Gastroenterology Coding Alert

Personal history, fecal impaction codes round out list of gastroenterology diagnosis changes.

Every October 1, you're faced with new diagnosis codes, code deletions, and code revisions.

This year is no exception, with new congenital malformation, fecal incontinence, and body mass index diagnosis codes to learn. Save yourself the hassle of scouring the full list, and focus on this rundown of the changes that may affect your gastroenterology practice. Turn to New Secondary Diagnosis Codes

The first set of codes that you may use in gastroenterology is actually V codes. The three codes are:

• V13.67 -- Personal history of (corrected) congenital malformations of digestive system
• V88.11 -- Acquired total absence of pancreas
• V88.12 -- Acquired partial absence of pancreas.

These codes are for information only and you should use them as secondary diagnosis codes associated with visits.

Example: Your gastroenterologist saw a patient for complaints of chronic bloating and diarrhea. The patient also reports that she had a subtotal pancreatectomy surgery for a pancreatic cancer several years ago. Your primary diagnosis codes would be 787.3 for abdominal bloating and 787.91 for diarrhea. Then, you would use V88.12 as a secondary diagnosis code for the prior surgical procedure that left the patient with an acquired partial absence of pancreas.

New Fecal-Related Codes Add Specific Details

You'll also find that ICD-9 2011 adds specificity to fecal-related diagnoses with the

following four new codes:

• 560.32 -- Fecal impaction
• 787.60 -- Full incontinence of feces
• 787.61 -- Incomplete defecation
• 787.62 -- Fecal smearing
• 787.63 -- Fecal urgency.

Good news: You might be able to use these codes to support colonoscopy and sigmoidoscopy procedures for commercial payers. However, you'll have to wait and see if Medicare will add these as acceptable diagnoses in their local coverage determinations (LCDs).

How it works: Just because you have these new codes to use doesn't mean you're suddenly going to get paid by payers who didn't pay you before. "Right now, even with the current 560.39 (Other impaction of the intestine) diagnosis code, we tend to run into some insurance carriers who do not view this as something that is medically necessary to remove," says Melanie Cramer, CMRS, a lead accounts receivable representative for NH Gastroenterology Inc. in Bedford, N.H. "Whether the old code or new code for fecal impaction is used, usefulness doesn't really apply when you have insurance companies who do not see eye-to-eye on the medical necessity of removing it."

Add BMI V Codes to Your E/M Arsenal

ICD-9 2011 has "expanded the body mass index (BMI) codes to demonstrate higher BMIs with five new codes," notes Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPCP, CENTC, CHCC, with CRN Healthcare Solutions in Tinton Falls, N.J. The current ICD-9 codes for BMI reporting are listed from V85.0 to V85.4 and provide specific 5th-digit codes for exact coding of the patient's BMI. The prior definition of V85.4 was "BMI 40 and over." With the upcoming changes it will be possible to be more specific in reporting the BMI for the extremely obese patient.

You'll need to stop using V85.4 (Body Mass Index 40 and over, adult) on Oct. 1 and start using one of the following new V codes in its place:

• V85.41 -- Body Mass Index 40.0 -- 44.9, adult
• V85.42 -- Body Mass Index 45.0 -- 49.9, adult
• V85.43 -- Body Mass Index 50.0 -- 59.9, adult
• V85.44 -- Body Mass Index 60.0 -- 69.9, adult
• V85.45 -- Body Mass Index 70 and over, adult.

The benefit: "BMI has become an important health tool, and those codes [V85.41-V85.45] will also provide more data," says Susan Vogelberger, CPC, CPC-H, CPCI, CMBS, CCP-P, CEO of Healthcare Consulting & Coding Education, LLC.

"There are seven vital signs that count for the constitutional bullet in the E/M physical exam coding, and there are those who are of the opinion that BMI should be an eighth option," Vogelberger says. If that eighth bullet gains traction and comes into play for coders, the new V codes could help considerably.