Anesthesia Coding Alert

Plus: Migraine revisions focus on punctuation addition, not descriptor change.

New and revised ICD-9 codes for 2012 go into effect October 1, which means it's time to brush up on the latest code options. Pay special attention to expanded lip neoplasm and glaucoma choices, plus new codes for acute respiratory failure and other complications following surgery.

Expand Digits for Some Neoplasm, Glaucoma Diagnoses

When ICD-9-CM 2012 goes into effect, you'll be able to pinpoint some neoplasms and glaucoma stages more specifically:

• Neoplasm codes 173.0-173.9 (Other malignant neoplasm of skin) will be deleted and replaced by new fifth-digit options 173.00-173.99.
• Glaucoma codes expand to the fifth-digit level in order to differentiate the different stages (unspecified, mild, moderate, severe, or indeterminate stage). The new codes will be 365.70-365.74.

Reasoning: You'll have much more specific diagnosis choices when ICD-10 goes into effect in October 2013. Adding fifthdigit expansions to codes such as these now will help coders and physicians start thinking in terms of more detailed diagnoses.

Watch for Gastric Band and Other Surgical Additions

Because anesthesiologists can find themselves involved in cases covering all surgical areas, get familiar with diagnosis changes for surgical procedures. New ICD-9-CM surgical procedure choices you'll want to check out include:

• Infection or complications due to gastric band or bariatric procedures (539.01-538.89)
• Erosion of implanted vaginal mesh and other prosthetic material surrounding an organ or tissue (629.31)
• Partial tear of rotator cuff (726.13)
• Acute or chronic respiration failure, in normal circumstances or following trauma and surgery (518.81, 518.83, 518.84, 518.51).

"An anesthesiologist will report a wide array of diagnosis codes," says Sharon Donelli, CPC, CPMA, administrative officer and director of coding and compliance with Integrated Physician Management Services in East Hartford, Conn. "Whatever someone can have done surgically and need anesthesia for, that's what anesthesiologists will need to know."

Get Familiar With New Personal, Family History Options

Five new V codes will help your physician better indicate conditions a patient might have as part of her personal or family medical history. Your new choices are:

• V12.21 -- Personal history of gestational diabetes
• V12.29 -- Personal history of other endocrine, metabolic, and immunity disorders
• V12.55 -- Personal history of pulmonary embolism
• V13.81 -- Personal history of anaphylaxis
• V13.89 -- Personal history of other specified diseases.

When coding for maternity care, you might also turn to new diagnoses V23.42 (Pregnancy with history of ectopic pregnancy) and V23.87 (Pregnancy with inconclusive fetal viability)

Migraine Revisions Don't Mean Real Change

When you read through the list of revised codes, you'll see many migraine diagnoses listed (such as 346.01, Migraine with aura, with intractable migraine, so stated, without mention of status migrainosus, and 346.11, Migraine without aura, with intractable migraine, so stated, without mention of status migrainosus). The descriptors themselves remain the same, but the punctuation changes slightly. Updated descriptors add a comma following the "so stated" phrase in the fifth-digit "1" subclassification descriptor for each type of migraine noted.

"I think this is mainly a 'housekeeping' type thing," says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, Co. "The change keeps the format consistent with the fifth-digit '3' subclassification descriptor."