Health Information Management

Take note of proposed new and revised ICD-9-CM codes for FY 2011

JustCoding News: Inpatient, May 26, 2010

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The ICD-9-CM code changes CMS outlined in the inpatient prospective payment system proposed rule for fiscal year (FY) 2011 didn’t contain any big surprises. But the revisions continue to reflect the overall move toward greater specificity and serve as a reminder of the looming tornado of change—the switch to ICD-10 in 2013.

New ICD-9 codes

A significant number of new codes address congenital anomalies:

  • 752.31 (agenesis of uterus)
  • 752.32 (hypoplasia of uterus)
  • 752.33 (unicornuate uterus)
  • 752.34 (bicornuate uterus)
  • 752.35 (septate uterus)
  • 752.36 (arcuate uterus)
  • 752.39 (other anomalies of uterus)
  • 752.43 (cervical agenesis)
  • 752.44 (cervical duplication)
  • 752.45 (vaginal agenesis)
  • 752.46 (transverse vaginal septum)
  • 752.47 (longitudinal vaginal septum)

“It’s important to capture these abnormalities of uterus, and physicians usually identify these things well in their documentation so they should be easy to pick up,” says Robert S. Gold, MD, CEO of DCBA, Inc., in Atlanta. However, cervical agenesis and duplication may be difficult to capture simply because these conditions are so rare, Gold adds.

Other changes include a new code for jaw pain, which providers have wanted for a long time. CMS answered this year with code 784.92 (jaw pain), says Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CCDS, director of coding and HIM at HCPro, Inc., in Marblehead, MA.

“This is an example of CMS putting a code in a more appropriate chapter of the [ICD-9] Manual,” McCall says. “Essentially providers had to use a very nonspecific code 526.9 (unspecified disease of the jaw) from the digestive system.”

Code 560.32 for fecal impaction is another interesting change to note, McCall says. “Right now when it comes to the term fecal impaction, which can be a common occurrence, coders would default to code 560.39, for other impaction of intestine,” she says. “In all honesty, fecal impaction was probably the most predominant use of this code so it makes sense to create a specific code.”

Codes addressing blood incompatibility also underwent significant change in the proposed rule. There are a number of new codes:

  • 999.60 (ABO incompatibility reaction, unspecified)
  • 999.61 (ABO incompatibility with hemolytic transfusion reaction not specified as acute or delayed)
  • 999.62 (ABO incompatibility with acute hemolytic transfusion reaction)
  • 999.63 (ABO incompatibility with delayed hemolytic transfusion reaction)
  • 999.69 (other ABO incompatibility reaction)
  • 999.70 (Rh incompatibility reaction, unspecified)
  • 999.71 (Rh incompatibility with hemolytic transfusion reaction not specified as acute or delayed)
  • 999.72 (Rh incompatibility with acute hemolytic transfusion reaction)
  • 999.73 (Rh incompatibility with delayed hemolytic transfusion reaction)
  • 999.74 (other Rh incompatibility reaction)
  • 999.75 (non-ABO incompatibility reaction, unspecified)
  • 999.76 (non-ABO incompatibility with hemolytic transfusion reaction not specified as acute or delayed)
  • 999.77 (non-ABO incompatibility with acute hemolytic transfusion reaction)
  • 999.78 (non-ABO incompatibility with delayed hemolytic transfusion reaction)
  • 999.79 (other non-ABO incompatibility reaction)

“They added a fifth digit to identify the kind of reaction—for example, acute, or delayed,” McCall says. “A lot of the new codes were related to blood and blood components, whereas previously providers only had code 999.6 for ABO incompatibility and code 999.7 for Rh incompatibility.”

In another effort to indicate more specificity, code 276.61 for a transfusion associated circulatory overload includes detail regarding the link between acute decompensation of congestive heart failure (CHF) to a transfusion, which coders have never been able to capture in the past, Gold says.

“We frequently see patients who are borderline stable who get a blood transfusion and develop symptoms because their circulatory system or their heart has difficulties in dealing with the increased volume. Sometimes they may become short of breath, but physicians don’t call it pulmonary edema and they don’t call it acute diastolic heart failure when that’s what happened,” Gold says. “The benefit you get from this code is the fact that you can now specifically link the patient’s development of acute diastolic heart failure to the transfusion.”

Coders should also note a few other new codes CMS provided in the proposed rule:

  • 447.70 (aortic ectasia, unspecified site)
  • 447.71 (thoracic aortic ectasia)
  • 447.72 (abdominal aortic ectsia)
  • 447.73 (thracoabdominal aortic ectasia)

Currently, when trying to assign a code for ectasia of the aorta, one is directed to code 441.9 (aortic aneurysm, unspecified), says Gold. Ectasia is weakening of the wall of the aorta with some dilation, but it is not an aneurysm. It can lead to dissection of the aorta or other complications and, if followed long enough, may lead to aneurysm; but, at the current time, it's not yet an aneurysm.

New V codes

The theme of greater specificity carries over to the V13 code series as well. CMS proposed to add nine new codes, many of which indicate a personal history of (corrected) congenital malformations of various systems (e.g., genitourinary, nervous, respiratory).

CMS also proposed two new V code series: V90 and V91. The 14 new V90.xx codes mainly address various kinds of retained fragments (e.g., metal fragments, plastic fragments, wood fragments).

“I assume that with all the arguments about retained foreign bodies after surgery, that these codes address other things that can be retained that aren’t surgical instruments,” Gold says.

The 17 new V91.xx codes CMS proposed indicate specificity for multiple gestations.

McCall is interested to read the instructional note that would eventually accompany the V91 codes if they are finalized.

“These codes provide more specificity, but I don’t know how these will be applied—on the baby’s charts or on the mother’s chart,” McCall says.

Currently, ICD-9-CM can identify the maternal outcome of delivery codes (V27.x) as being either single, twin, or multiple and for the neonates the same designation by assigning the birth status codes (V30-37). Neither sets of codes identify triplets, quadruplets, and other such multiples so these codes would add specificity to both code sets. With fertility assistance becoming more commonplace, these codes will add the specificity lacking in the current ICD-9-CM code set.

One new V code that may be of interest is V49.86 (do not resuscitate status). “That is something that is normally noted within the medical record but not something that had a code associated with it,” says McCall. She adds that this code, which helps identify when a patient has identified that they do not desire resuscitation (e.g., CPR) performed should they suffer from cardiac or respiratory arrest. This information would be helpful for data-gathering purposes.

CMS also proposed to expand the code series that indicates patient body mass index (V85), adding five new codes to include BMIs ranging from 40 to 70 and greater.

“These codes may present some opportunities in that they are [complications and comorbidities (CC)],” McCall says. “Clinical documentation improvement efforts may need to focus on getting more specificity for BMI because before we only had one code to indicate a BMI of 40 and higher.”

Note that CMS also created a specific code for obesity hypoventilation syndrome (code 278.03), Gold says. This code helps define a condition for a patient who is so large that the abdominal contents are pushing up on the diaphragm, preventing the lungs from working properly (i.e., Pickwickian syndrome).

Although code 278.03 is not a CC, the manifestations of having obesity hypoventilation syndrome frequently are CCs, Gold says. “These people will have right heart failure (chronic cor pulmonale) from restrictive lung disease and often manifest chronic respiratory failure.”

New procedure codes

Note the following new procedure codes:

  • 00.60 (insertion of drug-eluting stent[s] of superficial femoral artery)
  • 32.27 (bronchoscopic bronchial thermoplasty, ablation of airway smooth muscle)
  • 81.88 (reverse total shoulder replacement)

CMS also added a fourth digit for the carotid sinus stimulation device codes (39.8x), and this change accounts for the remaining nine new procedure codes.

The expansion of that fourth digit would be important because it helps to identify a specific device as well as a specific component of that device, McCall says.

“Adding specificity to codes we have now prepares us a little more for the transition to ICD-10,” says McCall, adding that this discussion of new codes raises the current debate over whether CMS should impose a code freeze and if so, when. To learn more about the discussion about a potential code freeze, go to the CMS website, and download the final report summary from the March 9–10 ICD-9-CM Coordination and Maintenance Committee Meeting.

“It’s interesting to think will we have a code freeze next year? Will this be the last year we see changes?” McCall says. “I just think it’s still important for providers to be able to identify new technologies and new diseases in the interim.”

Editor’s note: E-mail your questions to Dr. Gold at DCBAInc@cs.com. E-mail your questions to Shannon McCall at smccall@hcpro.com. Interested in learning more about code changes that take effect October 1? Dr. Gold and Gloryanne Bryant, RHIA, RHIT, CCS, CCDS, regional managing director of HIM for Kaiser Permanente in Oakland, CA, will discuss new and revised codes during HCPro’s August 30 audio conference, “The Impact of the New and Revised 2011 ICD-9-CM Codes.”



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