Anesthesia Coding Alert

Effective Oct. 1, 2001, CMS (formerly HCFA) implemented an updated and revised ICD-9 coding guide. In the 2002 guide, CMS incorporated new and excluded codes, lengthened codes and added subcodes to existing entries to clarify diagnoses. Familiarity with these changes will help anesthesiologists and their coding and billing personnel in filing accurate claims.
 
"While the number of changes is about the same as last year, it seems that they have added more five-digit codes," says Barbara Johnson, CPC, MPC, a professional coder with Loma Linda University Anesthesiology Medical Group in California and a member of the National Advisory Board for the American Association of Professional Codes. "The fact is as codes become more specific, we have to be more specific."

Expanded codes can be found throughout ICD-9 2002. Areas such as evelopmental dislocation of joints, pathological fractures and abnormal mammography may be of special interest to anesthesiologists.
 
A new subcategory, 718.7[0-9] (developmental dislocation of joint), has been introduced. These codes define dislocations in an unspecified site, shoulder, upper arm, forearm, hand, pelvic region and thigh, lower leg, ankle and foot, other specified sites, and multiple sites. Note that the subcategory excludes congenital dislocation of hip (754.30-754.35) and traumatic dislocation of hip (835.00-835.13).
 
Expanded definitions are new also for pathological fracture (733.1), which now excludes stress fractures. These injuries are described with three new codes:
 

733.93 stress fracture of tibia or fibula (stress reaction of tibia or fibula)
 

733.94 stress fracture of the metatarsals (stress reaction of metatarsals)
 

733.95 stress fracture of other bone (stress reaction of other bone).

Coding for abnormal mammograms has also changed. Previously, abnormal mammogram findings were reported with 793.8. This code has been expanded to include 793.80 (abnormal mammogram, unspecified), 793.81 (mammographic microcalcification) and 793.89 (other abnormal findings on radiological examination of breast).
 
Revised Codes

In addition to expanded codes, a number of code revisions have been made. Johnson cites an example involving revised coding for asthma. "Category 493 contains a revised fifth-digit subclassification for '0'," she says. The new definition reads without mention of status asthmaticus or acute exacerbation or unspecified. In addition, 493.2 (chronic obstructive asthma) now contains an additional exclusion, acute bronchitis (466.0)." Corresponding changes to bronchitis codes exclude chronic obstructive asthma with acute exacerbation, which is represented by a new code, 493.22. Anesthesiologists should take note of these changes because they may perform intubation or other treatments for patients suffering from severe obstructions associated with these diseases.

Although relatively few changes have been made to V codes that affect anesthesiology , Kelly Dennis, CPC, of Central Florida Anesthesia Associates of Leesburg, Fla., and president of the Florida Anesthesia Administrators Association, suggests coders look at new code V10.53 (personal history of malignant neoplasm, renal pelvis). "Sometimes our anesthesiologists do personal histories, and in these cases this code might be relevant to include on the claim," she says.
 
A number of new codes have been added to the external causes of injury and poisoning (E codes). Of note are those related to falls (E886, E888) and striking (E917). For example, the definition of E888 (other and unspecified fall) deletes "fall from bumping against object" but incorporates four new codes:
 

E888.0 fall resulting in striking against sharp object; use additional external cause code to identify object (E920)
 

E888.1 fall resulting in striking against other object
 

E888.8 other fall
 

E888.9 unspecified fall; fall NOS.

Descriptors for the E917 series (striking against or stuck accidentally by objects or persons) contain six new codes:  

E917.3 furniture without subsequent fall, excludes fall from furniture [E884.2, E884.4-E884.5])
 

E917.4 other stationary object without subsequent fall; bath tub, fence, lamp-post.
 

E917.5 object in sports with subsequent fall; knocked down while boxing
 

E917.6 caused by a crowd, by collective fear or panic with subsequent fall
 

E917.7 ... furniture with subsequent fall, excludes fall from furniture [E884.2, E884.4-E884.5])
 

E917.8 other stationary object with subsequent fall; bath tub, fence, lamp-post.

"While it is not common for an anesthesiologist to know how a person was injured, pain-management specialists may have occasion to report these codes," Dennis comments.
 
While 10 new drug codes have been added, Johnson says these are irrelevant to anesthesiologists, especially those practicing pain management. She adds, however, that pain can come from many directions and that anesthesiologists provide services in many ways. Providers, coders and billers should know all of the changes to ensure coding accuracy. "The best advice I can offer is to try to be as exact as possible," Johnson says. "This is not always easy, partially because coders and billers do not get pathology reports and partially because we rely on the patient information for diagnoses. Try to get copies of all surgical and diagnosis documentation and develop working relationships with physicians so that you can discuss their cases. Often, this direct contact can resolve many questions." Dennis concurs: "I can't stress enough the importance of receiving the most accurate information possible directly from the physician. This is where it all starts."
 
As stated in a program memorandum dated June 28, 2001, CMS requires carriers and intermediaries to accept both codes until Dec. 31, 2001. "This allows providers sufficient time to obtain and integrate the updated ICD-9-CM codes into their billing systems," the memorandum notes. The new codes become mandatory Jan. 2, 2002.
 
For the memorandum and a complete list of changes, visit www.hcfa.gov/pubforms/transmit/AB0191.pdf.