Home Health & Hospice Week

The new and revised 2010 ICD-9 codes were effective Oct. 1 without any grace period -- making it crucial that you're onboard with the changes most likely to impact your agency.

The Centers for Medicare & Medicaid Services is giving you fewer changes to master this year than you had last year, said Judy Adams, president and  CEO of Adams Home Care Consulting in Chapel Hill, N.C. during a recent Eli-sponsored audioconference. This reduction in changes may be a trend we'll continue to see as we ramp up for ICD-10, she says.

You have six new codes for Merkel cell carcinoma at 209.3x (Malignant poorly differentiatedneuroendocrine tumors). These additions expand on the 209.3x subcategory that was added last year,along with the 209.xx (Neuroendocrine tumor) category. This neoplasm case mix category welcomes the six new codes:

• 209.31 (Merkel cell carcinoma of the face)

• 209.32 (Merkel cell carcinoma of the scalp and neck)

• 209.33 (Merkel cell carcinoma of the upper limb)

• 209.34 (Merkel cell carcinoma of the lower limb)

• 209.35 (Merkel cell carcinoma of the trunk)

• 209.36 (Merkel cell carcinoma of other sites)

The Merkel cell carcinomas are aggressive skin cancers and are actually more prevalent and more aggressive than melanomas. Before Oct. 1, you would code these skin cancers in the 173 category along with other skin cancers, such as basal cell carcinomas. These new codes help differentiate Merkel cell carcinomas from other skin cancers to better track treatment and prevalence.

Additions for secondary neuroendocrine tumors at 209.7x provide seven new case mix codes:

• 209.70 (Secondary neuroendocrine tumor, unspecified site)

• 209.71 (Secondary neuroendocrine tumor of distant lymph nodes)

• 209.72 (Secondary neuroendocrine tumor of liver)

• 209.73 (Secondary neuroendocrine tumor of bone)

• 209.74 (Secondary neuroendocrine tumor of peritoneum)

• 209.75 (Secondary Merkel cell carcinoma)

• 209.79 (Secondary neuroendocrine tumor of other sites)

Disappointing: The new skin cancer codes don't earn non-routine supply points, says Trish Twombly, director of coding with Foundation Management Services in Denton, Texas. Up until Oct. 1 the codes for this type of cancer earned NRS supply points. Now, the new codes will be more specific but they aren't on the NRS list, she says.

However, both the 209.3x codes and the 209.7x codes are case mix ,so they add points to the home health resource group calculation, says Lisa Selman-Holman, consultant and principle of Selman-Holman & Associates in Denton, Texas.

Speech-language pathologists will welcome two new Neuro 3 case mix codes for late effects of cerebrovascular disease: 438.13 (Late effects of cerebrovascular disease, dysarthria) and 438.14 (Late effects of cerebrovascular disease, fluency disorder).

You'll also see changes to other speech disorder codes:

• 784.42 (Dysphonia, a disorder of voice production)

• 784.51 (Dysarthria, weakness in musculature of mouth and throat caused by brain lesions)

• 784.59 (Other speech disorder)

• V57.3 (Speech therapy)

Code V10.9 (Unspecified personal history of malignant neoplasm) is no longer a valid code. Use V10.90 (Personal history of unspecified malignant neoplasm) instead, Adams says.

Long a topic of debate, the 2010 ICD-9 update settles how to code for a pressure ulcer of the coccyx. Use 707.03 (Pressure ulcer; lower back), which has been revised to include the coccyx. Unfortunately, 707.05 (Pressure ulcer; buttock) is currently the only code that supports reimbursement for pressure-relieving pads or cushions for patients with a pressure ulcer of the coccyx. But CMS often goes back in to make coverage changes after the new diagnosis codes go into effect, so that may change, Adams says.

Maybe next year: "I was hoping they would add the 249.xx (Secondary diabetes mellitus) series, which was new last year to the case mix list this year, but that didn't happen," Twombly says. View the summary tables to see all of the new, revised, and invalid codes at www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp#TopOfPage.