary to" drug abuse. As appropriate also code 99.
(Late effects, poisoning). For some conditions, a combined diagnosis code points to
alcoholism as the cause of the disorder or physical complication. In such instances, the
use of the one code is sufficient; for example, alcoholic psychosis (category 291) ;
alcoholic cirrhosis of liver (571.2) and acute alcohol hepatitis (571.1). However, if
alcohol dependence or abuse is associated with the disorder or physical complication,
both will be coded.
APPLICATION
Drug and Alcohol
When admission is for both drug abuse and drug dependency, the drug dependency will
be the principal diagnosis:
EXAMPLE:
34.2 35.2
PRINCIPLE XIII. HEART CONDITIONS AND HYPERTENSION
1. Diseases relating to the circulatory system are difficult to code due to the many
synonymous terms and phrases used by physicians in writing the narrative description
of the disease process. The code(s) assigned depends on the words used in the
diagnostic statement. Carefully read and adhere to all written codes. The use of codes
which classify conditions to "other" or "unspecified" is discouraged.
2. ICD-9-CM provides fourth and fifth digits in many categories specifically relating to
the circulatory system. It is very important to follow the basic coding rule to always
locate the condition in the Alphabetic Index and verify in the Tabular List.
3. The alphabetic Index provides a table to classify hypertension whether as a sole
condition or in combination with other disease conditions.
a. To code hypertensive disease, refer to the table on pages 375-377 in Volume 2.
Specificity is provided by the terms malignant, benign, or unspecified.
b. Hypertension when associated with specific heart and renal conditions in a
cause-and-effect linkage are coded to categories 42, 43, or 44 as appropriate.
When using specific combination codes involving hypertension with heart and/or renal
conditions, the type of hypertension will determine the assignment of the fourth or fifth
digit.
MD0753
A-40
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