Published in the January 2010 issue of Today’s Hospitalist
THE BIG BILLING NEWS THIS MONTH concerns consultation codes. While the AMA’s CPT book for 2010 still uses these codes, the Centers for Medicare and Medicaid Services (CMS) as of Jan. 1 is eliminating the use of both outpatient consult codes (99241-99245) and inpatient consult codes (99251-99255).
Related resource: 40+ Collected Coding Tips
Apparently, the CMS decided to end the use of consult codes because of all the confusion over how to distinguish a transfer of care from a consultative service. Just to add to the confusion, while this change applies to Medicare patients as of the beginning of this month, you can continue to bill consults (when you legitimately render them) for private-payer patients. Private insurers may, however, implement a similar change of their own sometime this year.
It’s important to note that admitting physicians may not be the only ones using the admit codes. Any provider who renders an inpatient consultation service for a Medicare patient should bill one of the initial hospital visit codes (99221-99223). (For non-hospital locations, use the initial nursing facility care codes “99304-99306 “or initial office visit codes, 99201-99205.)
However, if you are the admitting physician, you also will use an admission code, but you will append a modifier to that code to indicate your status as admitting physician. At press time, I received the official word that the modifier to be used is “-AI.”
As for documentation requirements, those will now mirror the requirements for the initial visit code that you select. However, according to CMS guidance, “physicians should continue to follow appropriate medical documentation standards and communicate the results of the evaluation to the requesting physician.” (For more analysis, see “Consult codes are going away.”)
The other big news is that the 2010 edition of the ICD-9 codes was published and took effect Oct. 1, 2009. Most of the new codes add a higher level of disease specificity, which is the look of things to come when ICD-9 gives way to ICD-10 in October 2013. That gives you several years to get used to providing this level of detail in documentation and coding.
Here are some additions and changes that affect hospitalists:
A fifth digit is now required to report stages of gout arthropathy, 274.0:
- 274.00: gouty arthropathy, unspecified
- 274.01: acute gouty arthropathy
- 274.02: chronic gouty arthropathy without mention of tophus
- 274.03: chronic gouty arthropathy with tophus (tophi)
Venous embolism and thrombosis
Diagnosis code 416.2 has been added to identify chronic pulmonary embolism.
Some revisions and additions were made to differentiate between patients with chronic vs. acute venous embolism/thrombosis for both lower and upper extremities.
- 453.40-453.42: acute, lower extremities
- 453.50-453.52: chronic, lower extremities
- 453.71-453.79: chronic, upper extremities
- 453.81-453.89: acute, upper extremities
Further, diagnosis code 453.2 was revised to clarify that it should be used only for patients with an embolism or thrombosis in the inferior vena cava. Report embolisms and thrombosis of the superior vena cava with the upper extremity acute (453.77) or chronic (453.87) codes.
The new code for venous embolism and thrombosis of superficial vessels of lower extremity (453.6) allows you to report more superficial vessel embolism or thrombosis of the lower extremity.
The ICD-9 code for influenza due to identified avian influenza virus, 488, has been revised and expanded to two four-digit codes to specify either an avian or H1N1 flu infection:
- 488.0: influenza due to identified avian influenza virus
- 488.1: influenza due to identified H1N1 influenza virus
To report influenza viruses, continue to use the 487.0′ 487.8 category codes.
The description for diagnosis code 572.2, hepatic coma, has been revised to hepatic encephalopathy to more accurately reflect all levels.
The codes 584.5-584.9 for acute kidney failure have been revised to more clearly identify which codes should be used for acute kidney failure and not for other renal issues.
Signs and symptoms involving an emotional state
A new category of codes has been created to represent patients with a late effect of traumatic brain injuries without specific diagnoses.
The diagnosis code for nervousness (799.2) now encompasses a category of codes for signs and symptoms involving an emotional state, which requires a fifth digit. (If the symptom is inherent in the established diagnoses, don’t report it separately.) The late effect code for the injury can be used in addition to the symptom codes, such as late effect of intracranial injury without mention of skull fracture.
Here are the revised and added diagnoses:
- 799.21: nervousness
- 799.22: irritability
- 799.23: impulsiveness
- 799.24: emotional lability
- 799.25: demoralization and apathy
- 799.29: other signs and symptoms involving emotional state
The number of poisoning codes was increased and a new, fifth-digit requirement was added to better distinguish the substance taken in an overdose. The added code ranges are 969.00-969.09 and 969.70-969.79.
In addition, ICD-9 changes for 2010 include a host of new supplementary V-codes, which represent circumstances other than a disease or an injury that factor into patient care. ICD-9 has also added E-codes, which represent external causes. Among the latter, the biggest change was the substantial inclusion of war-related E-codes.
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.