Coding Consult
New codes you need to know

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.

Signs and symptoms

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:

• 780.91—fussy infant (baby)
• 780.92—excessive crying of infant (baby)
• 780.99—other general symptoms

Aftercare V codes

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-V54.19—aftercare for healing traumatic fracture (various sites)
• V54.20-V54.29—aftercare for healing pathologic fracture (various sites)
• V54.89—other orthopedic aftercare
• V58.42—aftercare following surgery for neoplasm
• V58.43—aftercare following surgery for injury and trauma
• V58.71-V58.78—aftercare following surgery to specified body systems, not elsewhere classified

Abnormal Paps

In the past, coders had one diagnosis code to use when a patient returned for a second Pap smear following an abnormal first one—795.0 (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:

• 795.00—nonspecific abnormal Papanicolaou smear of cervix, unspecified
• 795.01—atypical squamous cell changes of undetermined significance favor benign (ASCUS favor benign)
• 795.02—atypical squamous cell changes of undetermined significance favor dysplasia (ASCUS favor dysplasia)
• 795.09—other nonspecific abnormal Papanicolaou smear of cervix

Circulatory and respiratory systems

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:

• 438.6—alterations of sensations
• 438.7—disturbances of vision
• 438.83—facial weakness
• 438.84—ataxia
• 438.85—vertigo

ICD-9-CM added a new subcategory, 459.3 (chronic venous hypertension [idiopathic]), that includes five codes:

• 459.30—chronic venous hypertension without complications
• 459.31—chronic venous hypertension with ulcer
• 459.32—chronic venous hypertension with inflammation
• 459.33—chronic venous hypertension with ulcer and inflammation
• 459.39—chronic 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:

• 454.8—varicose veins of the lower extremities, with other complications
• 454.9—asymptomatic 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.

Menopausal and postmenopausal disorders

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.

• 627.2—symptomatic menopausal female climacteric states
• 627.4—symptomatic states associated with artificial menopause
• V49.81—asymptomatic postmenopausal status (age-related) (natural)

Maternity care

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:

• 765.20—unspecified weeks of gestation
• 765.21—less than 24 completed weeks of gestation
• 765.22—24 completed weeks of gestation
• 765.23—25-26 completed weeks of gestation
• 765.24—27-28 completed weeks of gestation
• 765.25—29-30 completed weeks of gestation
• 765.26—31-32 completed weeks of gestation
• 765.27—33-34 completed weeks of gestation
• 765.28—35-36 completed weeks of gestation
• 765.29—37 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:

• V13.21—personal history of preterm labor (which excludes: current pregnancy with history of preterm labor, V23.41)
• V23.41—pregnancy with history of preterm labor
• V23.49—pregnancy with other poor obstetric history

This information provided by The Coding Institute. For a free sample issue or information on how to subscribe to any of 29 specialty-specific coding newsletters, please contact The Coding Institute, 2272 Airport Rd. South, Naples, FL 34112; phone 800-508-2582; fax 800-508-2592; or visit www.codinginstitute.com.

Coding Consult: New codes you need to know.

Medical Economics

Dec. 9, 2002;79:23.