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Home Health & Hospice Week

Diagnosis Coding:

Are You Ready For New

Published on Fri Jul 25, 2003

If your coders aren't using the newest ICD-9 codes come Oct. 1, it could cost you big in time and money.

Home care providers should use the next few months to learn the newest coding update, which the Centers for Medicare & Medicare Services sent to its contractors June 20. Claims with incorrect codes are denied, meaning costly delays to reimbursement. Correct diagnosis codes also are required on OASIS forms.

Two new codes home care coders should get friendly with are 728.87 (muscle weakness) and 728.88 (rhabdomyolysis), advises Chapel Hill, NC-based clinical consultant Judy Adams with the Larson Allen Health Group. These codes "will be used considerably within home health," Adams predicts.

Three new general symptom codes also will see home care use, Adams adds: 780.93 (memory loss), 780.94 (early satiety) and 781.94 (facial weakness). The memory loss code is sure to see considerable use, Adams says.

Home health agencies must download either a new HAVEN release or a patch from CMS' Web site to install the new codes, once it becomes available, coding expert Prinny Rose Abraham with HIQM Consulting told listeners in a May Eli teleconference on coding.

While most of the changes for fiscal year 2004 add a fifth digit to increase code specificity, the exception is the deletion of six five-digit codes for difficulty walking, Adams observes. A new code, 719.7 (difficulty in walking) will replace 719.70, 719.75, 719.76, 719.77, 719.78 and 719.79.

Following, in numerical order, are new codes Adams and Abraham expect home care providers to use most when they go into effect Oct. 1:

  • Sickle-Cell. 282.41 (sickle-cell thalassemia without crisis), 282.42 (sickle-cell thalassemia with crisis) and 282.49 (other thalassemia). Providers can use these specific additions for thalassemia instead of a general code for anemias (282.4), Adams notes.

    Plus, 282.64 (sickle-cell/Hb-C disease with crisis) and 282.68 (sickle-cell thalassemia with crisis) are two additional codes for sickle-cell disease with crisis.

  • Dementia. 331.19 (other frontotemporal dementia) and 331.82 (dementia with Lewy bodies).

  • Encephalopathy. Current code 348.3 will be expanded to 348.30 (encephalopathy, unspecified), 348.31 (metabolic encephalopathy) and 348.39 (other encephalopathy), Adams points out.

  • Esophagus. 530.20 (ulcer of esophagus without bleeding) and 530.21 (ulcer of esophagus with bleeding). Plus, 530.85 (Barrett's esophagus).

  • Peripartum cardiomyopathy. 674.50 (peripartum cardiomyopathy, unspecified as to episode of care, or not applicable), 674.51 (peri-partum cardiomyopathy, delivered, with or without mention of antepartum condition), 674.52 (peripartum cardiomyopathy, delivered, with mention of antepartum condition), 674.53 (peripartum cardiomyopathy, antepartum condition or complication) and 674.54 (peripartum cardiomyopathy, postpartum condition or complication).

  • Shock. 785.52 (septic shock).

  • Abnormal glucose results. 790.2 was replaced with three new, more specific codes related to abnormal glucose results, Adams says: 790.21 (impaired fasting glucose), 790.22 (impaired glucose tolerance test [oral]) and 790.29 (other abnormal glucose). Providers will use 790.29 to support lab studies, she expects.

  • Ill-defined conditions. Two five-digit codes will replace the current 799.8 (other ill-defined conditions), Adams explains: 799.81 (decreased libido) and 799.89 (other ill-defined conditions).

  • Concussion. Two codes will show the length of time, up to an hour, a person lost consciousness with a concussion: 850.11 (concussion, with loss of consciousness of 30 minutes or less) and 850.12 (concussion, with loss of consciousness from 31-59 minutes).

  • Trunk injury. Five new codes will replace 959.1 (injury to the trunk), showing more specific location of the injury: 959.11 (other injury of chest wall), 959.12 (other injury of abdomen), 959.13 (fracture of corpus cavernosum penis), 959.14 (other injury of external genitals) and 959.19 (other injury of other sites of trunk).

    Editor's Note: A list of the new codes is at www.cms.gov/manuals/pm_trans/AB03091.pdf.

    To order Prinny Rose Abraham's coding teleconference, which reviewed FY 2004 coding changes, V and E codes and other coding strategies, go to http://codinginstitute.com/conference/tapes.cgi?detail=430 or call 1-800-508-2582.

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