ED Coding and Reimbursement Alert

New ICD-9 codes make multiple bedsore description easier

Heads up, ED coders: Don't just default to 707.0 for decubitus ulcer codes anymore. For 2005, ICD-9 created a barrel of site-specific codes to describe ulcers by anatomic location.

The Centers for Disease Control and CMS have unveiled their new 2005 ICD-9 codes, and because payers do not allow a grace period for the new codes, you should ensure that your superbills are updated by Sept. 30, 2004.

Decubitus ulcers include any chronic ulcer of the skin, including bedsores, plaster ulcers and pressure ulcers. "The code that you would use now to describe such an ulcer is 707.0 (Decubitus ulcer), which is a 'generalized' decubitus ulcer code," says Mary Brown, CPC, CMA, coding specialist for a seven-physician practice in Omaha, Neb. "However, it appears that this code range [707.00-707.09, see below for definitions] will now require a fifth digit to specify the location of the decubitus ulcer."

The new bedsore codes include:

707.00 -- Decubitus ulcer, unspecified site

707.01 -- ... elbow

707.02 -- ... upper back

707.03 -- ... lower back

707.04 -- ... hip

707.05 -- ... buttock

707.06 -- ... ankle

707.07 -- ... heel

707.09 -- ... other site.

"The new decubitus ulcer codes are very exciting because we can now specify the location of the ulcer," says Lori Sorenson, CPC, coding specialist at Billings Surgical Clinic in Billings, Mont. Before the change, "no matter where the decubitus ulcer was, we only had one choice: 707.0. By using the range of codes 707.00 to 707.09, we can explain the location of the ulcer in a more specific way," she says.

Example: Suppose the physician discovers decubitus ulcers on the patient's left hip and buttock. The physician debrides partial-thickness skin on the hip and full-thickness skin on the buttock. He sends you the chart, and you contemplate the best way to show the insurer why you performed two types of debridement.

Old way: Because previous ICD-9 editions listed only one decubitus ulcer code (707.0), you probably reported 11040 (Debridement; skin, partial thickness) and 11041 (... skin, full thickness) and linked both to 707.0. Practices often fought denials for these services because, without the physician's operative report, insurers failed to understand why the physician performed two debridement procedures for one bedsore.

New way: Coders can now specify the separate bedsore sites to demonstrate medical necessity. You should report 11040 with 707.04 (to identify the location as the hip) and 11041 with 707.05 (for the buttock).

For 2005, you'll also be able to access three new codes to describe lower-limb venous embolism and thrombosis: The following three codes are more specific than 453.8 (Other venous embolism and thrombosis; of other specified veins), which you previously used for deep venous thrombosis:

453.40 -- Venous embolism and thrombosis of unspecified deep vessels of lower extremity

453.41 -- Venous embolism and thrombosis of deep vessels of proximal lower extremity

453.42 -- Venous embolism and thrombosis of deep vessels of distal lower extremity.

The new venous embolism and thrombosis codes allow you to describe the location of the condition more specifically, Sorenson says.

For example, if a patient presents to the ED with a venous embolism and deep thrombosis of the thigh, you can now report 453.41 instead of the 453.9 (Venous embolism and thrombosis of unspecified site) you'd have reported previously. Look in your physician's documentation for "proximal" or "distal" to signal that you need to report one of the more specific codes.

Tip: To review a full listing of the new ICD-9 codes, visit the CMS Web site at www.cms.hhs.gov/medlearn/icd9code.asp#coding.