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Gastroenterology Coding Alert

Learn New Codes This Summer to Prevent Autumn Fall

Published on Tue Jun 08, 2004

New diagnosis codes are here, and you must start using them in October

If a patient reports to your office on October 1 with an esophagostomy infection, Medicare will expect you to use the new ICD-9 code 530.86 (Infection of esophagostomy) to represent the condition.

Don't pull your hair out trying to find the code in your ICD-9 book; it isn't there. But the Centers for Medicare and Medicaid Services (CMS) has created 530.86 -- along with some other gastroenterology-specific diagnosis codes -- for use in physician's offices beginning this autumn.

"There are five new ICD-9 codes that will affect gastroenterology practices," says Linda Parks, MA, CPC, CMC, CCP, coding specialist at GI Diagnostics Endoscopy Center in Marietta, Ga. Read on to find out more about the new diagnosis codes, and how they might be used at your office in October.

Link Esophagostomy Codes to E/Ms

CMS added two new ICD-9 codes to the 530.8 (Other specified disorders of esophagus) family -- 530.86 (Infection of esophagostomy) and 530.87 (Mechanical complication of esophagostomy).

The two new diagnosis codes are most likely to affect your E/M service coding, Parks says.

"You would see these [codes] attached to an E/M service most often," she says. "Anywhere from level 2 to level 5, for new or established patients, depending on the workup performed by the gastroenterologist."

Example: The gastroenterologist performs a level 4 E/M service on a new patient currently being treated for a mediastinal cancer and finds an infection of the esophagostomy. You would report 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity) with the new ICD-9 code 530.86 to reflect the infection.

Use V Code if Aspirin Affected Bleeding

You'll also need to learn a new secondary code to use when a patient has internal bleeding caused by aspirin intake: V58.66 (Long-term [current] use of aspirin).

Coders may use V58.66 with E/M visits for new or established patients, but the code is more likely to be linked to an endoscopy performed due to gastrointestinal (GI) bleeding or anemia, Parks says.

Example: Apatient reports to the emergency room after vomiting blood. The gastroenterologist performs an EGD on the patient and finds evidence of previous bleeding from numerous erosions in the stomach typical of aspirin injury.

He also performs an epinephrine injection in one area of active bleeding to stem the bleeding. The operative notes indicate that the patient had a gastrointestinal hemorrhage that may be linked to his consumption of four aspirin tablets a day.

In this instance, you would report 43255 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with control of bleeding, any method) with ICD-9 codes 578.0 (Gastrointestinal hemorrhage; hematemesis) and V58.66 to represent the aspirin consumption.

Remember: V codes are secondary diagnosis codes.

Never list them as the primary diagnosis, and certainly don't report them alone unless the examination is for a covered screening examination.

Hepatitis C Coding Gets More Specific

The new set of diagnosis codes will also give you two more options when reporting procedures for patients with hepatitis C. They are:

  • 070.70 -- Unspecified viral hepatitis C without hepatic coma
  • 070.71 -- Unspecified viral hepatitis C with hepatic coma

    When to use? These two diagnosis codes would be applied to a liver biopsy claim (47000, Biopsy of liver, needle; percutaneous), a common procedure for hepatitis C patients.

    Goodbye Grace Period

    Hot tip: Learn these codes before October 1. CMS has scrapped the 90-day grace period you once had for implementing new codes, according to two CMS transmittals (Nos. 89 and 95) from February. The new rule, however, shouldn't cause your gastroenterology practice many problems -- as long as you are familiar with the new codes before you are required to use them.

    The grace period was previously allowed so providers could "ascertain the new codes and learn about the discontinued codes," CMS says. But HIPAA's "transaction and code set rule" mandates that physicians and practices report codes that are valid at the time the physician rendered the service.

    Translation: You will have to begin using new and revised ICD-9 codes when CMS introduces them on Oct. 1, 2004, and you will not have 90 days to continue using the old codes.

    Don't Keep New Codes a Secret

    What to do: You shouldn't encounter many coding difficulties or denials without a grace period as long as you update your encounter forms by the ICD-9 and HCPCS deadlines, says Melanie Witt, RN, CPC, MA, an independent coding consultant in Fredericksburg, Va.

    CMS already has a file containing the new codes on its Web site available for download. To get a copy of the file, go to http://www.cms.hhs.gov/medlearn/icd9code.asp. Then, look for the link to Table 6-Aunder the "Effective October 1, 2004" heading on the left side of the page.

    You should download the file, print it out, and make copies for all the relevant personnel in the office as soon as possible, experts say.

    "You need to let your staff know that there is a set of new codes," says Witt, who recommends handwriting the new codes in the encounter form's "Other" blank to get used to using them.

    Beware: Medicare will be ready to accept these codes the day they become effective, but some private carriers may not be. If a private insurance carrier denies a correct code, talk to the carrier representative and alert him to the new code.

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