General Surgery Coding Alert

Show medical necessity with new 'supplemental factors' codes.

Your general surgery practice will have some new tools to explain the reason for a procedure when the latest ICD-9 codes become effective Oct. 1.

CMS recently published the full list of over 130 new diagnosis codes in the Federal Register, and our experts will guide you through the list to find the codes that impact your practice.

Surprise: More than a third of the new codes can be found in the "V" code section. That's where you'll find the new codes that impact general surgeons the most.

Expanded BMI Helps Bariatric Surgery, E/M Level

ICD-9 has "expanded the body mass index (BMI) codes to demonstrate higher BMIs with five new codes," notes Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC, with CRN Healthcare Solutions in Tinton Falls, N.J.

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.

Distinction crucial for bariatrics: Most coverage policies for gastric bypass or other bariatric surgeries designate a cut-off BMI, among other factors, to show medical necessity for the procedure. The expanded BMI  codes will give general surgeons a concrete way to document the degree of obesity and need for surgery.

Watch for E/M benefit: "BMI has become an important health tool, and those codes [V85.41-V85.45] will also provide more data," says Susan Vogelberger, CPC, CPCH, CPC-I, 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, especially in bariatrics and orthopedics/sports medicine," Vogelberger says. If that eighth bullet gains traction and comes into play for coders, the new V codes could help considerably.

Retained Fragments Add Specificity

ICD-9 adds 14 new codes for retained foreign bodies that your surgeon can use to further describe injury or illness requiring surgical intervention. The codes include the following subcategories:

V90.0x for retained radioactive fragments

V90.1x for retained metal fragments

V90.2 for retained plastic fragments

V90.3x for retained organic fragments

V90.8x for specified retained fragments such as glass and stone

V90.9 for unspecified retained foreign body.

How you'll use it: You should report these codes as "secondary status codes for cases such as injury codes that include the presence of a foreign body, or with toxic effect codes," according to minutes of the ICD-9-CM Coordination and Maintenance Committee.

For instance: If your surgeon performs a foreign body removal (such as 20520, Removal of foreign body in muscle or tendon sheath; simple) for a patient with diagnosis 728.82 (Foreign body granuloma of muscle), you should also add the appropriate V90.xx code to further define the fragment.

Don't miss: ICD-9 also adds related code V15.53 (Personal history of retained foreign body fully removed).

Use New 'Personal History' and 'Acquired Absence' Codes

ICD-9 provides a new V code category for personal history of corrected congenital malformations (V13.62-V16.68), with the following codes particularly relevant to general surgeons:

V13.67 --" ... of digestive system

V13.68 --" ... of integument, limbs, and musculoskeletal system.

You'll also find two new codes for patients who have previously had a pancreatectomy:

V88.11 --" Acquired total absence of pancreas

V88.12 --" Acquired partial absence of pancreas.

These latter codes will help provide additional information about patients with low insulin (251.3, Postsurgical hypoinsulinemia) following pancreatectomy (such as 48155,

Pancreatectomy, total). Until Oct. 1, you should continue using V45.79 (Other acquired absence of organ) to describe this condition.