Signs and symptoms, Aftercare V codes, Abnormal Paps, Circulatory and respiratory systems, Menopausal and postmenopausal disorders, Maternity care
From abnormal Pap smears to fracture follow-ups, many of the recent ICD-9-CM changes will affect primary care practices. Knowing about the changes will help you revise your encounter forms and prepare to code accurately so you can avoid denials.
CMS' new and revised diagnosis codes took effect Oct. 1, 2002. Here's the lowdown.
The new signs and symptoms codes that primary care providers will find most useful are those describing crying infants. "It's not unusual to see crying infants, and quite often after the history and exam you still don't have a specific diagnosis to explain their symptoms," says FP A. Clinton MacKinney, the American Academy of Family Physicians' representative on the AMA CPT Advisory Committee. "These new codes will allow the physician to code these symptoms more accurately."
Code 780.9 (other general symptoms) has been subdivided into three new codes:
780.91fussy infant (baby)
780.92excessive crying of infant (baby)
780.99other general symptoms
There's a new code for aftercare following joint replacement (V54.81); this code requires an additional code (i.e., V43.60-69) to identify the site.
Several codes now include new subcategories to more specifically identify the body parts involved. For example, instead of simply listing V54.1 for aftercare for healing of a traumatic fracture, you can choose from a number of codes, including V54.13 for a hip fracture and V54.16 for a lower leg fracture.
New subcategories for orthopedic aftercare include:
V54.10-V54.19aftercare for healing traumatic fracture (various sites)
V54.20-V54.29aftercare for healing pathologic fracture (various sites)
V54.89other orthopedic aftercare
V58.42aftercare following surgery for neoplasm
V58.43aftercare following surgery for injury and trauma
V58.71-V58.78aftercare following surgery to specified body systems, not elsewhere classified
In the past, coders had one diagnosis code to use when a patient returned for a second Pap smear following an abnormal first one795.0 (nonspecific abnormal Papanicolaou smear of cervix). But this code did not identify the reason for the abnormality. Now, the new ICD-9-CM codes require a fifth number to provide greater specificity. The new abnormal Pap smear codes include:
795.00nonspecific abnormal Papanicolaou smear of cervix, unspecified
795.01atypical squamous cell changes of undetermined significance favor benign (ASCUS favor benign)
795.02atypical squamous cell changes of undetermined significance favor dysplasia (ASCUS favor dysplasia)
795.09other nonspecific abnormal Papanicolaou smear of cervix
You can now choose from several new codes under the 438 series, which concerns late effects of cerebrovascular disease. The new rules require you to report an additional code to identify the altered sensation or visual disturbance you're treating.
For example, if you use 438.7, report a code from the 368 (visual disturbances) series, such as 368.2 (diplopia), which includes double vision. "These codes are good for general nonspecific complaints for cerebrovascular patients when you can document symptoms without any other diagnosis," says FP Daniel S. Fick, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City.
The new codes are:
438.6alterations of sensations
438.7disturbances of vision
ICD-9-CM added a new subcategory, 459.3 (chronic venous hypertension [idiopathic]), that includes five codes:
459.30chronic venous hypertension without complications
459.31chronic venous hypertension with ulcer
459.32chronic venous hypertension with inflammation
459.33chronic venous hypertension with ulcer and inflammation
459.39chronic venous hypertension with other complication
Code 454.9 has been revised to include varicose veins not otherwise specified, and a new code has been added:
454.8varicose veins of the lower extremities, with other complications
454.9asymptomatic varicose veins
ICD-9-CM also added a new code for patients who need an oxygen tank to manage COPD or emphysema. Code V46.2 (other dependence on machines, supplemental oxygen) includes long-term oxygen therapy.
The words "symptomatic" and "asymptomatic" have been added to the menopausal and postmenopausal diagnosis codes, Says MacKinney: "The codes now describe two different clinical situations." The patient who has hot flashes, fatigue, and dry vagina will be diagnosed with one of the codes specifying symptomatic, while the patient who may be worried about osteoporosis or wants a change of medication will be classified as asymptomatic.
627.2symptomatic menopausal female climacteric states
627.4symptomatic states associated with artificial menopause
V49.81asymptomatic postmenopausal status (age-related) (natural)
If you perform obstetric services, you must now include a fifth digit with each of the ectopic pregnancy codes (633.0-633.9). Specifically, a fifth digit of "0" indicates "without intrauterine pregnancy," while "1" denotes "with intrauterine pregnancy."
ICD-9-CM also added a new sub-category, 765.2, (weeks of gestation), under category 765 (disorders relating to short gestation and low birthweight). New codes in this subcategory are:
765.20unspecified weeks of gestation
765.21less than 24 completed weeks of gestation
765.2224 completed weeks of gestation
765.2325-26 completed weeks of gestation
765.2427-28 completed weeks of gestation
765.2529-30 completed weeks of gestation
765.2631-32 completed weeks of gestation
765.2733-34 completed weeks of gestation
765.2835-36 completed weeks of gestation
765.2937 or more completed weeks of gestation
Under the categories of personal history of other diseases (V13) and supervision of high-risk pregnancy (V23), new codes related to maternity care include:
V13.21personal history of preterm labor (which excludes: current pregnancy with history of preterm labor, V23.41)
V23.41pregnancy with history of preterm labor
V23.49pregnancy with other poor obstetric history
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Coding Consult: New codes you need to know.
Dec. 9, 2002;79:23.