ED Coding and Reimbursement Alert

Consider these new diagnosis codes to best capture your ED services.

Although everyone is anticipating the transition to ICD-10 in October of 2013, we can't forget about some key updates to ICD-9 2012 that take affect Oct. 1 that will affect your ED claims.

Resource: A file providing complete information on 2012 changes to the diagnosis part of ICD-9-CM is posted on CMS's webpage at https://www.cms.gov/icd9providerdiagnosticcodes/07_summarytables.asp.

Heed Dementia Adjustments

To illustrate, consider these ICD-9 code changes for dementia which more clearly indicates how the disease impacted the care provided in the ED including inability to obtain the normal history or physical exam requirements:

New sub 294.2 Dementia, Unspecified

Excludes mild memory disturbances, not amounting to dementia (310.89)

New code 294.20 Dementia, unspecified, without behavioral disturbance

Dementia NOS

New code 294.21 Dementia, unspecified, with behavioral disturbance

Aggressive behavior

Combative behavior

Violent behavior

Use additional code where applicable, to identify wandering in conditions classified elsewhere (V40.31)

Make note of these other ED relevant new ICD-9 codes

These new ICD-9 codes detail influenza with other specific respiratory manifestations

488.81 Influenza due to identified novel influenza A virus with pneumonia

488.82 Influenza due to identified novel influenza A virus with other respiratory manifestations

488.89 Influenza due to identified novel influenza A virus with pneumonia with other manifestations

These new ICD-9 codes detail cause of anaphylactic shock to greater specificity

999.34 Acute infection following transfusion, infusion, or injection of blood and blood products

999.41 Anaphylactic reaction due to administration of blood and blood products

999.42 Anaphylactic reaction due to due to vaccine

999.49 Anaphylactic reaction due to other serum

999.51 Other serum reaction due to administration of blood and blood products

999.52 Other serum reaction due to vaccination

999.59 Other serum reaction

These new V codes expand the list of factors influencing health status and contact with health services that could help explain the reason for an ED visit

V12.21 Personal history of gestational diabetes

V12.29 Personal history of other endocrine, metabolic, and immunity disorders

V12.55 Personal history of pulmonary embolism

V13.81 Personal history of anaphylaxis

V13.89 Personal history of other specified diseases

V23.42 Pregnancy with history of ectopic pregnancy

V23.87 Pregnancy with inconclusive fetal viability

V40.39 Other specified behavioral problem

Editor's note: Be sure to review the guide to the 2012 ICD-9 CM Updates published in the front of the diagnosis code book for codes relevant to your coding situation. That list notes each change effective for 2012 for new or revised codes, and if revised, whether language has been added or deleted from prior years.