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Anesthesia Coding Alert

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Sneak a Peek at ICD-9 Changes That Could Affect Your Practice

Published on Wed Jun 15, 2005

New codes for kidney disease, weight, and joint surgery get specific

Just because the new ICD-9 book won't hit your desk until October doesn't mean you have to be in the dark about code changes until then. Read on for the skinny on how some of the expected new and updated 2006 codes will transform your claims.

Code Chronic Kidney Disease by Stage

ICD-9 now has a single, catchall code for chronic renal failure (585). One of the most important changes for anesthesia coders might lie in the expanded 585.x series of codes for chronic kidney disease:

  • 585.1 - Chronic kidney disease, stage I
  • 585.2 - Chronic kidney disease, stage II (mild)
  • 585.3 - Chronic kidney disease, stage III (moderate)

  • 585.4 - Chronic kidney disease, stage IV (severe)

  • 585.5 - Chronic kidney disease, stage V

  • 585.6 - End stage renal disease

  • 585.9 - Chronic kidney disease, unspecified.

    "I'm glad to see an expansion of codes for chronic renal failure," says Emma LeGrand, CPC, CCS, coding supervisor for New Jersey Anesthesia Associates in Florham Park. "The addition of staging levels means a coder will have more definitive codes to choose from when coding for chronic kidney disease or end stage renal disease (failure) - based on the physician's documentation."

    "[Code] 585.6 is the biggest code from the group because it will give us a direct code for end stage renal failure," adds Barbara Johnson, CPC, MPC, owner of Real Code Inc. in Moreno Valley, Calif.

    The extra codes will be especially useful for patients whose status changes during their course of treatment. Example: LeGrand says it's common to see documentation ranging from renal insufficiency (593.9, Unspecified disorder of kidney and ureter) to chronic and/or end stage renal failure (585), or a code from the 403.x1 series (Hypertensive renal disease; with renal failure) during the same episode of inpatient care.
     
    Consider Patient's Weight Oct. 1

    News reports and scientific studies about the increasing numbers of overweight Americans - and the associated consequences - seem almost as common as "super size" meals. In fact, a Business Week article in October 2004 claimed that 61 million Americans are now technically obese (meaning their body mass index is 30 or higher) (Business Week online, Oct. 24, 2004; "Weighing Bariatric Surgery's Risks").

    Each year, more Americans turn to surgery as a way to treat their weight problem. ICD-9 2006 addresses that issue by including new codes for obesity, normal body mass index (BMI) ranges, and above-normal BMI ranges:

  • 278.02 - Overweight

  • V85.0 - Body mass index less than 19, adult

  • V85.1 - Body mass index between 19-24, adult

  • V85.21-V85.4 - Various ranges for adult body mass index from 25.0-40 and over. The codes are in nine-tenths increments (such as 25.0-25.9), which makes coding very specific. 

    Risk-factor help: Once the new diagnosis codes go into effect, anesthesiologist Scott Groudine, MD, in Albany, N.Y., recommends that you ask your physicians to include the patient's BMI on the information they send to the coding office. These codes better define morbid obesity, which in turn helps demonstrate any increased risk the anesthesiologist might face when treating the patient because of weight-related issues.

    Report More Details About Egg Donors and Recipients

    If your physicians provide anesthesia while a surgeon harvests eggs for in-vitro procedures, you'll have new codes in 2006 for egg donor cases: 

  • V59.70 - Egg (oocyte) (ovum) donor, unspecified

     
  • V59.71 - ... under age 35, anonymous recipient

     
  • V59.72 - ... under age 35, designated recipient

     
  • V59.73 - ... age 35 and over, anonymous recipient

     
  • V59.74 - ... age 35 and over, designated recipient.

    "The biggest problem with using these codes will be knowing whether the recipient is designated or anonymous," Johnson predicts. "Therefore, coders will use the 'unspecified' code (V59.70) a lot."

    Joint Surgery, UTI, Sleep Apnea and Respirator Codes Worth Checking Out

    Several other new ICD-9 codes are worth becoming familiar with:

  • 996.40-996.49 - These nine codes describe various complications that can arise from prosthetic joint implants (such as mechanical loosening, dislocation, surface wear or fracture around the prosthetic joint). ICD-9 balances these additions with the deletion of 996.4 (Mechanical complication of internal orthopedic device, implant, and graft). Caution: Before reporting these codes, Groudine reminds that they apply to "redos" or failures, not the original joint replacement procedures.

  • V13.02 - Personal history, urinary (tract) infection. "This identifies the UTI as a recurrent problem," LeGrand says. "That's good to see because ICD-9 currently does not have a specific code for recurrent UTI. It will probably help justify medical necessity for some procedures of the urinary tract system."

  • 327.23 - Obstructive sleep apnea (adult) (pediatric). "This is a big one because many patients are having surgery for obstructive sleep apnea," Johnson says. "The fact that the codes give us 'adult' and 'pediatric' gives us a better way to distinguish those patients." The 2006 edition revises some other codes related to sleep apnea, such as 780.53 (Hypersomnia with sleep apnea, unspecified) and 780.57 (Unspecified sleep apnea).
     
  • V46.13 - Encounter for weaning from respirator (ventilator). This addition extends the critical care diagnosis codes and helps you report time spent with a respiratory distress/failure patient who is recovering.

    Wait for the Starting Gun

    As always, remember that these codes are not official until ICD-9 2006 is published and in effect on Oct. 1, 2005. Check your new book and visit CMS online at www.cms.hhs.gov to see complete lists of new and revised codes for 2006.

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