Anesthesia Coding Alert

Detailed diagnoses help with current and long-term care

ICD-9 now makes your pain management coding easier--and gives physicians a heads-up about conditions to consider when planning long-term care--thanks to new codes for alcohol-induced and sleep disorders, plus other pain-related conditions. 

Show Alcohol-Induced, Sleep Disorder Difference

Last year's ICD-9 revised the title for the 291 series (Alcohol-induced mental disorders). The new edition adds two more codes to the family, expanding the group to include: 

- 291.81--Alcohol withdrawal

- 291.89--Other (which includes anxiety disorder, mood disorder, sexual dysfunction and sleep disorders)

- 291.82--Alcohol-induced sleep disorders.

Some coders are very excited over this new breakdown of codes because patients will sometimes be intoxicated when they arrive for elective or emergency surgery.

The 292 series adds one new code, 292.85, Drug-induced sleep disorders.

Pain management application: Not all intoxication is due to alcohol dependence, but it does affect the course an anesthesiologist will choose when he assesses a patient for possible pain management care. The choice of medications becomes more complicated because it could be dangerous to give the patient a narcotic while he is in withdrawal.

Another use: This expanded group of codes could be useful for pain physicians because they might also be weaning the patient from alcohol or other forms of self-medication for depression or pain, says Scott Groudine, MD, an anesthesiologist in Albany, N.Y.

The new code for obstructive sleep apnea (327.23, Obstructive sleep apnea [adult] [pediatric]) is another important addition, says Barbara Johnson, CPC, MPC, owner of Real Code Inc. in Moreno Valley, Calif. Previously, ICD-9 included obstructive sleep apnea with the more inclusive apnea code, so having separate codes will allow you to be more accurate.

Remember: If you report 327.23, note whether the patient is an adult or a child.

Pinpoint Pain With Erythromelalgia Code

ICD-9 adds a new choice for reporting peripheral vascular disease: 443.82 (Erythromelalgia). Although this might not seem like a change that will greatly impact your coding, it could come in handy more often than you think. With its definition of -burning pain and increased skin temperature and redness,- erythromelalgia is more specific than a broad diagnosis of pain (such as 729.5, Pain in limb).

Some coders believe this category helps give more reason for the patient's pain. Example: If the pain is vascular in nature, reporting 443.82 would justify the need for Doppler more than less detailed codes.

Put it in practice: Implementing the new codes might not be very difficult, but it can still make a difference. Train your physicians to be detailed-oriented and your staff to use the new diagnoses, and you-ll definitely boost your claims- accuracy.