The Coding Sleuth 22
by Tara Conklin
They’re Coming!
The wait is on. The 2007 ICD-9 Codes have been released and the waiting game has begun. We’ve seen them and now we fidget and fuss in our chairs, working with the current coding thinking to ourselves, “Oh, that new pain code would be so handy right about now.”
The best thing we can do while watching the calendar tick down to October first is to learn the codes and how to apply them appropriately. You know what, that’s a great idea, why don’t we do just that.
Come on, let’s take a peek at what’s to come in the world of diagnosis coding.
The first thing we notice perusing through them is where the emphasis has been placed. Several sections received more attention than others. Looking through these we notice they are:
Disease of the Blood and Blood Forming Organs
Nervous and Sense Organs
Disease of the Digestive System (especially disease of the periodontal and dental structures)
Complications of Pregnancy and Childbirth and the Pueriperium
A few other sections had additions and the complete list also covers deletions and revisions, but here we’ll look at some of the additions and how they will effect coding.
The first thing we’ll look at is neutropenia, which is a decreased level of neutrophils, a type of white blood cell. This condition is commonly found in viral infections and after radiotherapy or chemotherapy. Up until now this form of anemia has been coded with 288.0 Agranulocytosis and 776.7 Transient neonatal neutropenia, with this code specific to newborns.
Thankfully this year we see the addition of six new codes to report neutropenia.
288.00 Neutropenia, unspecified
288.01 Congenital neutropenia
288.02 Cyclic neutropenia
288.03 Drug induced neutropenia
288.04 Neutropenia due to infection
288.09 Other neutropenia
A few of these are pretty self explanatory such as congenital, due to infection and well, unspecified. Cyclic neutropenia is that occurring in cycles or regular intervals. It’s also known as periodic neutropenia.
Drug induced neutropenia would be used for chemotherapy, radiotherapy or any other drug that might have caused the condition.
The next section we look at is the neurological and sense organs chapter which sees a large bulk of the new codes this year. Expansive additions have been made to report encephalitis and myelitis.
323.01 Encephalitis and encephalomyelitis in viral diseases classified elsewhere
323.02Myelitis in viral diseases classified elsewhere
323.41 Other encephalitis and encephalomyelitis due to infection classified elsewhere
323.42 Other myelitis due to infection classified elsewhere
323.51 Encephalitis and encephalomyelitis following immunization procedures
323.52 Myelitis following immunization procedures
323.61 Infectious acute disseminated encephalomyelitis (ADEM)
323.62 Other post infectious encephalitis and encephalomyelitis
323.63 Post infectious myelitis
323.71 Toxic encephalitis and encephalomyelitis
323.72 Toxic myelitis
323.81 Other causes of encephalitis and encephalomyelitis
323.82 Other causes of myelitis
341.20 Acute (transverse) myelitis NOS
341.21 Acute (transverse) myelitis in conditions classified elsewhere
341.22 Idiopathic transverse myelitis
Myelitis is an inflammation of the spinal cord and encephalomyelitis also includes the brain. These conditions can be brought on by many separate factors. Looking at the codes they leave the bread crumb trail pointing to infections, other diseases, adverse effect of immunizations and toxic effects from drugs and external causes. Encephalomyelitis is often a late effect of stroke in which we would now use 323.81 to report this condition. Radiologists will find this very useful when coding this when it is found on MRI’s of the brain. There has never been a code in the past to report this often significant finding.
One of the most welcome and helpful additions we see in the coming year are the multiple new codes to report different types of pain.
333.94 Restless Legs Syndrome
338.0 Central pain syndrome
338.11 Acute pain due to trauma
338.12 Acute post-thoracotomy pain
338.18 Other acute postoperative pain
338.19 Other acute pain
338.21 Chronic pain due to trauma
338.22 Chronic post-thoracotomy pain
338.28 Other chronic postoperative pain
338.29 Other chronic pain
338.3 Neoplasm related pain (acute) (chronic)
338.4 Chronic pain syndrome
Many times patients are seen or treated for pain postoperatively, following other treatments, post traumatically or even other conditions such as cancer, in which new tests, work-up, or services may need to be performed independently of these primary conditions. Under the current codes and coding guidelines often the condition causing the pain is used to report medical necessity for these services. However, since the pain is the reason for the service and not the condition itself, often the diagnoses don’t support the medical necessity thus resulting in denials and wasted man hours working appeals on the backend. Thankfully, with the following new codes, services directed specifically for pain can now be accurately coded.
Moving right a long we come to the next major section change. Fortunately (or not) a large portion of the additions will have little to do with the medical side of coding and billing and are more for our friendly neighborhood dentists. The dental and periodontal structure section received a serious booster. Multiple codes for gingivitis, periodontitis, and complication of dental restorative structure were added. The new codes are found in the gastrointestinal chapter in the 523-528 code ranges.
But fear not, the pearly white weren’t the only part of the GI system to get some attention this year. New codes for mucositis will be available:
528.00 Stomatitis and mucositis, unspecified
528.01 Mucositis (ulcerative) due to antineoplastic therapy
528.02 Mucositis (ulcerative) due to other drugs
528.09 Other stomatitis and mucositis (ulcerative)
538 Gastrointestinal mucositis (ulcerative)
Mucositis is an inflammation of the mucous membranes lining the digestive tract. These lead from the mouth all the way to the anus. This is a common side effect of chemotherapy and/or radiotherapy but can be cause by other factors such as an adverse effect to other types of drugs. Stomatitis on the other hand is an inflammation specifically of the oral mucosa. There can be multiple causes of this condition and may effect the buccal and labial mucosa, palate, tongue, floor of the mouth and the gingivae. Some of these factors can be allergic reactions, dentures, infection, viral, smoking and even poisoning such as from lead or mercury, to name a few. The new codes have also included the word “ulcerative’ in their descriptions. Since this is in parenthesis, it’s not a diagnostic requirement and simply means these codes include that with this additional complication when it’s found.
Traveling through chapters, our next set of major revision should make Obstetricians and Radiologist alike very happy. Unfortunately, the addition of many new codes this year reflects a sign of the times. Codes for tobacco use, obesity, and bariatric surgery status have all been added to the complication of pregnancy section.
649.0(0-4) Tobacco use disorder complicating pregnancy, childbirth, or the puerperium
649.1(0-4) Obesity complicating pregnancy, childbirth, or the puerperium
649.2(0-4) Bariatric surgery status complicating pregnancy, childbirth, or the puerperium
Additional codes for this section include coagulation defects, epilepsy, spotting and uterine size date discrepancy complication during pregnancy.
649.3(0-4) Coagulation defects complicating pregnancy, childbirth, or the puerperium
649.4(0-4) Epilepsy complicating pregnancy, childbirth, or the puerperium
649.5(0, 1, 3) Spotting complicating pregnancy
649.6(0-4) Uterine size date discrepancy
Remember when using codes from the pregnancy and complication of pregnancy section to pay close attention to the fifth digits. Not all fifth digits are applicable to all codes, such as in the new spotting codes. Only the fifth digits of 0, 1, and 3 are appropriate for this code range. Always apply the correct fifth digit in this section based on the patient’s pregnancy status at the time of the exam being reported.
Some other stand out codes we’ll see added in the New Year include:
Compartment syndrome, - 729.7(1-9) for nontraumatic and 958.9(0-9) for traumatic
780.32 Complex febrile convulsions
780.96 Generalized pain
780.97 Altered mental status
784.91 Postnasal drip
784.99 Other symptoms involving head and neck
788.64 Urinary hesitancy
788.65 Straining on urination
793.91 Image test inconclusive due to excess body fat
793.99 Other nonspecific abnormal findings on radiological and other examinations of body structure
995.27 Other drug allergy
Many of these will be welcome additions for most specialties but most beneficial to radiology and diagnostic testing. Up until now there have no specific codes to accurately report such conditions as “generalized pain”, “altered mental status”, “or postnasal drip”; conditions commonly found that require the use of radiological and pathological services.
Lastly the upcoming ICD-9-CM unfortunately sees the addition of V codes to report body mass indices resulting from childhood obesity. They might be useful for coding and treatment purposes but sadly they again reflect the sign of the times, particularly here in the United States.
This is not an all inclusive list of the new codes we can look forward to seeing on October 1st, but the bulk of the codes have been provided. Remember, there is no longer a grace period for new codes and once these changes go into effect codes from our current 2006 coding manuals that might be effected by these changes will be obsolete. Use of the current coding manual after this date will result in denials. Be sure to get accustomed to the new codes - not just the additions but also see what’s been revised and deleted. See where your practice will find them most beneficial. Educate your physicians and staff, particularly the billing staff so they can watch for denial errors on the part of private payers. We all know they like to slip the new codes through the cracks after implementation. Keep on them and stay on top of what’s coming and going.
With each New Year we are faced with new changes and challenges in coding. Facing them head on ensures improved reporting and better accuracy for all.
--Tara Conklin, CPC