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For other articles and previous issues click here. October 10, 2005
2006 ICD-9-CM Changes
October 1 is the only day of the year that I don't regret having a mediocre memory. I know coders who seem to have memorized the entire ICD-9-CM code book, and I envy the blazing coding speed that accompanies this talent. My talent, unfortunately, is growing weeds in my garden, which is pretty useless for a career application. But as new codes are released, texts change, digits are added, and whole sections expanded. My weakness becomes my strength: Since I never memorized them in the first place, I don't have to worry about typing in the wrong codes from memory.
As I review the new codes, it becomes obvious that two of the only codes I have succeeded in memorizing over the years are finally changing. Good ole 276.5, dehydration/hypovolemia, is finally being subdivided into 276.51 and 276.52, respectively. Just as I recovered from this shock and saw with relief that Congestive Heart Failure NOS (not otherwise specified) remains 428.0, what did I find but corruption of Chronic Renal Failure. How many codes remain pure with only three digits? Well, not 585, that's for sure.
Additional digits will now specify various stages of associated chronic kidney disease, so I was evidently not the only coder frustrated by physicians using the terms end-stage renal disease, chronic renal insufficiency, and chronic kidney disease interchangeably. Now we don't have to figure out what they really mean and can code them all together. Of course, they still have to get them to tell us whether CKD means chronic kidney disease, cystic kidney disease, congenital kidney disease, or some additional cryptic diagnoses. Unfortunately for coders, no solution for this difficulty presents itself with the 2006 codes.
Obstructive sleep apnea finally has been assigned a code of its own. It has left its home in the Symptom chapter for new housing with the nervous system and sense organs codes. 327.23 will include the term obstructive sleep apnea, meaning coders won't have to search for documentation of where the obstruction is presumed to be located. Additional sleep disorders will also be easy to report in this code section, which has been expanded considerably this year.
If you worry about getting more detail in your diabetic retinopathy coding, you'll see a sweet surprise this fiscal year. If counting teeth is in your job description, the expanded codes for edentulism will make you smile with all of yours. Extra newborn codes are being delivered this year, and meconium staining or aspiration-with or without respiratory problems-will now be separately identifiable. More codes for mom's noxious substances affecting the baby have been injected; specifically, anticonvulsants and antimetabolic agents.
Moving to the other end of the age spectrum, when you start getting your joints replaced and have related complications, your coder can now report whether the issue is a periprosthetic fracture, a mechanical loosening vs. a dislocation of the prosthetic joint, or a few other similar concerns that can cause you many sleepless postsurgical nights.
Until now, you've only had one choice for muscle abscess, and the pesky psoas abscess had to hang out with all the others in the Musculoskeletal/Connective Tissue chapter. Beginning October 1, it finally got the recognition it deserves at 567.31 in the Digestive System codes, which means a promotion to a new diagnosis-related group (DRG) series as well. For those who have been annoyed that a peritoneal or retroperitoneal abscess has always defaulted to a peritonitis code, you'll no longer have a reason for bellyaching. Each now has its own code, and cousins of these infections are separately represented in the same neighborhood.
There must be a need to track multiple gestation, reduction of the same, and detail on fertility encounters because there are new diagnosis codes and V codes for these types of care. Speaking of V codes, check out the expanded section. Suicidal ideation finally has its own code, and not a moment too soon for those who memorize codes. They may be wondering what will happen first, absorbing this year's list or personally earning that new V code. Vaccination, respirator, family history, and body mass index issues are all tended in this section.
ICD-9-CM procedure codes have not been neglected. Detailed joint replacement revisions are showing up in the 00.7X section of the "not elsewhere classified" codes. You'll have to cruise to 84.56 to visit the new code for "insertion of cement spacer" or its later removal at the 84.57 address.
Another double-0 new code is "single Coronary PTCA, no thrombolytic agent" (00.66), recently relocated from 36.01. Its associates 36.02 and 36.05 remain at their original homes. You will find more vascular stents and procedures in the double-naught section, especially 39.73, "Endovascular Implant of Graft in Thoracic Aorta." Another addition is a code for infusion of immunosuppressive antibody therapy during induction phase of solid organ transplantation. External fixator mechanical differences, single or dual-array rechargeable neurostimulator pulse generators, and liquid brachytherapy radioisotopes are represented as well.
Once you've become familiar with all the code changes, see what they've done to the DRGs they generate on the inpatient side. Nine cardiovascular surgery DRGs more accurately reflect severity of illness by grouping patients based on an existing major cardiovascular condition. All the ortho code changes include a DRG change, too. DRG 209 Joint Replacement/Revisions was replaced itself, and 544 and 545 cover new placements and revisions, respectively.
Those who have to deal with the documentation and billing issues created by postacute care transfer DRGs are in even more trouble this year. Expect the price of stock in proton-pump inhibitors to rise, as gastric ulcers develop in this coder population. Our only consolation is that the public uproar succeeded in reducing the proposed number of transfer DRGs from 231 to only 182.
If you yearn for a detailed list of code changes, additions, revisions, and deletions, visit www.cms.hhs.gov/medlearn/icd9code.asp. Enjoy the challenges of a new ICD-9-CM year, and good coding.
- Judy Sturgeon, CCS, is the hospital coding senior manager at the University of Texas Medical Branch in Galveston. While her initial education was in medical technology, she has been in hospital coding and appeal management for the past 17 years.
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