Chapter IV: Inquiries Submenu (01)

DX/Proc Codes ICD-9 (15)

Purpose

The purpose of the DX/PROC CODES ICD-9 option is to provide a reference of ICD-9-CM code(s) used to identify a specific or various diagnosis codes or inpatient surgical procedure codes relating to the bill. These codes may be used to calculate payment (e.g., DRG) or make medical determinations relating to the claim.

Note: Claims submitted via DDE must contain ICD-10 codes for dates of discharge/through dates on or after 10/1/2015. Claims submitted containing ICD-9-CM codes for dates of discharge/through dates on or after 10/1/2015, will be RTPd.

Note: This option is for inquiry purposes only. Inclusion of any ICD-9-CM diagnosis or procedure code in this option does not guarantee the code will be accepted/reimbursed by Medicare.

FISS Inquiry Submenu

To access the DX/PROC CODES ICD-9 option from the FISS online Inquires submenu, type ‘15’ at the Enter Menu Selection: prompt and press the <Enter> key.

Upon selecting the DX/PROC CODES ICD-9 option, the ICD-9-CM Code Inquiry Screen is available:

Screen shot of the FISS Inquiries DX/Proc ICD-9 submenu used to research ICD-9-CM diagnosis and procedure codes.

To research an ICD-9-CM diagnosis code, type the diagnosis code in the STARTING ICD-9-CM CODE: field and press the <Enter> key. The ICD-9-CM Code Inquiry screen will refresh to provide details for diagnosis codes (listed in increasing alphanumeric order, starting with the diagnosis code being researched).

Press the <Enter> key without entering an ICD-9-CM code to display a complete list of codes available in the system, starting with E0000.

In the example included below, ICD-9-CM diagnosis code V760 is displayed.

Screen shot of the ICD-9-CM Code Inquiry Screen in FISS displaying ICD-9-CM diagnosis code V760.

Field	Description
ICD9 CODE	Identifies the starting ICD-9-CM Code (seven-position alphanumeric field)
DESCRIPTION	Description for the ICD-9-CM code (64 position alphanumeric field)
EFFECTIVE DATE	Effective date of the Medicare Code Editor program (six-position alphanumeric field in MMDDYY format, with three occurrences)
TERMINATION DATE	The date in which the Medicare Code Editor program was no longer in effect (six-position alphanumeric field in MMDDYY format, with three occurrences)

To research an ICD-9-CM procedure code, type the procedure code, preceded by a ‘P’, in the STARTING ICD-9-CM CODE: field and press the <Enter> key. The ICD-9-CM Code Inquiry screen will refresh to provide details for procedure codes (listed in increasing alphanumeric order, starting with the procedure code being researched).

Press the <Enter> key without entering an ICD-9-CM code to display a complete list of codes available in the system, starting with 0001.

In the example included below, ICD-9-CM procedure code 5201 is displayed.

Screen shot of the ICD-9-CM Code Inquiry screen in FISS displaying ICD-9-CM procedure code 5201.

Field	Description
ICD9 CODE	Identifies the starting ICD-9-CM Code (seven-position alphanumeric field)
DESCRIPTION	Description for the ICD-9-CM code (64-position alphanumeric field)
EFFECTIVE DATE	Effective date of the Medicare Code Editor program (six-position alphanumeric field in MMDDYY format, with three occurrences)
TERMINATION DATE	The date in which the Medicare Code Editor program was no longer in effect (six-position alphanumeric field in MMDDYY format, with three occurrences)

Revewed 8/16/2023