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Tip: Understand ICD-9-CM procedure codes

Ambulatory Surgery Reimbursement Update, April 21, 2008

Some payors require you to file ICD-9-CM procedure codes, located in volume 3 of the ICD-9-CM handbook for ASC facility services filed on UB-04 claim forms (excluding Medicare, for whom ASCs file CMS-1500 claim forms).

There are considerably fewer ICD-9 procedure codes than there are CPT procedure codes, which are usually more detailed. For each CPT code to be billed, look up a corresponding ICD-9-CM procedure code using a coding software program or in the index to procedures in volume 3 of the ICD-9-CM handbook. These codes are two digits, with occasional third or fourth digits following a period.

For example, the 53.03 ICD-9 procedure code for a unilateral repair of a direct inguinal hernia with mesh, indicates mesh was used in the procedure and does not focus on the patient's age, whereas the corresponding CPT code 49505 for the repair of an initial inguinal hernia, age five years or older; reducible, focuses on whether the hernia was an initial or recurrent hernia, the patient's age, and whether the hernia was reducible or not. It does not reference whether or not the physician used mesh.

Another example would be with colonoscopy procedures. For CPT code 45385 for a colonoscopy with polypectomy by snare technique, the corresponding ICD-9 procedure code (45.42) for an endoscopic polypectomy of the large intestine would also be used for polypectomies by hot biopsy forceps (45384) and fulguration/ablation or other method (45383).

The National Correct Coding Initiative (NCCI) unbundling materials do not reference ICD-9 procedure codes, because they are for CPT codes only. Thus, you should look up the CPT codes for multiple procedures in the NCCI material prior to assigning ICD-9 procedure codes. You may not use modifiers on ICD-9 procedure codes. Usually, only one ICD-9 procedure code is assigned to correspond with each CPT code you bill, however, some procedures will have two ICD-9 procedure codes to correspond with one CPT procedure code.

For example, a procedure that would have one CPT code and two ICD-9 procedure codes would be CPT code 58262 for a vaginal hysterectomy, for uterus 250g or less; with removal of tube(s), and/or ovary(s). The corresponding ICD-9 procedure codes are code 68.59 for other and unspecified vaginal hysterectomy and code 65.61 for other removal of both ovaries and tubes during same operative episode.

This tip is brought to you by Ellis Medical Consulting, Inc.

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