Vol. 16 •Issue 21 • Page 12
Know the October 2006 ICD-9-CM Changes: Part 1 Diagnosis Codes
To be prepared for the CCS and CCS-P exams, coders should be aware of the latest ICD-9-CM code revisions, additions and deletions. Being conscious of these coding changes will help applicants prepare for the test. Especially now that the exam is electronic, the latest coding updates will be included to prevent coders from using memorized codes and to test that they are using the necessary ongoing education required of coding professionals. This column focuses on ICD-9-CM diagnosis changes, especially commonly used and memorized diagnosis codes, as well as areas where a significant number of revisions have been made. Part 2 will review the procedure changes. There are a total of 211 new, 55 revised and 29 invalid diagnoses codes effective Oct. 1, 2006. All of the invalid codes are a result of code expansions. Visit www.advanceweb.com/him for a complete list of all diagnoses codes and descriptions.
Twenty-eight new codes have been created for this section. Code 238.7, Lymphatic and hematopoietic tissue neoplasm of uncertain behavior, has been expanded to create seven unique codes for essential thrombocythemia, myelodysplastic syndrome and myelofibrosis with myeloid metaplasia.
Category 284, Aplastic anemia, has been expanded to read as Aplastic anemia and other bone marrow failures, and two new codes have been added. Subcategory 284.0, Constitutional aplastic anemia, has been expanded to create two new codes.
Category 288, Disease of white blood cells, has a number of changes. Code 288.0, Agranulocytosis, was deleted and new subcategory 288.0, Neutropenia, was created in its place to create unique codes for congenital, cyclic and drug-induced neutropenia. New subcategory 288.6 was created to report elevated white blood count diagnoses.
Thirteen codes have been added to category 323, Encephalitis, myelitis and encephalomyelitis. The majority of the changes were made so that myelitis, an inflammation of the spinal cord, can be uniquely identified. Myelitis can have a number of possible presentations and possible underlying causes. Some of the potential causes of myelitis include infectious, post-infectious, post-vaccination and toxic mechanisms. A number of other disorders can also cause a secondary demyelinating acute transverse myelitis, including tumor, trauma, herniated intervertebral disk, hemorrhage, dissecting aortic aneurysm arteritis and systemic lupus erythematosis.
A number of new codes have been created for reporting pain. A new category, 338, Pain, not elsewhere classified, was added to the nervous system chapter. This new subcategory includes codes that can be used to report acute pain, chronic pain, postoperative pain, pain due to trauma, neoplastic pain and others.
Code 780.96, Generalized pain, has been created to report pain not otherwise specified.
Hypertension Chronic Kidney Disease
Changes were made again this year for codes used to report chronic kidney disease. This year, however, the changes have been made to the hypertension codes. The code descriptions for categories 403 and 404 have been revised to specify CHRONIC kidney disease. The fifth digit designations for categories 403, Hypertensive chronic kidney disease, and 404, Hypertensive heart and chronic kidney disease, have also been revised as follows:
403, Hypertensive Chronic Kidney Disease
0 with chronic kidney disease stage I through stage IV, or unspecified
1 with chronic kidney disease stage V or end stage renal disease
404, Hypertensive Heart and Chronic Kidney Disease
0 without heart failure and with chronic kidney disease stage I through stage IV, or unspecified
1 with heart failure and with chronic kidney disease stage I through stage IV, or unspecified
2 without heart failure and with chronic kidney disease stage V or end stage renal disease
3 with heart failure and chronic kidney disease stage V or end-stage renal disease
The “code also” notes have also been revised for categories 403 and 404. An additional code is assigned to specifically identify the stage of chronic kidney disease based on the fifth digit selected. For example, if code 403.91, Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease, is assigned, only codes 585.5 or 585.6 are used to identify the stage of chronic kidney disease.
Mucositis is the inflammation of mucosal surfaces throughout the body causing redness or painful sores. This condition is a frequent complication of anticancer treatment, including chemotherapy and radiation therapy and is particularly common in patients preparing for bone marrow transplant. The oral mucosa is the most frequent site along with the alimentary tract. Treatment of ovarian and nasopharyngeal cancer can also result in vaginal and nasal mucositis. The condition may affect swallowing and tolerance of food or fluids, as well as the patient’s tolerance of cancer therapy. A number of new codes were created to differentiate mucositis from other types of inflammations.
A new code, 518.7, was created to identify transfusion-related acute lung injuries (TRALI). TRALI is a serious pulmonary complication of a blood transfusion. Symptoms include acute respiratory distress, severe hypoxia, hypotension, fever and acute bilateral pulmonary edema. Treatment includes discontinuation of transfusion and in some cases mechanical ventilation.
Dental, Gingival and Periodontal Disease
Twenty six new codes have been added for these conditions. Eleven of the new codes are for gingival and periodontal diseases. Code 523.0, 523.1, 523.3 and 523.4 have been deleted and are now subcategories.
Prior to this change there were codes to identify the broad classification of gingival diseases, but did not provide subclassifications to identify whether it was plaque-induced or not. There are many non-bacterial causes of gingivitis and the knowledge of the etiology permits precise therapies to intercept the gingival lesions and prevent their progression. Chronic plaque-induced is coded when documentation does not provide further specificity. The periodontal codes were expanded to specify localized or generalized periodontal diseases.
Hyperplasia of the Prostate
The fifth digit descriptions for subcategories 600.0, Hypertrophy of prostate, 600.2, Benign localized hyperplasia of prostate, and 600.9 Hyperplasia of prostate unspecified have been revised to identify the presence or absence of other lower urinary tract symptoms as follows:
0 Without urinary obstruction and other lower urinary tract symptoms
1 With urinary obstruction and other lower urinary tract symptoms
The requirement to use additional codes to identify symptoms has been added to report symptoms associated with hypertrophy and hyperplasia. The following symptoms are to be assigned with codes 600.01, 600.21 and 600.91 when documented.
599.69 Urinary obstruction
788.21 Incomplete bladder emptying
788.65 Straining on urination (New code)
788.41 Urinary frequency
788.64 Urinary hesitancy (New code)
788.30-788.39 Urinary incontinence
788.20 Urinary retention
788.63 Urinary urgency
788.62 Weak urinary stream
New category 649, Other conditions or status of mother complicating pregnancy, childbirth, or the puerperium, has been added to Chapter 11 at the request of the American College of Obstetrics and Gynecology. Included are seven new subcategories and 33 new codes. These changes allow for the coding of a number of conditions complicating pregnancy that could not previously be reported using their own specific codes. The new subcategories are:
649.0X Tobacco use disorder complicating pregnancy, childbirth, or the puerperium
649.1X Obesity complicating pregnancy, childbirth, or the puerperium
649.2X Bariatric surgery status complicating pregnancy, childbirth, or the puerperium
649.3X Coagulation defect complicating pregnancy, childbirth, or the puerperium
649.4X Epilepsy complicating pregnancy, childbirth, or the puerperium
649.5X Spotting complicating pregnancy
649.6X Uterine size discrepancy
Two new categories of codes have been created to report compartment syndrome. The new categories differentiate nontraumatic and traumatic compartment syndrome.
729.7X, Nontraumatic compartment syndrome
958.9X Traumatic compartment syndrome
Compartment syndrome involves increased pressure in an enclosed tissue space leading to decreased blood flow and may cause necrosis. External compression or soft tissue swelling, edema or hematoma, are broad causes. Nontraumatic compartment syndrome may be caused by extreme exertion and occurs in individuals who exercise a lot–particularly runners. Traumatic compartment syndrome can be caused by burns, frostbite, snakebite, postsurgical edema and bleeding, etc. The nine new codes identify the site of the compression syndrome and include the upper and lower extremities, the abdomen and other sites.
New code 780.32, Complex febrile convulsions, was created and existing code 780.31 was changed to read Febrile convulsions (simple) unspecified. These changes we made to provide a specific code for complex febrile convulsions. Complex febrile convulsions are defined as fever-associated seizures that are focal, prolonged (greater than 15 minutes) or recur within 24 hours in children between 6 months and 5 years of age. Complex febrile convulsions may also be referred to as atypical or complicated. Fever associated seizures that do not meet these criteria are referred to as simple febrile seizures. Long-term risks of complex febrile convulsions included epilepsy.
Body Mass Index
A new subcategory V85.5 Body Mass Index, pediatric, was added. V85.5X includes 4 new codes, to identify the body mass index (BMI) in patients 2 to 20 years old. These new codes are to be used in conjunction with codes from subcategory 278.0, Overweight and obesity, and with code 783.2, Abnormal loss of weight or underweight, to identify the BMI in pediatric patients if known.
In addition to the code changes outlined above, there are a number of other new and revised codes and related and unrelated changes to the Includes, Excludes, Code Also and Code First notes in the Tabular Listing as well as many Index changes.
The FY07 diagnosis addenda include all of these changes and should be reviewed. CMS Transmittal 990 at www.cms.hhs.gov/Transmittals/Downloads/R990CP.pdf, which provides a complete listing of all new codes as well as the addenda. It will be beneficial to review the April and October 2005 and March 2006 ICD-9-CM Coordination and Maintenance Committee meetings proposals, attachments and minutes at www.cdc.gov/nchs/about/otheract/icd9/maint/maint.htm for background information on the changes to the diagnoses codes. It is expected that revised Official Coding Guidelines will be released based on these Oct. 1, 2006 changes.
After review of the above, test your knowledge with the quiz below.
1. A patient is admitted with congestive heart failure (CHF) due to hypertension. The patient is also on dialysis for end-stage renal disease. The patient is treated for CHF and discharged. What is the correct code assignment for this case?
a. 428.0, 401.9, 585.6, V45.1
b. 404.93, V45.1
c. 428.0, 403.91, 585.6, V45.1
d. 404.93, 428.0, 585.6, V45.1
2. A patient is admitted to the hospital with symptoms of urinary retention and incomplete bladder emptying secondary to benign prostatic hypertrophy (BPH). TURP is performed and the patient is discharged home. What is the correct diagnosis code assignment for this case?
a. 600.01, 788.20, 788.21
b. 600.00, 788.20, 788.21
d. 600.01, 788.21
3. A Medicare patient presents for an outpatient screening colonoscopy. The patient is asymptomatic with only a family history of colon polyps. The colonoscopy is performed and is normal and the patient is discharged. What is the correct diagnosis and procedure code assignment for this case?
a. V76.51, G0105
b. V76.51, V18.51, G0121
c. V76.51, G0121
d. V76.51, V18.51, G0105
This month’s column has been prepared by Cheryl D’Amato, RHIT, CCS, director of HIM, and Melinda Stegman, MBA, CCS, manager of clinical HIM services, HSS, An Ingenix Company, (www.hssweb.com), which specializes in the development and use of software and e-commerce solutions for managing coding, reimbursement, compliance and denial management in the health care marketplace.
Answers to CCS Prep!:
1. d. Code 404.93 is the principal diagnosis because the CHF is due to the hypertension and the patient also has end-stage renal disease. Additional codes 585.6 and 428.0 are assigned to identify the end-stage kidney disease and congestive heart failure. Code V45.1 is assigned to indicate kidney dialysis status.
2. a. If a patient with BPH has symptoms of urinary retention and incomplete bladder emptying code 600.01 is assigned for the BPH with obstruction. Secondary diagnoses codes identifying the associated lower urinary tract symptoms urinary retention, 788.20 and incomplete bladder emptying 788.21 are also assigned.
3. b. Diagnosis code V76.51 is assigned first to identify the screening for malignant neoplasm of intestine. Diagnosis code V18.51 is also assigned for the family history of colon polyps. Procedure code G0121 is reported for colorectal screening; colonoscopy on individual not meeting criteria for high risk. The family history does not indicate the type of colon polyp so the patient does not meet the criteria for the high risk code G0105.