ED Coding and Reimbursement Alert

ICD-9 has released its preliminary list of new diagnosis codes for late 2008 and 2009, and coders should get familiar with them now. Once October rolls around, the law requires that you use these new codes.

You can wrap your head around the upcoming secondary diabetes codes and hematuria definitions with this rundown.

Remember: Since the passage of the Health Insurance Portability and Accountability Act (HIPAA) Transaction and Code Set Rule, there is no grace period for new ICD-9 codes. You-ve got to be ready to go with the new codes on Oct. 1, says Joan Gilhooly, CPC, CHCC, president of Medical Business Resources in Chicago.

"This federal law applies to all payers, so in essence, your time to prepare for these codes is now," she says.

While the codes on this list have been approved for use, there may be some slight changes before the list is finalized during the summer. Check future issues of ED Coding Alert for all of the latest news on ICD-9 2009.

The newest ICD-9 version will have an entire code set for secondary diabetes.

"Secondary diabetes mellitus is a type of diabetes caused by something other than genetics or environmental factors," says Greer Contreras, CPC, senior director of coding for Marina Medical Billing Service Inc. in California.

For example, the condition may develop "when the pancreatic tissue responsible for the production of insulin is absent because it is destroyed by a disease," Contreras says.

The code set starts with 249.00 (Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified) and ends with 249.91 (Secondary diabetes mellitus with unspecified complication, uncontrolled).

In between, you-ll find a host of codes that describe the patient's diabetes and the underlying factor causing the condition, such as:

- 249.10 -- Secondary diabetes mellitus with ketoacidosis, not stated as uncontrolled, or unspecified

- 249.11 -- - uncontrolled

- 249.30 -- Secondary diabetes mellitus with other coma, not stated as uncontrolled, or unspecified

- 249.31 -- - uncontrolled

- 249.60 -- Secondary diabetes mellitus with neurological manifestations, not stated as uncontrolled, or unspecified

- 249.61 -- - uncontrolled

- 249.70 -- Secondary diabetes mellitus with peripheral circulatory disorders, not stated as uncontrolled, or unspecified

- 249.71 -- - uncontrolled.

Example: A patient with benign hypertension and subacute pancreatitis reports to the ED with abdominal pain and episodes of vomiting. The ED physician performs a comprehensive metabolic panel (CMP), which reveals secondary diabetes without complication.

Beginning Oct. 1, you-ll need a code from the secondary diabetes code set in this example. On the claim, report the following:

- 80053 (Comprehensive metabolic panel) for the CMP

- 401.1 (Benign essential hypertension) linked to 80053 to represent the patient's hypertension

- 577.0 (Acute pancreatitis) linked to 80053 to represent the patient's pancreatitis

- 249.00 linked to 80053 to represent the patient's secondary diabetes.

There are also new ICD-9 codes for hematuria, or blood in the urine, says Jeffery F. Linzer Sr., MD, FAAP, FACEP, associate medical director for compliance and business affairs for the division of pediatric emergency medicine Department of Pediatrics at Children's Healthcare of Atlanta at Egleston, Ga.

The new ICD-9 codes are:

- 599.70 -- Hematuria, unspecified

- 599.71 -- Gross hematuria. A patient has gross hematuria when blood is visible to the naked eye upon urination. "The urine is red or the color of cola" when a patient has gross hematuria, Contreras says.

- 599.72 -- Microscopic hematuria. A patient has microscopic hematuria when there is no blood visible to the naked eye upon urination but blood appears on a urinalysis, Linzer says.