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Hospitalists need to know new ICD-9 codes for neoplasms, diabetes, headaches, fractures, MRSA, and fever
Is your practice up to speed on changes that have taken effect?
by Kristy Welker, CPC



Published in the November 2008 issue of Today’s Hospitalist


Stay up-to-date with coding changes: Coding Tips & Strategies for 2014


While you may be used to reading about changes to ICD-9 codes each fall, this year’s changes, which took effect Oct. 1, may come as a surprise. That’s because there are more than 300 new codes, 55 revised codes and more than 20 code deletions, which far exceed the number of changes in recent years.

With so many revisions, it’s more important then ever to make sure you think about how these changes may affect your practice.
This year, physicians have to wrestle with more than 300 new codes.

You need to immediately update your superbills, electronic medical records and billing/coding software and make sure that your coding staff is up to speed.

If your practice isn’t ready, expect to see more delayed payments and denied claims. With that in mind, here’s a look at some of the changes that affect hospitalists the most.

MRSA
A new ICD-9 code was added to identify MRSA infections: 041.12, methicillin-resistant Staphylococcus aureus. In the past, this infection was reported using one of two codes: 041.11 (Staphylococcus aureus), or 038.11 (Staphylococcus aureus septicemia with V09.0, methicillin- resistant Staphylococcus aureus) to capture the nature of a MRSA infection. The good news is that now, only one code is required.

New codes have also been added or changed to report other conditions related to MRSA: ν 041.11 has been revised and should now be used to report methicillin-susceptible Staphylococcus aureus (MSSA).

  • 038.11 has been revised to indicate that the infection is MSSA septicemia.

  • 038.12 has been added to indicate MRSA septicemia.

  • 482.42 has been added to report methicillin-resistant pneumonia due to Staphylococcus aureus.

Prion disease
Section 046 has been revised to reflect current medical knowledge by including prion diseases. This condition is now described as slow virus infections and prion diseases of the central nervous system.

A new subcategory for other prion diseases has been added to report Gerstmann-StrSussler- Scheinker (GSS) syndrome and fatal familial insomnia (FFI), both of which are familial neurodegenerative disorders. Previously, all forms were reported with 046.1, which specified Jakob Creutzfeldt disease.

Neoplasms
There are a significant number of new and revised codes to report neoplasms.

First, there is a new code—199.2—that you must use to represent malignant neoplasm associated with transplanted organs.

To indicate that patients with multiple myeloma, immunoproliferative neoplasms and leukemia are in relapse, you must use the fifth-digit subclassification “2” for codes in categories 203 through 208. In the past, fifth-digit choices were available only to indicate a mention of remission. You now need to document that the patient is “in relapse,” so don’t code a patient with multiple myeloma in relapse as 203.02

A new series of codes—209.0 through 209.69—covers three general areas primarily involving carcinoid tumors, carcinomas and benign carcinoid tumor. These new codes also allow for specific site locations.

Diabetes
In the past, there was no way to link diabetes to any secondary manifestations. This year, a new section— 249—has been created, and 20 new codes have been added to indicate secondary diabetes.

A fifth-digit indicator must be used much in the way that codes are reported in the 250 section for diabetes mellitus. Use “0” to indicate “not stated as uncontrolled, or unspecified,” and “1” for uncontrolled secondary diabetes.

As with the 250 series, codes in the 249 section allow you to report complications. These codes will not, however, be used to report secondary diabetes caused by removal of the pancreas. Continue to use ICD-9 code 251.3, postsurgical hypoinsulinemia.

Here’s a look at other new and revised codes:

Heparin-induced thrombocytopenia (HIT). A new code—289.84—has been added to the diagnosis of HIT. Previously, two codes were required to report this condition: secondary thrombocytopenia, 287.4, and the adverse effect of an anticoagulant, E934.2.

Headaches. Another new section—339, other headache syndromes—identifies 24 different types of headaches. You need to use these codes to document not only the type of headache, but whether it’s episodic, chronic or acute. (Headache as a symptom without further specification should still be coded as 784.0.) Migraine headaches (section 346) has had a fifth-digit subclassification code added or revised to indicate the following:

  • 0: without mention of intractable migraine, without mention of status migrainosus;

  • 1: with intractable migraine, so stated, without mention of status migrainosus;

  • 2: without mention of intractable migraine with status migrainosus; and

  • 3: with intractable migraine, so stated, with status migrainosus.

Pressure ulcers. The description of code 707.0 has changed from decubitus to pressure ulcers. There are also five new codes—707.20 through 707.25—that must be used to describe the stage of the pressure ulcers. Four of these codes refer to the standard stages of pressure ulcers, while the fifth allows you to describe pressure ulcers as being in an “unspecified stage.”

Stress fractures. Codes 733.93 through 733.98— which are used to document stress fractures of tibia/ fibula, metatarsals, other bone, various femoral fractures and stress fracture of the pelvis—must all be supplemented with an additional external cause code (E code) to identify the cause of stress fractures.

Fever. It’s no longer adequate to use a single code—780.6— for fever. You must now use a fifth digit— and choose from codes 780.60 through 780.65— to include other physiologic disturbances of temperature regulation and to identify the various causes of fevers. Here are the new codes:

  • 780.61: fever presenting with conditions classified elsewhere;

  • 780.62: postprocedural fever;

  • 780.63: postvaccination fever;

  • 780.64: chills (without fever); and

  • 780.65: hypothermia not associated with low environmental temperature

Wound disruption. This year’s expansion and modifications to the disruption of wound codes 998.30 through 998.33 help distinguish between types of wounds: traumatic wounds, surgical wounds and external.

V codes. Finally, there are many new “V” codes, which represent circumstances other than a disease or an injury that factor in patient care. For hospitalists, the most commonly used would be “history of,” “noncompliance,” “status post surgical” diagnoses, new “personal history” codes and exposures to hazardous substances.




Kristy Welker is an independent medical coding consultant based in San Diego. E-mail your documentation and coding questions to her at kristywelker@hotmail.com. We’ll try to answer your questions in a future issue of Today’s Hospitalist.

A complete list of the 2009 ICD-9 codes is available on the CDC’s Web site: www.cdc.gov/nchs/icd9.htm.

A look at 2008 codes that are no more

046.1: Jakob-Creutzfeldt disease
051.0: Cowpox
136.2: Specific infections by free-living amebae
259.5: Androgen insensitivity syndrome
337.0: Idiopathic peripheral autonomic neuropathy
511.8: Other specified forms of pleural effusion, except tuberculous
599.7: Hematuria
611.8: Other specified disorders of breast
695.1: Erythema multiforme
729.9: Other and unspecified disorders of soft tissue
760.6: Surgical operation on mother
777.5: Necrotizing enterocolitis in fetus or newborn
780.6: Fever
788.9: Other symptoms involving urinary system
795.1: Nonspecific abnormal Papanicolaou smear of other site
997.3: Respiratory complications
999.8: Other transfusion reaction
V13.5: Personal history of other musculoskeletal Disorders
V15.2: Personal history of surgery to other major organs
V15.5: Personal history of injury
V28.8: Encounter for other specified antenatal screening
V45.1: Renal dialysis status
V51: Aftercare involving the use of plastic surgery
V61.0: Family disruption
V62.2: Other occupational circumstances or maladjustment
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