2006 ICD-9-CM OFFICIAL CODES
Volume 2, Diseases: Alphabetic Index
This volume is the Alphabetic Index to Volume 1, Diseases: Tabular List of the
International Classification of Diseases, 9th Revision, Clinical Modification.
The Alphabetic Index is an important supplement to the Tabular List since it contains
many diagnostic terms which do not appear in Volume 1. Terms may be listed in the
categories of the Tabular List are not meant to be exhaustive; they serve as examples
of the content of the category. The Index, however, includes most diagnostic terms
currently in use.
Never code from the Alphabetic Index. After locating a code in the index, refer to that
code in the Tabular List for important instructions. These instructions are in the form of
notes suggesting or requiring the use of additional codes, and exclusion notes which
indicate the conditions to be noted elsewhere.
In accordance with A Manual of Style, the University of Chicago Press (1), letter-by-letter
alphabetizing is used throughout the Alphabetic Index. Letter-by-letter alphabetizing
ignores single spaces and hyphens producing sequences such as the following:
Beer-drinkers' heart (disease) 425.5
Bee sting (with allergic or anaphylactic
Numbers, whether Arabic or Roman, or the adjective version of the number (first,
second, third, fourth) are placed in numerical sequence before alphabetic characters.
XIII (fibrin stabilizing)
"With" references immediately follow the main term to which they refer. When multiple
"with" references are present, the are indented under "with" and listed in alphabetical
(catarrh) (spasmodic) 493.9
hay fever 493.0
The Alphabetic Index is divided into three sections.
Section 1, Index to Diseases and Injuries.
This section contains terms referring to diseases (categories 001-799), injuries
(categories 800-999), excluding poisoning by drugs and chemicals (categories 960-989),
found in Section 2), the Supplementary Classification of Factors Influencing Health
Status and Contact with Health Services (categories V01-V82), and the morphology of
neoplasms (M codes).
Section 2, Table of Drugs and Chemicals.
This table contains an extensive but not exhaustive listing of drugs and other chemical
substances such as drugs, alcohols, petroleum products, industrial solvents, corrosives,
metals, gases, noxious plants, household cleaning agents, pesticides, and other toxic
agents. Manifestations of poisoning and adverse effects of drugs and chemicals are
found in Section 1, unde6r the specific symptom or disease (e.g., Rash, Gray
The table identifies the following types of poisoning by drugs and nonmedical chemical
substances as the external cause of adverse effects:
Misadventure in therapeutic use
Undetermined (i.e. accidental or intentional)
Each of the listed substances is given a code assignment according to the poisoning
section classification (960-989). The appropriate codes from the supplementary
External Cause of Injury and Poisoning Classification, listed in columns 2-6,
classify accidental poisoning, misadventure in therapeutic use, suicide attempt,
assault, or undetermined cause of poisoning.
The table also contains the American Hospital Formulary Service (AHFS) List (2)
numbers, keyed to the continually revised American Hospital Formulary Service,
which can be used to classify new drugs not listed in the table by name. The AHFS
List numbers are found in the Table of Drugs and Chemicals under the main term
Drug. The AHFS List numbers and their ICD-9-CM equivalents are also found in
Appendix C of Volume 1.
Section 3, Alphabetic Index to External Causes of Injuries and Poisonings (E Code).
These terms are not medical diagnoses, but describe circumstances under which an
accident or act of violence occurred (i.e., the underlying cause or means of injury). The
main terms in this section usually represent the type of accident or violence (e.g.,
assault, collision) with the specific agent or other circumstance listed below the main
term. For example:
motor vehicle (on public highway) (traffic accident) E812
not on public highway, nontraffic accident E822
off-road type motor vehicle (not on public highway) E821
pedal cycle E826
railway (rolling stock) (train) (vehicle) E800
with antecedent derailment E802
Conventions Used in the Alphabetic Index
The Alphabetic Index is organized by "main terms".
In Section 1 of the Alphabetic Index the main terms usually identify disease conditions.
Thus "chronic bronchitis" will be found under Bronchitis, chronic. There are several
exception to the general rule.
1) Obstetric conditions will be found under Delivery, Pregnancy, and
2) Complications of medical and surgical procedures are indexed under
3) Late effects of cerebral infections, lesions, injuries (e.g., fractures,
dislocations, open wounds), and infectious diseases will be found under Late
4) The V codes from the Supplementary Classification of Factors Influencing
Health Status Contacts with Health Services will be found under such main term
A main term may be followed by a series of terms in parentheses. The presence or
absence of these parenthetical terms in the diagnosis has no effect upon the selection
of the code listed for the main term. The are called nonessential modifiers. For example:
Ileus (adynamic) (bowel) (colon) (inhibitory)
(intestine) (neurogenic) (paralytic) 560.1
A main term may also be followed by a list of subterms (modifiers), which do have an
effect upon the selection of an appropriate code for a given diagnosis. These subterms
form individual line entries and describe essential difference in site, etiology, or clinical
type. For example:
esophageal-pharyngeal (newborn) 787.2
papillary muscle 429.81
General adjectives, such as "acute", "chronic", "epidemic", or "hereditary"6, and
references to anatomic site, such as "arm", "stomach", and "uterus" will appear
as main terms, but they will have only a "see condition" for reference. For
Hereditary -- see Condition
Uterus -- see Condition
Not Elsewhere Classifiable.
NEC is used for two purposes which can only be distinguished by reference to the
1) with ill-defined terms as a warning that specified forms of the condition
classify differently. The codes given for such terms should be used only if more
precise information is not available.
2) with terms for which a more specific category is not provided in the
Tabular List, and no amount of additional information will alter the selection of
Cross references provide the user with possible modifiers for a term or its synonyms.
There are three types of cross references:
"see -- " is an explicit direction to look elsewhere. It is used for anatomical sites and
many general adjective modifiers not normally used in the Alphabetic Index or for
reference to the appropriate main term under which all the information concerning
a specific disease will be found. For example:
Encephalomeningitis -- see Meningoencephalitis
Endamebiasis -- see Amebiasis
Kidney -- see Condition
Leukosis -- see Leukemia
Lipofibroma (M8851/0) -- see Lipoma, by site
"see also -- " directs the user to look under another main term if all the information
he is searching cannot be located under the first main term entry. For example:
Laryngoplegia -- see also Paralysis, vocal cord, 478.30
"see category -- " directs the user to Volume 1, Diseases, Tabular List for important
information governing the use of the specific code. For example:
late effect or old -- see category 438
Certain main terms are followed by notes which are used to define terms and give
Note -- "Complicated" includes
traumatic amputation with delayed
healing, delayed treatment, foreign
body, or major infection.
Notes also are used to list the fifth-digit subclassifications for those groups of categories
- all of which use the same fifth-digits - such as "Tuberculosis", "Diabetes, mellitus",
"Ulcer", "Inguinal hernia", etc. In these cases only the four digit code is given for the
individual entry; the user must refer to the note following the main term to obtain the
appropriate fifth-digit subclassification.
Diabetes, diabetic (congenital) (controlled)
(familial) (mellitus) (severe) (slight)
(without complication)) 250.0
Note -- Use the following fifth-digit
subclassification with category 250
0 adult-onset or unspecified as to type
1 juvenile type
Eponyms (diseases or syndromes named for persons) are listed both as main terms
in the appropriate alphabetic sequence and under the main terms "Disease" or
"Syndrome". A description of the disease or syndrome is usually included in
parentheses following the eponym. For example:
Crigler-Najjar disease or syndrome
(congenital hyperbilirubinemia) 277.4
Crigler-Najjar (congenital hyperbilirubinemia) 277.4
Crigler-Najjar (congenital hyperbilirubinemia) 27.4
Neoplasms are listed in the Alphabetic Index in two ways. Anatomic site: A
comprehensive list of anatomic sites is found in a table under the main term "Neoplasm".
The table contains six columns. The first three are for malignancies as "primary",
"secondary" and "carcinoma in situ". The following three columns are "Benign",
"Uncertain behavior", and "Unspecified".
Morphology: Histological terms for neoplasms such as "carcinoma" and "adenoma"
are listed as main terms in the appropriate alphabetic sequence and are usually
followed by a cross reference to the neoplasm table. Each morphological term will
appear with morphology code from the ICD-Oncology (ICD-O). For example:
Adenocarcinoma (M8140/3) -- see also Neoplasm, by site, malignant
These morphology codes are used to supplement the appropriate ICD-9-CM
neoplasm code which indicates the site of the neoplasm. A complete listing of the
ICD-O morphology codes is found in Appendix A of Volume 1.
Etiology and Manifestations of Disease
For certain conditions it is important to record both the etiology and the manifestation
of the disease. In many cases this is accomplished with the use of a singe five digit
code (e.g., gonococcal cystitis (098.11). For some conditions it is was not possible to
provide specific fifth-digit sub-classifications giving both etiology and manifestation. In
such cases the two facets of the disease are coded individually, and the Alphabetic
Index lists both codes. It is important to record these codes in the same sequence
used in the Alphabetic Index. For example:
glomerulosclerosis 250.4 [581.81]
The first code listed represent the etiology (250.4 Diabetes mellitus with renal
complications) and the code in brackets represents the manifestation (581.11 Nephrotic
syndrome in diseases classified elsewhere).
1) A Manual of Style, 12th Edition, Revised, University of Chicago Press, 1969
2) American Hospital Formulary Service, 2 volumes, Washington, D.C. (American
Society of Hospital Pharmacists, 1959-)