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A look at new and revised ICD-9 codes that will affect hospitalists
The newly updated diagnosis codes need to be implemented right now
by Tamra McLain, CPC, CPC-H, CMC

Published in the October 2006 issue of Today's Hospitalist

With students once again trudging off to school, it’s time to start studying the ICD-9 code updates mandated every year by the Centers for Medicare and Medicaid Services (CMS).

Keep in mind that, unlike in years past, the CMS no longer provides any grace period to learn and implement changes. The changes take effect with services as of Oct. 1, which means you need to be implementing them right now. When you’re implementing the changes in your practice, be sure to update all systems, including PDAs and billing software.

It’s a good idea to
Coding changes take effect with services as of October 1

look over the code changes in their entirety to make sure you’re up-to-date with any changes that could affect your practice. The complete list of new, deleted and revised ICD- 9 codes for 2007 is available on the CMS’ Web site.

Here’s a look at the new and revised ICD-9 codes most relevant to hospitalists.

There are now three new codes to use for myelitis:
• 052.2: post varicella myelitis
• 053.14: herpes zoster myelitis
• 054.74: herpes simplex myelitis

Pancytopenia was previously grouped under “other anemias.” It now has its own ICD-9 code: 284.1.

New codes for neutropenia are now cause-specific:
• 288.00: unspecified
• 288.01: congenital neutropenia
• 288.02: cyclic neutropenia
• 288.03: drug induced neutropenia
• 288.04: neutropenia due to infection
• 288.09: other neutropenia

White blood cell diseases
Many of these conditions used to be classified under non-specific codes. Due to their frequency of occurrence, they have now been individualized:
• 288.4: hemophagocytic syndromes
• 288.50: leukocytopenia, unspecified
• 288.51: lymphocytopenia
• 288.59: other decreased white blood cell count
• 288.60: leukocytosis, unspecified
• 288.61: lymphocytosis (symptomatic)
• 288.62: leukemoid reaction
• 288.63: monocystosis (symptomatic)
• 288.64: plasmacytosis
• 288.65: basophilia
• 288.69: other elevated white blood cell count

Nervous system and sense organs
This represents a new coding category. It includes a long-overdue code—338.4—for chronic pain syndrome, so we can stop using the overly generic 780.99 “other general symptoms” code:
• 338.0: central pain syndrome
• 338.11: acute pain due to trauma
• 338.12: acute post-thoractomy pain
• 338.18: other acute postoperative pain
• 338.19: other acute pain
• 338.21: chronic pain due to trauma
• 338.22: chronic post-thoractomy pain
• 338.28: other chronic postoperative pain
• 338.29: other pain
• 338.3: neoplasm related pain (acute/chronic)
• 338.4: chronic pain syndrome

The 345 category for epilepsy has been revised. The new codes include the following:
• 345.40: localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy
• 345.41: localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy
• 345.50: localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy
• 345.51: localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy

Hypertension heart disease with chronic kidney disease
The code revisions in categories 403 and 404 are driven by the following three characteristics:
• chronic kidney disease stages 1-4 vs. 5 or end stage
• malignant vs. benign
• with heart failure vs. without

Base your code choice for the fourth and fifth digit on those three characteristics. Check your coding book carefully to ensure the proper choice.

Pregnancy-related codes
Several new codes for 2007 are for conditions that affect pregnant patients, including smoking, coagulation issues, obesity issues and epilepsy. Keep in mind that general symptoms and diseases are not coded the same way for pregnant patients. Instead, refer to ICD-9 categories 630 to 677.

Other new codes to consider
These include a code—780.96—for generalized pain, which again helps us steer clear of the too generic 780.99 code:
• 780.96: generalized pain
• 780.97: altered mental status
• 784.91: postnasal drip
• 788.64: urinary hesitancy
• 788.65: straining on urination

Traumatic compartment syndrome
This category now has five new codes:
• 958.90: compartment syndrome unspecified
• 958.91: compartment syndrome of upper extremity
• 995.92: compartment syndrome of lower extremity
• 995.93: compartment syndrome of abdomen
• 995.99: compartment syndrome of other sites

The sepsis codes have been revised to include the following:
995.91: sepsis
995.92: severe sepsis
995.93: systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction
995.94: systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction

Always remember that the more specific and accurate we can be with diagnosis coding, the cleaner the claim. While that won’t guarantee higher levels of reimbursement, it will show the medical necessity of the services you are billing for.

Tamra McLain is an independent coding consultant in Southern California. E-mail your documentation and coding questions to her or send a fax to 951-926-2702. We’ll try to answer your questions in a future issue of Today’s Hospitalist.

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