Health Information Management

A round-up of new ICD-9 procedure codes for 2010

JustCoding News: Inpatient, September 30, 2009

Want to receive articles like this one in your inbox? Subscribe to JustCoding News: Inpatient!

by Christina Benjamin, MA, RHIA, CCS, CCS-P

In the calm before the ICD-10 storm, CMS added 14 new ICD-9 procedure codes that take effect October 1. These changes include new codes for procedures pertaining to the cardiovascular and respiratory systems. Seven of the new codes will appear in the 17.x procedure code series of the ICD-9 Manual. There are other significant revisions to both the tabular and alphabetical indices for Volume 3 of ICD-9, the most significant of which involves the musculoskeletal system.

Cardiovascular procedure codes

Two new cardiovascular procedure codes denote a cardiac contractility modulation (CCM) system (e.g., Optimizer™ III). CMS added the following two codes for procedures related to this device:

  • 17.51: For the implantation of the whole system, includes parts such as the generator, leads, and pocket creation
  • 17.52: For and the replacement and insertion of the pulse generator portion of the system

The CCM system is rechargeable. Although it is similar to a pacemaker or other cardiac rhythm monitoring device, the CCM is designed to use non-excitatory signals—instead of excitatory signals—to enhance the strength of the left ventricular heartbeat rather than initiate a new one. CCM systems are more complex than pacemakers or defibrillators, so it is more complicated for physicians to insert them as well.

Just as with other cardiac devices, intraoperative device testing is not coded separately. However, coders should report any concomitant procedures (e.g., cardiac bypass or extracorporeal circulation) separately.

The next significant code additions are for intravascular imaging of vessels by optical coherence tomography:

  • 38.24: For coronary vessels
  • 38.25: For non-coronary vessels

This new imaging technology allows providers to see a detailed image of the degree of vessel plaque build-up as well as any associated injury following stent implantation.

The last pair of new cardiovascular-related procedure codes are for endovascular embolization or occlusion of vessels of the head and neck:

  • 39.75: Using bare coils
  • 39.76: Using bioactive coils 

Note that the head and neck vessels include the common carotids and all branches of the common carotids.

Report code 39.72 (Endovascular embolization or occlusion of head and neck vessels) for procedures that do not involve the coils.

In accordance with these changes and the new guidance from Coding Clinic 2009, second quarter, procedure code 39.79 was revised to state ‘other endovascular procedures on other vessels.’ Instead, CMS includes other coil embolization or occlusion not classifiable with procedure codes 39.75 and 39.76.

Transcatheter embolization or occlusion is also classified to procedure code 39.79 instead of procedure code 99.29 per new index directives in ICD-9. Code 99.29 is reserved for embolization via percutaneous transcatheter infusion, per the alphabetical index.

Coders may become confused when they try to assign the codes for stenting and angioplasty. Procedure codes 39.50 and 39.90 (a revised code) specify non-coronary vessels only. The following crosswalk may help coders understand the proper reporting for percutaneous angioplasty/atherectomy and the related stenting codes:

  • Report code 00.61 with code 00.63 (carotid vessels)
  • Report code 00.61 with code 00.64 (other precerebellar vessels)
  • Report code 00.62 with code 00.65 (intracranial vessels only)
  • Report code 00.66 with either code 36.06 for non-drug eluting or code 36.07 for drug eluting stent (coronary vessels only)
  • Report code 39.50 with either code 39.90 for non-drug eluting or code 00.55 for drug eluting stent (all other non-coronary vessels)

Other minor revisions include the new index entry classifying the impella external heart assist to procedure code 37.68 (Insertion of percutaneous external heart assist device).

CMS also revised codes 00.56 and 00.57 for intracardiac hemodynamic monitoring to include great vessels (e.g., aorta, vena cavae, and pulmonary arteries and veins).

Respiratory procedure codes

A new technology provision resulted in the sole procedure code change for the respiratory system: Code 33.73 for endoscopic insertion/replacement of bronchial valve(s), multiple lobes.

Code 33.71 was revised to indicate insertion or replacement of the valve(s) in a single lobe.

Per the 2010 inpatient prospective payment system (IPPS) final rule, the new technology was called the Spiration® IBV® Valve System. According to the 2010 IPPS final rule:

This is a device that is used to place, via bronchoscopy, small, one-way valves into selected small airways in the lung in order to limit airflow into selected portions of lung tissue that have prolonged air leaks following surgery while still allowing mucus, fluids, and air to exit, thereby reducing the amount of air that enters the pleural space. The device is intended to control prolonged air leaks following three specific surgical procedures: lobectomy; segmentectomy; or lung volume reduction surgery.

Therefore, the add-on payment (a maximum of $3,437.50) is rendered only for cases that include the procedure codes for a lobectomy, segmentectomy, or lung volume reduction surgery.

Another respiratory-related revision to the alphabetical and tabular indices is the inclusion of transbronchial needle aspiration and Wong needle aspiration biopsy of bronchus for code 33.24 (Closed [endoscopic] biopsy of bronchus). CMS also revised the notes below codes 34.1 (Inclusion of mediastinum) and 34.22 (Mediastinoscopy), instructing coders to separately report any biopsy when performed.

Other new procedure codes

CMS added two new codes related to procedures of the digestive system:

  • 46.86: For the endoscopic insertion of colonic stent(s)
  • 46.87: For the insertion of colonic stent(s) via any method other than endoscopy

Other miscellaneous revisions in the code instructions for ICD-9 Volume 3 include the following:

  • Coders are directed to omit the code for retightening of a noninvasive or external fixation device
  • Intrauterine pressure measurement is indexed to code 75.35 (Other diagnostic procedures on fetus and amnion)
  • Intraoperative anesthetic effect monitoring and titration is indexed to 00.94 (Intra-operative neurophysiologic monitoring). Code 89.14 (Electroencephalogram) must be secondary.

The following new procedure codes relate to oncology-related technologies:

  • 17.70: For IV infusion of the CLOLAR® (clofarabine), which is a chemotherapeutic agent used for leukemia and requiring inpatient admission
  • 17.61: For laser interstitial thermal therapy [LITT] of lesion or tissue of brain under guidance, which is used to treat patients with glioblastoma multiforme brain tumors

CMS created an entirely new code category for LITT of various sites:

  • 17.62: For the head and neck
  • 17.63: For the liver
  • 17.69: For other and unspecified anatomical sites

CMS made several important code revisions for orthopedic procedures, although it did not create any new codes.

Code series 80.0x is revised to indicate arthrotomy for removal without replacement of prosthesis. Physicians perform this type of procedure in cases involving infection. This change was meant to distinguish this procedure from arthrotomies performed for removal and replacement of prosthesis done during the same encounter. For these procedures, report a code such as 00.8x for total or partial revision of hip and knee replacements.

One important revision to the index now directs coders to assign the code for total joint replacements for elbow and knee replacements even when the physician only performed a partial initial replacement.

Do not confuse the fact that the 00.8x code category mentioned above addresses partial knee revisions; this is different from initial partial knee replacements.

On the other hand, coders can report the initial hip replacement codes (e.g., code 81.51) for revision of a hip replacement when the revision components are not specified. This is why it is necessary for CMS to add a note that coders should not separately report the removal of a prosthesis in the instance of a revision.

This index revision—as well as several other changes outlined in this article—reflect ICD-9’s inability to expand. These changes also further support a rationale for transitioning to ICD-10.

Editor’s note: Christina Benjamin, MA, RHIA, CCS, CCS-P, is an independent coding and education consultant in East Dublin, GA. E-mail her at cmbenjamin@bellsouth.net.

This article was based primarily on a September 17American Health Information Management Association audio seminar series, “FY10 ICD-9-CM Procedure Code Updates.”



Want to receive articles like this one in your inbox? Subscribe to JustCoding News: Inpatient!

Most Popular