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Topic: ICD-9-CM Coordination and Maintenance Committee announces several proposed ICD-9 changes (part two)

HIM Connection, April 22, 2008

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Last week, we looked at several changes that the ICD-9-CM Coordination and Maintenance Committee proposed during its March 19–20 meeting. This week, we'll look at several more proposed changes.

[Note that CMS released its 2009 IPPS proposed rule on April 14 in which it suggested new, revised, and invalid ICD-9 diagnosis and procedure codes. Refer to Tables 6A–6F of the proposed rule for changes that CMS is considering.]

• Incidental dural tear—Currently classified as code 998.2, Accidental puncture or laceration during a procedure. Proposal includes a specific code to assist in differentiating this diagnosis. Most surgeons do not consider it a complication, but rather an expected and commonplace occurrence with few long-term issues.
• Hepatic coma and encephalopathy—Proposal to expand code 572.2 to the 5th digit to differentiate between the two conditions.
• Premature birth status—Proposal to add new V code to denote preemies who experience other problems later in life due to being born premature.
• Acute chemical conjunctivitis—Proposal to add a specific code for adequate monitoring.
• Acute heart failure—Proposal to add additional codes to the heart failure code category, 428.
• Family circumstances—Proposal to expand V codes for family disruption to further specify divorce, child in welfare custody, and child in foster care. Other proposals include expanding V codes to include parent-child problems to specify type of parent (e.g., foster versus adopted, etc).
• Awaiting joint prosthesis—Proposal to add a V code for situations in which a patient must undergo a joint prosthesis removal but cannot have a new joint inserted immediately until after he or she has healed.
• Underimmunized or lapsed immunization status—Proposal to add new codes for patients who are underimmunized or whose immunizations have lapsed or have been delayed.
• Preprocedural evaluations—Proposals to expand the prelab code to the fifth digit to identify lab work as part of a general exam versus preoperative lab work.
• Poisoning by antidepressants and psychostimulants—Proposal to expand the now generic code for "poisoning by antidepressants" to include specific types of drugs, such as monoamine oxidase inhibitors, tricyclics, etc. There is also a proposal to expand stimulants to include specific drugs, such as caffeine, methamphetamines, amphetamines, etc.
• Diabetes "out of control"—Proposal to assign this condition as uncontrolled.

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