This year's ICD-9 update
A look at code changes that hospitalists need to know
Keywords: Key 2012 ICD-9 code changes for infection, respiratory failure, personal history, anaphylaxis, and more
by Kristy Welker, CPC, CAC
Published in the January 2012 issue of Today's Hospitalist
Once again, it's time to review the annual update to diagnostic codes, which actually took effect Oct. 1. The new year ushers in more than 168 new codes, as well as 41 revised codes, 32 invalid ones and one that's been deleted.
That's a minimal number of changes compared to recent years—and rumor has it, there won't be any changes at all in the 2012 edition of ICD-9 coming out this fall. That's to give people a chance to gear up for the impending implementation of ICD-10, which takes place in October 2013.
But even with the relatively few changes this year, it's important to think about the impact these changes could have on your practice. To successfully implement new codes, you need to update your superbills, electronic medical records, and billing and coding software. You also need to make sure that your coding staff is completely up to speed on what's new and different. If you have not already done that housekeeping, do so immediately to head off an increase in delayed payments or denied claims.
Here are some code changes that affect hospitalists. A complete list of the new, revised and deleted ICD-9 codes is available on the Centers for Disease Control and Prevention Web site.
Mental health disorders (294.20-294.21)
The category 294.2 was added to identify the presence or absence of behavioral disturbance when you don't know the etiology of the dementia.
Pneumothorax and air leak (512.2, 512.82-512.89)
The subcategory 512 has been expanded to include codes for postoperative and other air leaks. In addition, four new codes have been added for primary, secondary, chronic or other pneumothorax.
Postoperative respiratory failure (518.51-518.53)
Three unique new codes were added to classify acute respiratory failure following trauma and surgery (518.51); other pulmonary insufficiency, NEC, following trauma and surgery (518.52); and acute and chronic respiratory failure following trauma and surgery (518.53).
Pilar cyst (704.41–704.42)
These codes were added to correctly identify the condition of pilar cysts.
Postoperative shock (998.00-998.02, 998.09) Postoperative shock now requires a fifth digit. It has also been expanded into codes for cardiogenic, septic, other and unspecified.
Infection due to central venous catheter (999.31-999.34)
Three new codes have been added to the existing (but newly revised) code 999.31 to further identify the type of infection:
999.32: bloodstream infection due to central venous catheter
999.33: local infection due to central venous catheter
999.34: acute infection following transfusion
Anaphylactic reaction (999.41-999.49)
These codes used to be titled "anaphylactic shock," but "anaphylactic reaction" is now the umbrella term that includes both with and without shock. Additionally, codes for anaphylactic reactions have been expanded to include specific codes for reactions due to administration of blood and blood products, vaccinations, and other serum.
Personal history V-codes
Hospitalists will also find several new personal history V-codes. V-codes represent circumstances other than a disease or injury that you must factor into patient care. Here's a list of the V-codes that hospitalists will likely use:
V12.21: personal history of gestational diabetes
V12.29: personal history of other endocrine, metabolic and immunity disorders
V12.55: personal history of pulmonary embolism
V13.81: personal history of anaphylaxis
V13.89: personal history of other specified diseases
V40.39: other specified behavioral problem
Other new codes of interest include:
414.4: coronary atherosclerosis due to calcified coronary lesion
425.11: hypertrophic obstructive cardiomyopathy
425.18: other hypertrophic cardiomyopathy
444.01: saddle embolus of abdominal aorta
488.81: influenza due to identified novel influenza A virus with pneumonia
488.82: influenza due to identified novel influenza A with other respiratory manifestations
488.89: influenza due to identified novel influenza A virus with other manifestations
516.30: idiopathic interstitial pneumonia, not otherwise specified
516.31: idiopathic pulmonary fibrosis
516.32: idiopathic nonspecific interstitial pneumonitis
516.33: acute interstitial pneumonitis
516.34: respiratory bronchiolitis interstitial lung disease
516.35: idiopathic lymphoid interstitial pneumonia
516.36: cryptogenic organizing pneumonia
516.37: desquamative interstitial pneumonia
997.32: post-procedural aspiration pneumonia
In addition, several code revisions bring new language to existing codes:
323.41: other encephalitis and encephalomyelitis due to other infections classified elsewhere
323.42: other myelitis due to other infections classified elsewhere
488.11: influenza due to identified 2009 H1N1 influenza virus with pneumonia
488.12: influenza due to identified 2009 H1N1 influenza virus with other respiratory manifestations
488.19: influenza due to identified 2009 H1N1 influenza virus with other manifestations
Kristy Welker is an independent medical coding consultant based in San Diego. E-mail your documentation and coding questions to her at email@example.com. We'll try to answer your questions in a future issue of Today's Hospitalist.