The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) manual provides a comprehensive overview of the general conventions or rules for assignment of codes. Part 1 of this series concentrated on some of the ICD-9-CM abbreviations and punctuation (see “Do You Understand the Official ICD-9-CM Conventions?” in the March 2009 [Volume 4, Number 6] AAP Pediatric Coding Newsletter™). This article will address ICD-9-CM instructional notes. Understanding how to interpret and use these notes is fundamental to the correct assignment of diagnosis codes.

Indicates a definition of disease term (printed in blue typeface).

Identifies a V code (ie, supplementary classification of factors influencing health status and contact with health services) that can only be used as a primary diagnosis.

Identifies a V code that may only be used as a secondary diagnosis.

Tip:Any V code that does not have an associated symbol may be reported as primary...

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