Anesthesia Coding Alert

New diagnoses give better pain management options

As the new ICD-9 codes kick in this month, be sure to identify patients in two groups: those who have one of the diagnoses with changing codes, and those who have conditions that qualify for one of the new diagnosis codes.

Take Advantage of New Pain Codes 

ICD-9 2007 includes 200 new and 55 revised diagnosis codes. Anesthesia and pain management coders will rely on several new additions:

• 338.0--Central pain syndrome
• 338.18--Other acute postoperative pain
• 338.19--Other acute pain
• 338.21--Chronic pain due to trauma
• 338.28--Other chronic postoperative pain
• 338.29--Other chronic pain 
• 338.4--Chronic pain syndrome.

You shouldn't have trouble figuring out when to report some of these new codes, such as acute postoperative pain. But here are examples for when you might use some of the more general codes:

• Other acute pain (338.19) could be when a patient complains of pain without an indication of its cause (such as back pain without an injury or definitive diagnosis).

• Chronic pain from trauma (338.21) could be when a patient has continued pain after her injuries heal.

• Chronic post-op pain (338.28) could be when the patient has continued pain after the postoperative period ends and the surgical site heals.

• Chronic pain syndrome (338.4) could be for an unspecified pain syndrome such as psychosocial dysfunction.

 The new pain diagnoses don't stop with general descriptors such as those above. Some new diagnoses are very specific, such as 338.12 (Acute post-thoracotomy pain) and 338.22 (Chronic post-thoracotomy pain).

"The anesthesiologist can address acute pain issues at the time of the patient's surgery," says Kelly Dennis, CPC, owner of Perfect Office Solutions in Leesburg, Fla. "This benefits the patient by reducing his pain and shortening recuperation time."

When to use it: Some patients' status moves from acute to chronic pain when their pain persists beyond the usual time (for example, six to eight weeks is usual for sternotomy healing). The new code 338.22 will come in handy when your physician treats patients whose pain persists past that time.
 
Say Goodbye to V58.49--In Many Cases

ICD-9 2007 doesn't stop with adding the new acute pain codes. The new edition changes the descriptor for V58.49, which has been a stand-by code for pain management.

The descriptor for code V58.49 (Other specified aftercare following surgery) now includes "change or remove drains." Coders will use it when physicians remove surgical drains.

"I suspect that these new acute pain diagnosis codes will take the place of the much-used V58.49 diagnosis code," Dennis says. "Coders often used V58.49 for postoperative pain management requested by the surgeon. The new codes are more descriptive, and the descriptor change to V58.49 changes the meaning tremendously."

Heads-up: Many local coverage determinations require physicians to report V58.49 for post-op pain epidurals. Now carriers will need to rewrite policies to reflect the new descriptors, so look for changes.

Watch for Diagnoses to Justify Anesthesia

Some of ICD-9's other new diagnoses will help your physicians justify anesthesia during procedures or will help your physician document the patient's condition more accurately. See ICD-9 2007 for complete descriptors:

• Transfusion-related acute lung injury (518.7) if your physician sees intensive care unit patients

• Acute bronchospasm and other diseases of trachea and bronchus (519.11 and 519.19) to help explain ICU care or why the physician made extra pre- or postoperative visits

• Conditions complicating pregnancy, childbirth or the puerperium--tobacco use disorder (649.00-649.04), obesity (649.10-649.14), bariatric surgery status (649.20-649.24), coagulation defects (649.30-649.34) and epilepsy (649.40-649.44)

• Altered mental status (780.97) to help justify anesthesia during magnetic resonance imagings or other tests, or when the patient is in and out of a coma or when he has some mental lapses due to injury, illness or medication

• Unspecified adverse effect of anesthesia (995.22) to help support an anesthesia consult if the patient has prolonged confusion, prolonged weakness or persistent headache after an anesthetic. Seeing 995.22 in a patient's record can also give your provider a heads-up about potential problems before he administers anesthesia for a later procedure.

See for yourself: You'll find the list of new ICD-9 codes at www.cms.hhs.gov/AcuteInpatientPPS/downloads/cms1488p.pdf. Skip to page 840, Table 6A, where the lists of new and revised diagnosis and procedure codes begin.

Is ICD-10 on the Horizon?

The next ICD revision, ICD-10, won't premier in the United States before the fall of 2007, says Linda Martien, CPC, CPC-H, overseer of coding operations at National Healing Corp. of Boca Raton, Fla.
 
Changes to expect: The first character of each ICD-10 code will be alphabetical, Martien says. Some of the codes will have as many as seven characters, she adds.

The new code sets will offer significantly more choices, including an expanded trauma section. Combination diagnosis/symptom codes "should reduce the number of codes needed to fully describe the condition," Martien adds.

Adjustment time: Once the ICD-10 codes do premier, you'll have a two-year window to implement them. Learn more about ICD-10 at the World Health Organization site www.who.int/classifications/icd/en/.