November 8, 2010

ICD-9-CM Changes: Boring but Vital
By Judy Sturgeon, CCS
For The Record
Vol. 22 No. 20 P. 6

The annual list of changes, deletions, and additions to ICD-9-CM is perhaps the least exciting subject matter produced by Coding Corner. Nevertheless, although the list of code modifications is a serious snoozer, don’t be deterred from reading every word. It is critical for competent coders to be aware of changes that have been made for the new federal fiscal year. While many of us are inclined to manually type in codes we have memorized to save time, October 1 always signals a time to return to basics.

Become familiar with those codes that have split into additional digits for detail and those that have been deleted or are no longer valid. Unless you start the new coding year in this manner, your facilities and physicians will have more billing errors and subsequently less income. Fortunately, there are fewer changes this year than in the past. With ICD-10 looming on the horizon, perhaps the Centers for Medicare & Medicaid Services is more focused on gearing up for the new system than in continuing to significantly modify the current version.

There are only 13 newly invalid diagnosis codes, all of which have been expanded to five digits to provide the necessary specificity that apparently cannot wait until 2013. The deletion list for procedure codes contains a single casualty: 39.8, Operations on carotid body, carotid sinus, and other vascular bodies. In this instance, as in the diagnosis code deletions, the code is adding digits and more description for greater detail.

When reviewing for new diagnosis codes, it is obvious that the chapter for infectious disease is completely overlooked this year. The neoplasm chapter is barely affected; the only additions are 237.73 for schwannomatosis and 237.79 for other neurofibromatosis. The endocrine/metabolic/nutritional/immunity codes were slightly impacted. The archaic 275.0, Disorders of iron metabolism, has expanded digits in order to record those caused by heredity, repeated red blood cell transfusion, or other causes. Fluid overload has developed “multiple personality disorder” as well. 276.6 has gained fifth digits that explain whether the cause is documented as being associated with transfusion. Bringing up the rear for endocrine codes is the new 278.03 for obesity hypoventilation syndrome.

Chapter 5 has a single change. Secondary thrombocytopenia (287.4) now has fifth digits to separate posttransfusion purpura from the others. Mental disorders in this section were left intact other than the addition of code 315.35 for childhood onset fluency disorder. New codes for nervous system and sense organs will be neither seen nor heard in the current update.

The circulatory system has “dilated” slightly to allow more detail under disorders of arteries and arterioles. Aortic ectasia, now at 447.7, has fifth digits 0 through 3 to define sites more clearly. Avian and swine flu expansions continue to inflate the respiratory chapter. In the new year, it will be possible to assign combined codes specific to pneumonia or other respiratory manifestations that are associated specifically with avian influenza or H1N1 influenza virus infections. The digestive chapter, however, didn’t suffer much upset this year; the single code addition here is 560.32, Fecal impaction.

Run on past the genitourinary, pregnancy, and skin/subcutaneous codes and brace yourself for a lone diagnosis addition in the musculoskeletal chapter. Included this year is 724.03 for spinal stenosis, lumbar region, with neurogenic claudication.

The next stop is congenital anomalies, where significant expansion has been made for uterine and cervical deformities. Agenesis, hypoplasia, unicornuate and bicornuate uterus, and septate and arcuate uterus have been differentiated from the other uterine anomalies. Cervical and vaginal agenesis have their own distinct codes, as do cervical duplication and transverse and longitudinal vaginal septum. Perinatal diagnoses have had no new deliveries but seize the new code 780.33 to distinguish posttraumatic seizures from any type of epilepsy. There is also a “hot” new fever code: 780.66, Febrile nonhemolytic transfusion reaction. More symptom codes have been created to cover diagnoses such as jaw pain, unspecified hemoptysis, fecal evacuation problems, communication deficits, and various cognition disorders.

Poisoning by cocaine has moved from the newspaper headlines to the codebook; see 970.81 to distinguish this “party favor” from that caused by other central nervous system stimulants.

More concerns with coding transfusion reactions are apparent in the 999 categories. ABO incompatibility reaction is now detail oriented in the 999.6X codes, and Rh conflicts are similarly affected in the 999.7X code group. If you just can’t tell whether the issue is ABO or Rh incompatibility, you will still find expansion in the 999.8X codes.

There is little activity in the E code chapter; E000.2 describes volunteer activity as an external cause of injury or poisoning. The V code chapter, however, has added all sorts of personal histories, including anomalies, contraceptive devices, body mass index, retained foreign bodies, and even detailed types of multiple gestations.

Procedure code additions number a mere 22. It’s now possible to code specifically for the insertion of a drug-eluting stent into a superficial femoral artery (00.60). Codes 01.20 and 01.29 differentiate cranial implantation or replacement of a neurostimulator pulse generator from removal of the same. Noncoronary intraoperative fluorescence vascular angiography now has its own code (17.71), as does the comparatively new sustained treatment for asthma: bronchoscopic bronchial thermoplasty for ablation of airway smooth muscle (32.27).

Cardiovascular procedure codes add percutaneous mitral valve repair with implant, thoracoscopic approach for excision or destruction of cardiac lesions, and even guided central venous catheter placement. There are eight new codes to describe procedures involving carotid sinus stimulator leads and/or pulse generators.

If your operative note describes a reversal of a total shoulder placement, look at 81.88 in the October codebook. Insertion of a sternal fixation device with rigid fixation plates (as opposed to floppy fixation plates?) now codes to 84.94, and there are three fresh codes for fat grafts.

Should you need to find minutiae not included here or if you need detail on revised diagnosis code titles associated with the addition of new codes, the websites below will serve as excellent sources. Familiarize yourself with the new codes most likely to affect your daily tasks and enjoy the improved productivity and accuracy that will result. And be sure to enjoy ICD-9 for another year! ICD-10 is (still) just around the corner.

(The following site has the annual code changes dating back to October 1, 2006: www.cms.gov/icd9providerdiagnosticcodes/07_summarytables.asp. If you need a conversion table to find out what codes used to be and when they changed, visit www.cdc.gov/nchs/data/icd9/icdcnvfy11.pdf.)

— Judy Sturgeon, CCS, is the clinical coding/reimbursement compliance manager at Harris County Hospital District in Houston and a contributing editor at For The Record.