Anesthesia Coding Alert

Just as autumn is always marked by changing leaves, the beginning of new school years and baseball playoffs, in the coding world it also means implementation of new ICD-9 codes - and this year some of those changes will mean big changes for anesthesia coders.

The changes to ICD-9 were first announced in May and become effective Oct. 1, 2002. Following is a rundown of what's ahead with diagnosis coding for 2003.

Many New Codes,As Always

The ICD-9 updates include 147 new codes, 19 deleted codes and 23 revised codes from last year.

Although anesthesiologists usually aren't involved with assigning diagnosis codes, these codes help justify the need for anesthesia services or pain management treatment. Several new additions for 2003 will lay the foundations for more accurate anesthesia coding.

One such group is the long list of new aftercare codes (V54.xx for fracture, and V58.xx for surgery), which will simplify anesthesia coding by pinpointing what kind of postoperative status the patient has, says Kelly Dennis, CPC, president of Perfect Office Solutions in Leesburg, Fla., and president of the Florida Anesthesia Administrators Association.

"We also use the tubal pregnancy codes sometimes, and these were expanded to fifth digits for more specific descriptions of with or without intrauterine pregnancy," she adds. (New codes related to abdominal, tubal, ovarian or ectopic pregnancy include 633.00-633.91.) But, as Dennis points out, using the new, more specific five-digit codes correctly depends on obtaining accurate information about the case from physicians or nurses.

New codes in a related area, prematurity and newborn infant problems, will also be helpful to anesthesiologists. (There are now 10 codes for prematurity, instead of two.) By having new codes that pinpoint the exact week of gestation, carriers will better understand the increased physical status level and complications or risk factors involved in treating these infants.

Several new diagnosis codes related to critical illness will help anesthesiologists in the long run. The new codes for critical illness polyneuropathy (357.82), critical illness myopathy (359.81), and SIRS (systemic inflammatory response) due to noninfectious process with organ dysfunction (995.94) each represent relatively new disease entities that are frequently seen in the ICU.

"Physicians have been writing a diagnosis of SIRS in charts for a few years, but had to find another ICD-9 code for billing purposes," says Scott Groudine, MD, an Albany, N.Y., anesthesiologist. "Now anesthesiologists can assign a better diagnosis code for some of the long-term ventilator patients they care for, and the diagnosis and billing codes can reflect each other more accurately."

Nineteen of the 23 revised ICD-9 codes deal with hypertensive heart disease, hypertensive heart and renal disease, heart aneurysm or congestive heart failure. These changes will help justify the need for anesthesia in some cardiac cases.

"Many more procedures can be done to help a patient with heart disease than in the past, and the tests and treatments require more specific diagnoses," Groudine says. For example, diastolic dysfunction is a relatively new concept, and the treatment options for this condition may be different than for angina patients. Different types of dysfunction warrant different tests and have different prognoses, Groudine says, so adding or revising codes to differentiate these conditions is useful (such as adding 428.22, Chronic systolic heart failure, and 428.32, Chronic diastolic heart failure, to distinguish these conditions and their treatments from the general heart failure codes, 428.0-428.9).

"A surgical patient with diastolic dysfunction may require advanced forms of anesthesia or monitoring," Groudine says. "The carrier might question a diagnosis of congestive heart failure because of the lack of clinical support for the diagnosis. The new code 428.32 tells the carrier that the patient can have a significant heart problem even if he doesn't have the classic signs of congestive heart failure, and therefore merit more advanced monitoring or treatment."

Nineteen diagnosis and aftercare codes were deleted for 2002-2003, but you'll probably never miss them. Most were rather vague and have now been replaced by new, more detailed codes. For example, codes 633.8 (Other ectopic pregnancy) and 633.9 (Unspecified ectopic pregnancy) have been replaced by a range of codes related to ectopic pregnancy (new codes 633.80-633.91). The single code V54.8 (Other orthopedic aftercare) has been replaced by 20 orthopedic aftercare codes that list the particular type of fracture and location (V54.10-V54.89).

"Of the codes that were deleted, most were revised with fifth-digit identifiers," Dennis notes. "One example is that deleted code 998.3 (Disruption of operation wound) was replaced by codes 998.31 (Disruption of internal operation wound) and 998.32 (Disruption of external operation wound). The new codes are more specific and informative, making them better than the old ones."

Though the new codes become effective Oct. 1, carriers must accept both the old and new codes until Dec. 31, 2002. This gives carriers a 90-day grace period during which Medicare accepts claims with either the 2002 or 2003 ICD-9-CM codes. The new codes become mandatory Jan. 1, 2003.

But Cindy Parman, CPC, CPC-H, principal and cofounder of the consulting firm Coding Strategies Inc., in Dallas, Ga., says commercial carriers don't always follow the Medicare guidelines and may require the new codes beginning either Oct. 1 or Jan. 1. She recommends verifying each carrier's policy regarding ICD-9 implementation before receiving rejections or claim suspensions for using 2002 codes.

"It's always essential for physicians to communicate the patient's medical condition accurately and completely, but coders don't always have complete information unless they're working from an operative report in addition to the anesthesia record," Parman adds. "Every October is a great opportunity to remind physicians of the specificity of diagnosis coding and encourage complete medical record documentation."