New ICD-9 and CPT codes that every hospitalist needs to know
A slew of new codes affects how you bill for conscious sedation, decubitus ulcers, diabetes mellitus and cerebral problems
Keywords: New ICD-9 and CPT codes for DVT, Diabetes, CVA, and more
by Tamra McLain, CPC, CPC-H, CMC
Published in the March 2005 issue of Today's Hospitalist
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At the end of every year, medical coders wait to see what changes will be made to code sets in the form of new codes, revised text and deletions of obsolete codes. As quickly as medical technology changes, the codes we use for reimbursement change as well.
Here’s an overview of the recent changes in both ICD-9 and CPT codes, and how they will affect hospitalists.
As of Jan. 1, 2005, there are now 173 new CPT codes, 59 revised codes and 46 deleted codes. A new feature of this year’s CPT book is that all of these changes are summarized in appendix B, helping you avoid the frustrating task of flipping from page to page to find changes.
When it comes to evaluation and management coding, the single biggest change applies to the care of neonates. CPT revised the definition of neonate to birth through 28 days of age (from the old definition of birth through 30 days).
While there are no major changes to CPT for hospitalists, the codes for many procedures commonly performed in the inpatient setting now include conscious sedation. CPT has flagged these codes with a new symbol to indicate that you should not use a separate code for sedation. (CPT also lists codes that include conscious sedation in appendix G.) If you bill for both the code and sedation, Medicare will consider it unbundling, and you will be denied payment.
While the list of codes that now includes conscious sedation is long, it includes bronchoscopy, upper and lower GI endoscopy, echocardiography, cardiac electrophysiology studies, and several procedures involving surgical debridement for necrotizing soft tissue infection.
Effective Oct. 1, 2004, ICD-9 took several codes that were previously vague and made them much more specific. In all, there are 171 new codes, 25 deleted codes and more than 200 revisions to consider.
These changes will have the greatest impact on you as a hospitalist as you strive to show medical necessity for higher levels of care. Here are a few of the more important ICD-9 changes to keep in mind:
• Decubitus ulcers. In the past, ICD-9 gave physicians no chance to list anatomical sites for ulcers. This was a problem if you were treating patients with multiple ulcers because you had no way to show that your medical decision-making was complex. With the changes that took place last year, you must now use a fifth digit to show anatomical location.
• Diabetes mellitus without complication. While the code for this condition remains the same—250.0—ICD-9 has made revisions to the fifth digit of this code. (Revisions are marked by text that has a line through it.) 0. Type II or unspecified type, not stated as uncontrolled. 1. Type I [insulin dependent type] [IDDM] [juvenile type], not stated as uncontrolled. 2. Type II [non-insulin dependent type] [NIDDM] [adult onset type], or unspecified type, uncontrolled. 3. Type 1 [juvenile type], uncontrolled.
There are some other significant changes to ICD-9 codes for diabetes mellitus in the inpatient setting. For long-term use of insulin, add new code V58.67. In addition, several new codes allow you to specify other types of manifestations associated with diabetes. (See “New ICD-9 codes to indicate manifestations of diabetes,” for a list of these new codes.)
• Cerebral vascular accident (CVA). While the definition of ICD-9 code 436 remains “acute, but ill-defined, cerebrovascular disease,” ICD-9 has created a new code, 434, and several fifth digits for occlusion of cerebral arteries. Because the following new codes are much more specific, consider using them instead of the older, more vague codes for cerebral problems:
434.00: cerebral thrombosis without mention of cerebral infarction.
434.01: cerebral thrombosis with mention of cerebral infarction.
434.10: cerebral embolism without mention of cerebral infarction.
434.11: cerebral embolism with mention of cerebral infarction.
434.90: cerebral artery occlusion (ischemic), unspecified, without mention of cerebral infarction.
434.91: cerebral artery occlusion (ischemic), unspecified, with mention of cerebral infarction.
• Deep vein thrombosis (DVT). In the past, ICD-9 used code 453.8 for “other specified veins” and 453.9 for “unspecified site.” Those codes have been changed to the following:
453.40: venous embolism and thrombosis of unspecified deep vessels of lower extremity.
453.41: venous embolism and thrombosis of deep vessels of proximal lower extremity.
453.42: venous embolism and thrombosis of deep vessels of distal lower extremity.
Tamra McLain is an independent coding consultant in Southern California. E-mail her your documentation and coding questions or send a fax to 888-202-1601. We’ll answer your questions in a future issue of Today’s Hospitalist.