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August 18, 2008

Back to School: New ICD-9-CM Codes Coming Soon
By Judy Sturgeon, CCS
For The Record
Vol. 20 No. 17 P. 6

Ah, October … autumn breezes, falling leaves, a slightly reduced chance of hurricanes on the Texas Gulf coast and, best of all, the brand new ICD-9-CM codes become effective. To paraphrase self-proclaimed redneck comedian Jeff Foxworthy, if you could read that entire sentence with a straight face, you might be a coder! For noncoders, however, it may be best to ingest large amounts of caffeine before attempting to tackle the rest of this article.

Last year was somewhat light in coding updates, but it seems like we’re making up for lost time in fiscal year 2009. Procedure code changes aren’t as staggering as those for the diagnosis chapters. There are new codes for intravascular pressure measurements in arteries and aneurysms, located in the James Bond code section—that’s double O for nonspy fans. A lone, similar new code is located in a different category: 33.72, Endoscopic pulmonary airway flow measurement.

There is a brand-new section that includes all kinds of intestinal surgeries with 17.XX codes. For coder geeks, the immediate response will be, “But wait! That’s between chapter 3 for eye procedures and chapter 4 for ear surgeries. How can that be?”
For some unfathomable reason, there is a new chapter titled 3A, Other miscellaneous diagnostic and therapeutic procedures, and a new category 17, Other miscellaneous procedures. When you need codes for some types of laparoscopic hernia repairs with graft or prosthesis, laparoscopic intestinal resections, and robotic assisted procedures, this is probably the place to look.

Cardiovascular procedure changes include additions and alterations to codes for various heart assist systems, the excision of a left atrial appendage, and even intravascular spectrography.

The traditional gastrointestinal surgery codes have changes and additions for types of colectomy, rectal pull-through resections, hernia codes specifying other and open repairs, and even more laparoscopic codes for hernia repairs.

When you get down to skin and bone, you’ll find text changes at percutaneous vertebroplasty 81.65 vs. percutaneous vertebral augmentation 81.66 instead of simply vertebroplasty and kyphoplasty. Cement spacer code 84.56 is now insertion or replacement of (cement) spacer. The current 85.7 code for total breast reconstruction is extensively split into subcategories for all kinds of flaps and other reconstructions. TRAM, DIEP, SIEA, and GAP are among those with new specificity.

Procedure code changes are almost complete and—take a deep breath—know that you can now code noninvasive mechanical ventilation without time modifiers vs. continuous invasive mechanical ventilation with the familiar 96-hour time considerations.

Now, take a break and stock up on food and drink because there are 10 pages of new diagnosis codes plus two pages of revised titles. Rather than detailing the changes here, let’s look at the major issues and then save the reference site for browsing at our leisure on a later date—say, October 1.

The infectious diseases section boasts methicillin-resistant Staphylococcus aureus (MRSA) “septicemia” and “in conditions classified elsewhere,” as well as methicillin-susceptible versions of the same. Not all MRSA is found in the infectious disease codes, expect a new one for MRSA pneumonia at 482.42 and a redefined 482.41 to describe the methicillin-susceptible version of the same. Malignant pleural effusion has a new code (511.81) to keep up with the one for malignant ascites.

A new category (059) enables us to code orthopox, yatapox, and tanapox and poxes from your monkey, seal, cow, other bovine, and nearly any other kind of animal that can possibly spread a pox virus.

Leukemias, multiple myeloma, and other immunoproliferative neoplasms have been given a new fifth digit and associated modified texts. Fifth digits for categories 203 through 208 are now as follows:

• 0, without mention of having achieved remission;

• 1, in remission; and

• 2, in relapse.

Another new category (209) will contain benign carcinoid tumors.

There will also be a new category (249) for secondary diabetes that will mirror the fourth digits of diabetes from the 250 category. Fifth digits will reflect only controlled or uncontrolled states.

Other endocrine disorders will add codes for different types of androgen sensitivity. Even immune mechanisms are lightly represented with extra levels of graft-vs.-host diseases. A new code under disorders of mineral metabolism has finally validated what I’ve sworn to be true for years: There actually is such a thing as hungry bone syndrome. Now the codes for obesity can be replaced with a guilt-free syndrome, and I for one plan to make extensive use of this singular opportunity.

Migraines and other headaches have suffered growing pains this year. There are more types of headaches that can be coded than most of us have ever imagined, all of which can be found in a new category (339). Migraines add fourth and fifth digits to differentiate with and without aura, chronic, persistent, hemiplegic, and other types and even give options for intractability vs. a new term, status migrainosus.

Dural tears add a fifth digit for “procedural complication” as opposed to “other.” Retinopathy of prematurity codes specify stages from 0 to 5 while still allowing for the unspecified version.

Eosinophilic digestive inflammations can now be coded by site and severity. Autoimmune hepatitis has its own code, and hematuria is differentiated as gross, microscopic, or unspecified. Breast deformities and disorders have a few additional choices. Fetal hematologic conditions and fetal conjoined twins can now be reported as complications on the mother’s chart, as can maternal or fetal complications from in utero procedures. Newborns themselves can be coded after birth as having been affected by amniocentesis or other in utero procedures as well.

Category 695 has expanded digits for all kinds of erythematous conditions, and if any of them progress to exfoliation, they can be coded and reported similarly to burns—by percentage of affected body surface, not depth of involvement.

Pressure ulcers are being expanded to include stages when identified and so is necrotizing enterocolitis in newborns. Chapter 16 has some new residents among fevers, urinary symptoms, and quite a few new codes to describe abnormal Pap smears that fall short of qualifying as malignancy. Complication of medical care codes has even been modified to enable reporting of specific problems such as disruption of traumatic injury repair, ventilator-associated pneumonia, and extravasation of vesicant chemotherapy.

Even the V codes have undergone some upheaval among categories for carrier status, prophylactic treatment, personal medical history, and social issues, among others.

Now insert a big sigh of relief here.

We’ve made it through all the ICD-9-CM heavy hitters for the upcoming fiscal year. If you still haven’t had enough, visit the Centers for Medicare & Medicaid Services Web site (www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07
_summarytables.asp#TopOfPage) for detail that can only be found in a government publication. Then order your codebooks, purchase page index tabs and highlighters in multiple colors, and stand by for another challenging year in the world of coding.

— Judy Sturgeon, CCS, is the hospital coding senior manager at The University of Texas Medical Branch in Galveston and a contributing editor at For The Record. While her initial education was in medical technology, she has been in hospital coding and appeal management for nearly 20 years.