ICD-9: What's new

This year's tally: 211 new diagnosis codes, 55 revised codes, 29 deleted codes. Once again, it's time to review your encounter forms and charge tickets to incorporate the ICD-9-CM code changes that affect your practice. The codes take effect Oct. 1. Remember that CMS no longer allows a 90-day grace period for billing discontinued diagnosis codes; any claims using outdated codes will be rejected.

The new ICD-9 offers more specific signs and symptoms. These detailed codes help you support the medical necessity of diagnostic tests and exams that you request. For example, when you order an MRI of the brain because a patient presents with altered mental status, you'll now be able to use 780.97 (altered mental status) instead of a general symptoms code, says Jackie Miller, a senior consultant with Coding Strategies in Powder Springs, GA. "This new code explains the reason for the test, making it more likely that you'll be reimbursed." There's also a diagnosis code for mild cognitive impairment (331.83).

Beginning this fall, you'll no longer have to use generalized pain codes, either. A new pain section (338.x) includes specific codes for "chronic pain syndrome" (338.4) and "acute pain due to trauma" (338.11), along with nine other defined types of pain. The ability to code for other acute postoperative pain (33.18) or other chronic postoperative pain (338.28) will be very useful, says Miller. The codes could help you justify a prolonged hospital stay or additional services after surgery.

Lewis also points out new symptom codes that will help pinpoint urination abnormalities. You'll now be able to code for urinary hesitancy (788.64) and straining on urination (788.65), so you won't have to use the "other" (788.69) code anymore.

Fifth digits have been added to code 995.2 for unspecified adverse effects of drug, medicinal, and biological substances. So you'll be able to indicate that the patient had an anesthesia reaction (995.22) or insulin reaction (995.23) instead of just a general medication reaction (995.2).

There are also revised descriptors in the 403.xx series for hypersensitive chronic kidney disease, as well as in the 404.xx series codes for hypertensive heart and chronic kidney disease. The codes now include the stages of the disease.

Review the following list of new, revised, and deleted diagnosis codes to see which ones impact your practice. You can find a complete list of changes-including codes that pertain to diseases of the digestive system (the vast majority of these are for dental providers) and complications of pregnancy, childbirth, and the puerperium-in this article at http://www.memag.com.

Deleted codes

Neoplasms

238.7 Other lymphatic and hematopoietic tissues

Endocrine, nutritional, and metabolic diseases, and immunity disorders

277.3 Amyloidosis

Diseases of the blood and blood-forming organs

284.0 Constitutional aplastic anemia
288.0 Agranulocytosis