Anesthesia Coding Alert

The Health Care Financing Administration (HCFA), like many other organizations last year, was leery of making unnecessary changes to computer-oriented materials because of possible Y2K problems. Because of this, no changes were made to the ICD-9 book. A rather long list of new codes for 2001 that incorporate changes for the past two years was first published in June 2000. These coding changes become official Oct. 1and will be mandatory for use on Jan. 1, 2001, for HCFA and some carriers. All coding professionals should become familiar with the updates to file claims accurately.

Most of the changes fall into one of three categories: lengthened codes, subcodes to an existing code or new codes.

Lengthened Codes

Many of the new codes add a fifth digit, which will help clarify ICD-9 coding. For example, codes for chronic ulcers will now be identified further by anatomical site. Before, we had only one code to use 707.9 (chronic ulcer of unspecified site), and many claims were denied because the carrier wanted the specific anatomical site, says Donna Gullikson, coding and insurance supervisor with the consulting firm Medical Computer Business Services in Augusta, Ga.

I see many other codes expanding as well.Having expanded codes will help with filing claims, she continues. It makes each diagnosis more specific, so well be able to code diagnoses more accurately. We are trained to code to the highest specificity, so being as accurate as possible is practically bred in coders. The expanded codes will definitely help us with that.

The most notable benefit of the more specific codes is better, more accurate recording of services. Practitioners need to be aware that the new codes can serve as a double-edged sword. Although, services can be recorded in more detail, claims also may be denied when nonspecific codes are used to report a diagnosis.
Claims could be denied when an old four-digit code is used to report a diagnosis instead of the appropriate new five-digit code. For example, 707.1 (ulcer of lower limbs, except decubitus) would no longer be used to report an ulcer of the heel; the more specific code 707.14 (ulcer of heel and midfoot) should be used instead.

We arent depicting a true picture of the patients condition when we use unspecified codes, Gullikson explains. The expanded codes are good to have. The more specific we can get with the code, the less time we spend working on the account and the faster payments will come in.

New Subcodes to Existing Codes

Some other codes, like failure to thrive (738.41) have been split into several related codes. Some of the expanded codes of interest to anesthesia providers include:

707.1 (ulcer of lower limbs, except decubitus). This diagnosis has been expanded to include codes 707.10-707.19. The new definition for 707.10 is ulcer of lower limb, unspecified. The new subcodes (707.11, 707.12, 707.13, 707.14, 707.15 and 707.19) all describe ulcers on specific parts of the lower limbs.

783.4 (lack of expected normal physiological development). This general code was the only one related to a patients failure to thrive. Now it has been modified and enhanced by two additional codes. The new definition for 783.40 (note that it is now also a five-digit code) is lack of normal physiological development, unspecified. The new subcodes are 738.41 and 738.7 (adult failure to thrive). The primary difference to keep in mind when using the new codes is whether the patient is an adult or child.

New Codes

A number of new codes also will become official
Oct. 1. This is a welcomed change to many anesthesia coders because some diagnoses that anesthesia providers need on a regular basis never have been available. Three examples of new codes that will be helpful for anesthesia providers include:

The closest code in the past to represent a patients allergy to latex was V15.0 (allergy, other than to medicinal agents). V15.07 is new and specifically for a patient who is allergic to latex.

Another pertinent series of new codes is V67.00- V67.09 that allow for follow-up exams after unspecified surgery, vaginal pap smear or other surgery. These codes will be especially helpful in situations such as follow-ups on children who have had tumor surgery, heart surgery, or other procedures and have come in for evaluation.

New ICD-9 codes related to the acquired absence of organs also have been added. These include V45.74-V45.78 and specify acquired absence of an organ for the stomach, lung, genital organs, eye and parts of the urinary tract. Code V45.79 (other acquired absence of organ) also has been added to this series.

The main thing to remember is that the anesthesiologist should use the same codes as the surgeon or at least code as closely as possible. An ICD-9 code like foot ulcer (707.1) justifies the need for surgery. The surgery justifies the need for anesthesia. The surgeon needs to code diagnoses appropriately to justify his or her care, and anesthesia providers need to use the same diagnosis whenever possible.

ICD-9 codes also are important in pain management or critical-care practices. For example, a pain block for a patient with herpes zoster (053) could be justified if the original diagnosis is coded as 053.12 (postherpetic trigeminal neuralgia), but not if the original diagnosis is 053.13 (postherpetic polyneuropathy).

Where to Go From Here

Just as coding professionals are getting accustomed to using new codes and carriers are accepting the new codes with no problems, updated versions of ICD-9 and CPT are being released. Fortunately for many coders, the new
ICD-9 manual does not include as many changes as some people expect.

There dont seem to be too many changes in the volumes that affect physicians, says Barbara Johnson, CPC, MPC, a professional coder with Loma Linda University Anesthesiology Medical Group in California and member of the National Advisory Board for the American Association of Professional Coders. I would have expected more codes to be added since none were for 2000.

Other coders such as Gullikson feel there are more updates for this year than usual because no changes were issued in 2000. She adds, These updates are a welcomed site to coders who have wanted these additional subcodes for many years. If you are a coder, you know the importance of coding to the highest specificity, and its frustrating when you have to code to an unspecified condition or dont have a code for a particular anatomical site.

Most carriers are pretty good about having new codes in place by Jan. 1, the date HCFA mandates for its carriers, Johnson says. Well have to work with them while their systems are being updated, but those are just the usual challenges we face every year.