Health Information Management

ICD-9 procedure code clarification

APCs Insider, September 27, 2003

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September 26, 2003
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MBA, PhD (c),
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HRM, Hospital Resource Management

Andrea Clark
Health Revenue Assurance Associates

Cheryl D'Amato,
director, health information management
HSS, Inc.

Julie Downey,
ambulatory coding coordinator, HIM
University Colorado Hospital

Carole Gammarino,

Julia R. Palmer
president, Health Information Management Division

Valerie Rinkle, MPA,
revenue cycle director
Asante Health System




ICD-9 procedure code clarification

The information concerning ICD-9 procedure codes presented in last week's Monitor created quite a stir in the coding community, and for that, the editor apologizes. The editor acknowledges that the brevity of the announcement probably led to the confusion, as more details would have clarified the information.

The editor would also like to make it clear that the members of the APCs Weekly Monitor Advisory Board had no participation in or knowledge of the article published on Friday, September 19.

Today, we would like to clarify the announcement as a result of further research conducted over the past week.

During the 13th National HIPAA Roundtable hosted by CMS on Thursday, September 25, a question was posed to the panel concerning the confusion created by last week's news brief. A caller asked, "In regards to ICD-9 codes on outpatient claims, is it my understanding that Medicare no longer wants to see ICD-9s on outpatient claims?"

Stanley Nachimson, team leader of regulation staff at CMS's Office of HIPAA Standards, gave this reply, "We must maintain the distinction between diagnosis codes and procedure codes. For diagnosis codes, the ICD-9 code set is the adopted code set for all types of claims and should be continued to be used on any claim. However, if we are talking about ICD-9 procedure codes, ICD-9 procedure codes are only to be used for hospital inpatient procedures; [for] the other procedures, you need to use HCPCS or CPT-4 codes as appropriate.

So this was a discussion perhaps on outpatient procedures where my understanding is some hospitals were putting in the appropriate HCPCS and CPT-4 codes but then providing additional information in the form of the ICD-9 procedure codes. The ICD-9 procedures codes are not the recognized or adopted code set for outpatient procedures, so those should not be used."

The editor also confirmed this information with Stanley Nachimson by phone, and he has offered to help answer any further questions regarding ICD-9 procedure code use. Please e-mail your questions to the editor.

It's important to point out that HIPAA does not restrict the internal use of other coding systems. Therefore, hospitals using mapping tables or other software programs that rely on ICD-9-CM procedure codes can continue using them internally.

It is also important to note that although CMS had set a deadline of October 16 for providers to comply with the HIPAA transactions and code sets rule, on September 23, it published a statement that it will continue to accept noncompliant claims after that date.

Again, the editor gravely regrets any inconvenience the September 19th announcement caused.

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TODAY'S TOPIC: Two days, two claims

Question: A patient is seen in our ED on Tuesday for back pain and receives an injection (90782) and is discharged home, but returns the next day to the ED for sinusitis and receives an injection (90788) and is also discharged home. Our billing department combines these two claims together. Is this the correct way to bill these two claims?

Answer: No, these claims should not be combined. To our knowledge, there are no payers requiring distinct, non-recurring outpatient visits on different dates of service to be combined to a single account. ED visits occurring on different dates are outpatient visits that are non-recurring.

Ask the Expert: What code is being used for non-Q-wave myocardial infarction (MI)?

Questions from readers are answered by a team of experts working in the APC area within the health care industry. Their answers are provided as advice. Readers should consult the federal regulations governing OPPS, related CMS sources, and with their local fiscal intermediary before making any decisions regarding the application of OPPS to their particular situations.

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