ED Coding and Reimbursement Alert

Diagnosis codes for 2004 take a turn toward the specific - so starting Oct. 1, be prepared to score physician documentation you didn't need previously.

There's more: For certain conditions that left you with an unspecific code as your only choice, you'll now have extra codes to describe those ailments more accurately. For example, rhabdomyolysis, which you'd report under the 2003 codes as 728.89 (Other disorders of muscle, ligament, and fascia; other), you can report with a code that describes it exactly: 728.88 (Rhabdomyolysis).

"Previously, coders had some leeway when reporting codes for concussion. For 2004, the code set has become more exact," says Mike Granovsky, MD, CPC, chief financial officer of Greater Washington Emergency Physicians in Fort Washington, Md. In place of code 850.1 (Concussion, with brief loss of consciousness), which becomes invalid, you'll use one of these two more detailed codes: 850.11 (Concussion, with loss of consciousness of 30 minutes or less) or 850.12 (... with loss of consciousness from 31 to 59 minutes). Because of this change, "physicians and coders must be more exact when looking at the duration of time the patient was unconscious," Granovsky says.

The codes describing sickle-cell disease have also become more specific, and now distinguish between different strands of abnormal hemoglobin. With current codes 282.61 (Sickle-cell anemia, Hb-S disease without mention of crisis) and 282.62 (... with mention of crisis), "the intention all these years was for these codes to describe SS [sickle-cell] disease," says Jeff Linzer, MD, MICP, physician in the emergency services division of Children's Healthcare of Atlanta and Hughes Spalding Children's Hospital in Atlanta. But other common strains of sickle cell weren't being documented, Linzer says. "So 282.61 and 282.62 will have an editorial change that will say, 'Hb-SS disease.' "

Five entirely new sickle-cell codes also enter the scene, and their language describes the condition as "disease" rather than "anemia" in order to capture greater variations of the ailment, Linzer says. The new codes are: