ICD-9-CM codes: The latest changes

Prepare your practice for the changes this fall.

You've barely gotten used to last year's ICD-9-CM changes-but it's time to review your charge tickets and encounter forms again to see if any of this year's revisions affect your practice. Remember, these diagnosis codes take effect this Oct. 1, and CMS doesn't allow a grace period: Claims with invalid codes will be rejected.

This time, at least, you have far fewer changes to contend with: 142 new, five revised, and 17 invalid codes compared with almost 300 changes last year. As before, many of the new codes were created to allow you to be more precise in identifying signs, symptoms, and conditions. For example, there are more than 30 subtypes of non-Hodgkin's lymphoma, and all are currently indexed to code 202.8x. Come October, you'll be able to identify specific kinds of non-Hodgkin's lymphoma with any of the 54 new codes in categories 200 and 202.

Dysphagia is another example, with six new codes that expand your choices when you submit claims related to the swallowing disorder. These codes (787.2x), says Jackie Miller, a senior consultant with Coding Strategies in Powder Springs, GA, "are broken down according to the specific phase of the swallowing process that's affected." Miller also points out that the changes relating to myotonic disorders (359.2x) reflect differences in etiology and manifestations of this condition. You will now have the ability to differentiate among myotonic muscular dystrophy (359.21), myotonia congenital (359.22), and myotonic chondrodystrophy (359.23), for instance. An additional code was created for drug-induced myotonia (359.24).

A new category of codes (058.xx) lets you precisely identify human herpesvirus 6 and 7. Three codes for subtypes of roseola infantum (058.10-058.12) are also included in this series. You'll no longer be able to use 057.8 (other specified viral exanthemata) when diagnosing roseola, says Maxine Lewis of Medical Coding/Reimbursement Management in Cincinnati.

There are also 20 new V codes that you can use not only to give insurers extra information, but to support the medical necessity for the diagnostic tests and exams you provide. For instance, the eight new personal and family history codes, Miller says, back up the need for screenings and follow-up exams for patients with a personal or family history of a particular disorder.

Check the following list of new, revised, and invalid codes to see which ones impact your practice:

NEW DIAGNOSIS CODES

Infectious and parasitic diseases

040.41 Infant botulism

040.42 Wound botulism

058.10 Roseola infantum, unspecified

058.11 Roseola infantum due to human herpesvirus 6

058.12 Roseola infantum due to human herpesvirus 7

058.21 Human herpesvirus 6 encephalitis

058.29 Other human herpesvirus encephalitis

058.81 Human herpesvirus 6 infection

058.82 Human herpesvirus 7 infection