Vol. 15 •Issue 23 • Page 12
Know the October 2005 ICD-9-CM Changes: Part 2 Procedure Codes
As mentioned in Part I of this series, 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 article focuses on ICD-9-CM procedure changes. There are a total of 37 new, 15 revised and five invalid procedure codes effective Oct. 1, 2005.
Immunosuppressive Antibody Therapy
Code 00.18, Infusion of immunosuppressive antibody therapy during induction phase of solid organ transplant, has been added. This code is used to report monoclonal antibody therapy and polyclonal antibody therapy provided to prevent organ transplant rejection during the induction phase. The induction phase occurs prior to, during and immediately after the surgical transplantation.
Percutaneous Transluminal Coronary Angioplasty (PTCA)
Significant changes occurred in the code assignment for PTCA. Three codes have been deleted and are replaced with one new code. The following three PTCA codes have been deleted:
36.01 Single vessel percutaneous transluminal coronary angioplasty (PTCA) or coronary atherectomy without mention of thrombolytic agent
36.02 Single vessel percutaneous transluminal coronary angioplasty (PTCA) or coronary atherectomy with mention of thrombolytic agent
36.05 Multiple vessel percutaneous transluminal coronary angioplasty (PTCA) or coronary atherectomy performed during the same operation, with or without mention of thrombolytic agent
The three deleted codes have been replaced by the following new code:
00.66 Percutaneous transluminal coronary angioplasty (PTCA) or coronary atherectomy
Code 00.66 also has a note to use additional codes as necessary for injection or infusion of thrombolytic agent, insertion of intracoronary stents, intracoronary artery thrombolytic infusion, number of vessels involved and number of stents inserted.
Subcategory 00.4, Adjunct Vascular System Procedures
A new subcategory 00.4 Adjunct Vascular System Procedures, which included eight new codes, has also been added.
00.40 Procedure on single vessel
00.41 Procedure on two vessels
00.42 Procedure on three vessels
00.43 Procedure on four or more vessels
00.45 Insertion of one vascular stent
00.46 Insertion of two vascular stents
00.47 Insertion of three vascular stents
00.48 Insertion of four or more vascular stents
These eight new codes apply to coronary, precerebral, intracranial, peripheral and other non-coronary vessels. These add-on codes are to be used in conjunction with other therapeutic procedure codes to provide additional information on the number of vessels affected by the procedure and the number of stents inserted. Codes 00.40-00.43 identify the number of vessels treated. Codes 00.45-00.48 describe the number of stents inserted. If the number of vessels treated or the number of stents inserted is not documented in the operative report the default code assignment is one vessel, 00.40 or one stent, 00.45. Codes from category 00.4 are not to be used with CABG procedure codes from subcategory 36.1, Bypass anastomosis for heart revascularization.
Cardiac Support Device
Code 37.4, Repair of heart and pericardium, has been deleted and new subcategory 37.4, Repair of heart and pericardium, has been created and includes two new codes:
37.41 Implantation of prosthetic cardiac support device around the heart
37.49 Other repair of heart and pericardium
Code 37.41 identifies the procedure in which an implant or sling is placed around the heart and adjusted to conform to the heart, supporting it without acutely changing hemodynamics. This procedure is performed to treat heart failure and resulting cardiomegaly, and is designed to reduce wall stress and prevent the progression of cardiac dilation associated with heart failure. This procedure may be performed alone or in addition to other procedures.
Endovascular Repair of Vessel
A new code has been added to subcategory 39.7 Endovascular repair of vessel
39.73 Endovascular implantation of graft in thoracic aorta
This new code identifies the implant made of ultra-thin graft material with an integrated, self-expanding metallic stent-graft inserted as an alternative for other more invasive treatments of thoracic aortic defects such as an aneurysm.
Neurostimulator Pulse Generators
Intracranial, spinal and peripheral neurostimulation is used for the treatment of chronic pain. New rechargeable batteries used in neurostimulators have a life span of 8 to 9 years compared to the average life span of 3 years for those that are not rechargeable. The pulse generator must be replaced when it reaches the end of battery life. The rechargeable batteries in these new neurostimulators reduce the need for repeat procedures. Because there was no way to distinguish between the different types, code revisions have been made to differentiate between rechargeable neurostimulator pulse generators and those that are not rechargeable. Effective Oct. 1, 2005, not specified as rechargeable, has been added to the description of codes 86.94 and 86.95 as follows:
86.94 Insertion or replacement of single array rechargeable neurostimulator pulse generator, not specified as rechargeable
86.95 Insertion or replacement of dual array rechargeable neurostimulator pulse generator, not specified as rechargeable
The following two new codes have been added to report rechargeable neuromuscular pulse generators:
86.97 Insertion or replacement of single array rechargeable neurostimulator pulse generator
86.98 Insertion or replacement of dual array rechargeable neurostimulator pulse generator
Revision of Joint Replacements
Prior to Oct. 1, 2005, only two codes captured all of the partial and full hip and knee joint replacement revision procedures. There was no way to differentiate the type of replacement revisions performed even though revisions may include replacing any or all of the implants.
New subcategory, 00.7, Other hip procedures, has been added and includes three new hip replacement revision codes that describe the components being removed or replaced:
00.70 revision of both acetabular & femoral components
00.71 revisions of acetabular component
00.72 revision of femoral component
00.73 revision of acetabular liner and/or femoral head only
In addition to the new hip procedure codes, three codes have been created to identify the type of hip bearing surface. These new codes may be assigned in addition to both initial hip replacement and hip replacement revision codes:
00.74 metal on polythylene
A new category, 00.8, Other knee procedures, has been created and includes five new knee replacement revision codes:
00.80 total revision (all components)
00.81 revision of tibial component
00.82 revision of femoral component
00.83 revision of patellar component
00.84 revision of total knee replacement, tibial insert (liner)
The two existing hip and knee joint replacement revision codes have been revised with the addition of NOS to the code description. These two codes will now be assigned to identify cases where the component replaced is not specified:
81.53 Revision of hip replacement NOS
81.55 Revision of knee replacement NOS
Two codes have been added to subcategory 84.5, Implantation of other musculoskeletal device and substance:
84.56 Insertion of (cement) spacer
84.57 Removal of (cement) spacer
Spacers are generally inserted when a total joint replacement is removed. Spacers are usually removed when the revision of the joint replacement is performed. These codes are to be used in addition to the code for the primary procedure.
Cranial Cavity Catheter and Liquid Brachytherapy
Because there is no way to capture the infusion of liquid radioisotopes into the brain, three new codes have been added:
01.26 Insertion of catheter into cranial cavity
01.27 Removal of catheter from cranial cavity
92.20 Infusion of liquid brachytherapy radioisotope
After the malignant brain tumor is resected, a balloon catheter is placed temporarily into the cranial cavity for the infusion of liquid brachytherapy radioisotope. Code 01.26 is used to report the insertion of the catheter into the cranial cavity. Code 01.26 is used in addition to the code for the primary procedure such as resection of a malignant brain tumor. The patient then returns to have the infusion of the liquid radioisotope. Code 92.20 is used to report the infusions of the liquid radioisotope such as I-125 radioisotope or Iotrex used for intracavity brachytherapy in the treatment of brain cancer. After three to seven days, the radioisotope and the catheter are removed from the cranial cavity and is coded to 01.27. Code 92.20 includes the removal of the radioisotope so no additional code is assigned when the radioisotope is removed.
360 Degree Spinal Fusion
Code 81.61, 360 degree spinal fusion, single incision approach, has been deleted because there has been considerable confusion on how to apply this add-on code. Continue to code the appropriate spinal fusion and refusion codes depending on the type of fusion performed. If the spinal fusion is a combined anterior/posterior technique, two codes are assigned, one for the anterior technique and one for the posterior technique. An additional code is no longer required to indicate when an anterior and posterior fusion, 360 degree, is performed through a single incision or approach.
Spinal Decompression Device
New code 84.58 Implantation of interspinous process decompression device, has been added. This procedure is performed for lumbar spinal stenosis and is currently only performed under clinical trails. FDA approval is expected in 2006.
External Fixation Devices
Subcategory 84.7, Adjunct codes for external fixator devices, has been added and includes three new codes:
84.71 Application of external fixator device, monoplanar system
84.72 Application of external fixator device, ring system
84.73 Application of hybrid external fixation device
These codes are used in addition to those used to report the application of an external fixator device and the reduction of fractures or dislocation. The codes are intended to provide additional information on the type of external fracture fixation device used.
In addition to the procedure 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 procedure 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 October 2004 and April 2005 ICD-9-CM C&M meetings proposals, attachments and minutes at http://www.cms.hhs.gov/paymentsystems/icd9/default.asp for background information on the changes to the procedure codes.
After review of the above, test your knowledge with the quiz below.
1. A patient is admitted with an infected hip prosthesis. The prosthesis was removed and the patient underwent a total hip arthroplasty. What is the correct procedure code assignment for this case?
a. 00.70, 80.05
d. 81.53, 80.05
2. A percutaneous transluminal coronary angioplasty (PTCA) is performed with stent insertion of the left circumflex. The physician also placed a stent in the obtuse marginal and the posterior descending. What is the correct procedure code assignment for this case?
a. 00.66, 00.42, 00.47, 36.07
b. 00.66, 00.42, 00.47, 36.06
c. 00.66, 36.06
d. 00.66, 00.47, 36.06
3. A patient is admitted with an infected knee prosthesis. The prosthesis was removed and a joint spacer was inserted. What is the correct code assignment for this case?
a. 996.66, 80.06, 84.56
b. 996.47, V43.65, E878.1, 80.06, 84.56
c. 996.66, V43.65, E878.1, 80.06
d. 996.66, V43.65, E878.1, 80.06, 84.56 n
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 for HSS (www.hssweb.com), an Ingenix company. HSS specializes in software and consulting solutions that streamline coding, regulatory and reimbursement processes.
Answers to CCPS PREP!: 1. c. Only code 00.70 is assigned because total hip arthroplasty is documented. Code 81.53 is only assigned when the type of replacement or the components are not specified. Code 80.05 is not assigned for the joint prosthesis removal because code 00.70 includes both the removal of the infected hip prosthesis and the insertion of a total replacement; 2. b. Assign code 00.66 for the percutaneous transluminal coronary angioplasty [PTCA]. Stents were inserted into the left circumflex, the obtuse marginal and the posterior descending, therefore codes 00.42 and 00.47 are assigned to indicate that three stents were inserted into three vessels. Code 36.06 is assigned for the insertion of the coronary stent not specified as drug eluting; 3. d. Code 996.66 is assigned for the infected joint prosthesis. V43.65 is assigned to provide information on the joint that had been placed. In this instance, the knee joint had been previously replaced. Because the knee joint prosthesis had only been removed but not replaced during this admission, procedure code 80.06 is assigned to identify the removal of the knee prosthesis. Code 84.56 is used to report the joint spacer insertion. The E code, E878.1, may be assigned to indicate that this complication is not a result of a misadventure at the time of the initial procedure.