ED Coding and Reimbursement Alert

With all the rush by emergency departments (ED) in hospitals to brace for ambulatory payment classifications (APCs), few coders or emergency department clinicians have taken the time to check out the 2001 revisions to ICD-9 codes, which take effect Oct. 1. Some of the Health Care Financing Administration (HCFA) changes will require the inclusion of more information. These new codes will force coders to change how they code, and will require doctors to change how they document some services.

HCFA didnt make the annual ICD-9 changes for fiscal year 2000 because it didnt want to conflict with possible year 2000 computer problems, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C. So this year, they announced a rather long list of the new codes for 2001, which incorporated the proposed changes for the past two years.

Many of these codes will affect the emergency department directly. The best way for coders to effectively integrate the new codes is to familiarize themselves with them before they take effect. To learn what codes have changes, read the May 5, 2000, edition of the Federal Register at www.access.gpo.gov/su_docs/fedreg/ a000505c.html, and start at page 26,382. Fewer than 200 codes are being added, removed or changed.

ED coders should know about the following changes:

The 493 asthma series has been expanded, adding fifth digits to 493.0, 493.1, 493.2 and 493.9 to delineate exacerbation. For example, 493.1 now stands for intrinsic asthma. Under the revision, 493.12 stands for intrinsic asthma, with acute
exacerbation. Code 494 for bronchiectasis also has received exacerbation modifiers.

Ulcer of lower limbs, 707.1, has been expanded, with fifth digits added to specify the location of
the ulcer.

Codes have been added for such symptoms, signs and ill-defined conditions as loss of height (781.91), abnormal posture (781.92), failure to thrive (783.41) and short stature (783.43).

V codes for allergies have been expanded, adding a fifth digit to V15.0 to signify substances such as peanuts, milk products, insects and latex.

V codes for acquired absence of organs also have been expanded, adding a fifth digit to specify which organ is missing.

These changes add versatility to the ICD-9 system, and Donna Savard, RHIA, medical records director at Mackinac Straits Hospital and Health Center in St. Ignace, Mich., appreciates that kind of change. I would hope there are many changes. I hope it would give you more to choose from to help you solve the puzzle.

Traditionally, HCFA and the National Center for Health Statistics dont make major changes every year, says Barbara Cole, RN, BSN, CPC, vice president of pre-billing operations at Reimbursement Technologies, a Conshohocken, Pa., billing and financial management company for emergency [...]