Vol. 15 •Issue 21 • Page 14
CCS Prep!
Know the October 2005 ICD-9-CM Changes: Part 1 Diagnosis Codes
To be prepared for the certified coding specialist (CCS) and CCS-P (physician based) exams, coders should be particularly aware of the latest ICD-9-CM code revisions, additions and deletions. By being conscious of these coding changes, exam applicants can ensure that they’re ready for the test. Especially now that the exam is electronic, the latest coding updates will be included to ensure that coders don’t use memorized codes and that they are doing 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 173 new, 28 revised and 14 invalid diagnoses codes effective Oct. 1, 2005. All of the invalid codes are a result of code expansions.
Endocrine, Nutritional, Metabolic, Immunity
Code 276.5, Volume Depletion, has been expanded to create specific codes for dehydration and hypovolemia. Dehydration is de-fined as a reduction of total water content while hypovolemia is defined as depletion of the volume of plasma or total blood volume. This change was necessary because the treatment of these conditions is different, therefore they should be reported separately. The new codes are:
276.50 Volume depletion, unspecified
276.51 Dehydration
276.52 Hypovolemia
Sleep Disorders
The American Academy of Sleep Medicine requested a significant number of new sleep disorder codes. As a result, a total of 43 new sleep disorder codes have been added. Two of the new codes are in the alcohol- and drug-induced mental disorders chapter.
291.82 Alcohol-induced sleep disorders
292.85 Drug-induced sleep disorders
The most significant change regarding sleep disorders includes 40 new organic sleep disorder codes. Organic sleep disorders are a result of an anatomic or physiologic abnormality or disease process. New category 327, Organic sleep disorders, has been created and includes the following new subcategories:
327.0x Organic disorders of initiating and maintaining sleep [Organic insomnia] (4 codes)
327.1x Organic disorder of excessive somnolence [Organic hypersomnia] (7 codes)
327.2x Organic sleep apnea (9 codes)
327.3x Circadian rhythm sleep disorder (9 codes). The label for code 307.45 is revised to indicate circadian rhythm sleep disorder of nonorganic origin.
327.4x Organic parasomnia (6 codes)
327.5x Organic sleep related movement disorders (4 codes)
327.8 Other organic sleep disorder
Sleep disorders that are defined as psychological, behavioral or due to substance abuse are not coded with codes from category 327, but with codes in the Mental Health or the Signs and Symptoms chapters.
The final new sleep disorder code is V69.5 Behavioral insomnia of childhood
Diabetic Retinopathy
Significant changes have been made to diabetic retinopathy codes in subcategory 362.0. Diabetic retinopathy is a disorder of the retinal vasculature that eventually develops to some degree in nearly all diabetic patients and is the third most common cause of blindness in the U.S. Five new codes have been added to this subcategory. Four of the new codes describe the different stages of non-proliferative diabetic retinopathy, which describes the early stages of the disease. The disease progresses from mild to severe non-proliferative diabetic retinopathy and becomes proliferative in its most advanced stages. The new codes are:
362.03 Non-proliferative diabetic retino-pathy, NOS
362.04 Mild non-proliferative diabetic retinopathy
362.05 Moderate non-proliferative diabetic retinopathy
362.06 Severe non-proliferative diabetic retinopathy
362.07 Diabetic macular edema
Code first the diabetes with ophthalmic manifestations, 250.5x, followed by the appropriate diabetic retinopathy code. Code 362.07 must be used with a code for diabetic retinopathy, 362.01-362.06.
Prior to the creation of these new codes, both non-proliferative diabetic retinopathy and diabetic macular edema were reported with code 362.01, Background diabetic retinopathy.
Acute Coronary Syndrome
Category 410, Acute myocardial infarction, has been modified to allow for the coding of ST-segment elevation myocardial infarction (STEMI) vs. non-ST segment elevation myocardial infarction (NSTEMI). NSTEMI is coded to 410.7X, Subendocardial myocardial infarction. STEMI is coded to 410.0x, 410.1x, 410.2x, 410.3x, 410.4x, 410.5x, 410.6x, or 410.8x depending on the site.
Peritonitis and Retroperitoneal Infections
The description for category 567 has been revised to include codes for retroperitoneal infections. The new description for category 567 is Peritonitis and retroperitoneal infections and includes 10 new codes.
Code 567.2, Other suppurative peritonitis is no longer a valid code but is now a new subcategory and includes four new codes:
567.21 Peritonitis (acute) generalized
567.22 Peritoneal abscess
567.23 Spontaneous bacterial peritonitis
567.29 Other suppurative peritonitis
New subcategory 567.3, Retroperitoneal infections includes three new codes
567.31 Psoas muscle abscess
567.38 Other retroperitoneal abscess
567.39 Other retroperitoneal infections
Three codes have been added to subcategory 567.8, Other specified peritonitis
567.81 Choleperitonitis
567.82 Sclerosing mesenteritis
567.89 Other specified peritonitis
Chronic Kidney Disease
New clinical practice guidelines for chronic kidney disease (CKD) have been published by the National Kidney Foundation and accepted by the National Institutes of Health (NIH). The guidelines include five stages of CKD based on the glomerular filtration rate (GFR). Accordingly code 585, Chronic renal failure has been deleted and replaced by a new subcategory 585, Chronic kidney disease, which includes seven new codes.
585.1 Chronic kidney disease, Stage I
585.2 Chronic kidney disease, Stage II (mild)
585.3 Chronic kidney disease, Stage III (moderate)
585.4 Chronic kidney disease, Stage IV (severe)
585.5 Chronic kidney disease, Stage V
585.6 End stage renal disease
585.9 Chronic kidney disease, unspecified
The GFR guidelines used to determine the above stages of CKD can be found in the Coordination and Maintenance (C&M) meeting proposals. Congress has mandated that only patients on dialysis or receiving kidney transplants may be considered as having end-stage renal disease (ESRD) and can be assigned code 585.6. Code 585.9 is to be used for incomplete terminology such as chronic renal disease, chronic renal failure NOS, and chronic renal insufficiency.
As a result of this change, the description of categories 403 and 404 and their fifth digits have also been revised to indicate chronic kidney disease instead of chronic renal failure.
Meconium and Other Aspiration in Neonates
A number of new codes have been created for meconium aspiration, meconium staining and neonatal aspiration. As a result of proposals by the American Academy of Pediatrics, the National Association of Children’s Hospitals and Related Institutions there are 13 new codes that can be used to report these conditions. Code 770.1, Meconium aspiration syndrome, is now a subcategory and has been renamed to Fetal and newborn aspiration and expanded to include nine new codes.
770.10 Fetal and newborn aspiration, unspecified
770.11 Meconium aspiration without respiratory symptoms
770.12 Meconium aspiration with respiratory symptoms
770.13 Aspiration of clear amniotic fluid without respiratory symptoms
770.14 Aspiration of clear amniotic fluid with respiratory symptoms
770.15 Aspiration of blood without respiratory symptoms
770.16 Aspiration of blood with respiratory symptoms
770.17 Other fetal and newborn aspiration without respiratory symptoms
770.18 Other fetal and newborn aspiration with respiratory symptoms
Four additional codes have been added to identify the following:
763.84 Meconium passage during delivery
770.85 Aspiration of postnatal stomach contents without respiratory symptoms
770.86 Aspiration of postnatal stomach contents with respiratory symptoms
779.84 Meconium staining
Asphyxia and Hypoxemia
Code 799.0, Asphyxia, has been deleted and replaced by new subcategory 799.0, Asphyxia and hypoxemia, and includes two new codes. Asphyxia is defined as impaired or absent exchange of oxygen and carbon dioxide on a ventilatory basis; combined hypercapnia and hypoxia or anoxia. Hypoxemia is defined as subnormal oxygenation of arterial blood, short of anoxia. This code expansion differentiates these two clinical states.
799.01 Asphyxia
799.02 Hypoxemia
Mechanical Complication Joint Prosthesis
Code 996.4, Mechanical complication of internal orthopedic device, implant and graft, has been expanded to include nine new codes. Common reasons for failed joint replacements include mechanical loosening of the prosthesis, wear of the bearing surface, dislocation of prosthetic device and implant fracture. These new codes allow for the differentiation of the various causes of failed joint replacements, which assist in refining indications, surgical technique and implant choice.
996.40 Unspecified mechanical complication of internal orthopedic device, implant and graft
996.41 Mechanical loosening of prosthetic joint
996.42 Dislocation of prosthetic joint
996.43 Prosthetic joint implant failure
996.44 Peri-prosthetic fracture around prosthetic joint
996.45 Peri-prosthetic osteolysis
996.46 Articular bearing surface wear of prosthetic joint
996.47 Other mechanical complication of prosthetic joint implant
996.49 Other mechanical complication of other internal orthopedic device, implant and graft
Respirator/Ventilator Codes
Two codes have been added to category V46.1 Dependence on respirator.
V46.13 Encounter for weaning from respirator [ventilator]
V46.14 Mechanical complication of respirator [ventilator]
There are times when a ventilator dependent patient must go to a facility to be connected to another ventilator until their ventilator is fixed or replaced. A new code has been created to identify these encounters when they are due to mechanical equipment failure. The second new code will be used when a patient is admitted for weaning from a respirator. This very often occurs in a SNF setting.
Cancelled Vaccinations
Code V64.0, Vaccination not carried out, is now a subcategory and has been expanded to include 10 new codes. These new codes identify why a patient did not receive a routine immunization or vaccination.
V64.00 unspecified reason
V64.01 because of acute illness
V64.02 because of chronic illness or condition
V64.03 because of immune compromised state
V64.04 because of allergy to vaccine or component
V64.05 because of caregiver refusal
V64.06 because of patient refusal
V64.07 for religious reasons
V64.08 because patient had disease being vaccinated against
V64.09 for other reason
Encounter for Immunotherapy
Code V58.1 Encounter for chemotherapy, has been deleted and replaced by subcategory V58.1 Encounter for antineoplastic chemotherapy and immunotherapy, and expanded to include two new codes.
V58.11 Encounter for antineoplastic chemotherapy
V58.12 Encounter for immunotherapy for neoplastic condition
This code expansion provides the ability to differentiate between encounters for patients receiving immunotherapy vs. chemotherapy.
Body Mass Index
A new category V85 Body Mass Index, which includes 18 new codes, has been added to identify the body mass index (BMI) in patients older than 20 years of age. 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 adults if known.
Other Diagnosis Code Changes
A number of other diagnosis changes have been made and include the following:
• Code 287.3 Primary thrombocytopenia, expanded to include five new codes.
• New subcategory 525.4 Complete edentulism with five new codes.
• New subcategory 525.5 Partial edentulism with five new codes.
• New subcategory 651.7 Multiple gestation following (elective) fetal reduction includes three new codes.
• Seven new personal history codes and three new family history codes.
• Code V26.3 Genetic counseling and testing expanded to include three new codes.
• New subcategory V59.7 Egg (oocyte) (ovum) donor includes five new codes.
In addition to the code changes outlined above, there are a number of 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 FY06 diagnosis addenda include all of these changes and should be reviewed. CMS Transmittal 591 at www.cms.hhs.gov/manuals/pm_trans/r591cp.pdf provided a complete listing of all new codes as well as the addenda. It will be beneficial to review the April and October 2004 and April 2005 ICD-9-CM C&M 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.
After review of the above, test your knowledge with the quiz below.
1. A patient is admitted with diabetic retinopathy and diabetic macular edema. What is the correct code assignment for this case?
a. 250.51, 362.01
b. 250.50, 362.03, 362.07
c. 250.50, 362.01, 362.07
d. 250.50, 362.01, 362.07
2. A patient is admitted with congestive heart failure (CHF). The patient is also hypertensive and is 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
3. A patient is admitted with bone metastasis originating from the breast, which are both still present on this encounter. This admission is for chemotherapy and radiation therapy. What is the correct diagnosis code assignment for this case?
a. V58.11, 174.9, 198.5
b. V58.0, V58.11, 174.9, 198.5
c. 174.9, 198.5, V58.0, V58.11
d. V58.0, V58.11, 198.5, V10.3
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 Inc. (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 250.50 is reported for the diabetes with ophthalmic manifestations. A fifth digit of 0 is assigned because the type is not specified. Code 362.01 is assigned for the diabetic retinopathy because the type of retinopathy is not specified. Code 362.07 is assigned for the macular edema; 2. c. 428.0 is the principal diagnosis because there is no indication that the CHF is due to the hypertension. Codes 403.91 and 585.6 are assigned to identify the end stage kidney disease with hypertension. A cause-and-effect relationship is assumed unless the documented indicates that the kidney disease is not due to hypertension. Code V45.1 is assigned to indicate kidney dialysis status; 3. b. Because the patient is admitted for chemotherapy and radiation therapy during the same encounter both are assigned and either V58.0 or V58.11 may be listed first. Codes 174.9 and 198.5 are assigned for the primary malignant neoplasm of the breast and the bone metastasis.
