Home Health & Hospice Week

New pneumonia, fluency disorder, and cystostomy complication codes are just a few of the proposed diagnosis coding changes that will affect home care folks the most, come Oct. 1.

The Centers for Medicare & Medicaid Services has unveiled the proposed changes to the hospital inpatient prospective payment system, giving home care organizations the first look at the ICD-9 changes for 2011.

For starters, 488.0x (Influenza due to identified avian influenza virus) and 488.1x (Influenza due to identified novel H1N1 influenza virus) provide more detail for your influenza coding. The co-operating parties who make up the ICD-9 Coordination and Maintenance Committee found that these subcategories didn't provide the level of specificity that category 487 (Influenza) does, so they expanded the codes at 488.0 and 488.1. The result is six new influenza with pneumonia codes for the 2011 ICD-9 update:

• 488.01 -- Influenza due to identified avian influenza virus with pneumonia

• 488.02 -- Influenza due to identified avian influenza virus with other respiratory manifestations

• 488.09 -- Influenza due to identified avian influenza virus with other manifestations

• 488.11 -- Influenza due to identified novel H1N1 influenza virus with pneumonia

• 488.12 -- Influenza due to identified novel H1N1 influenza virus with other respiratory manifestations

• 488.19 -- Influenza due to identified novel H1N1 influenza virus with other manifestations

In a letter responding to the proposed ICD-9 changes, credentialed coder Sue Bowman with the American Health Information Management Association, asked that a "use additional code" note be added under code 487.0 (Influenza with pneumonia), indicating that an additional code should be assigned for the type of pneumonia. Bowman also recommended adding the same note under proposed new codes 488.01 and 488.11. "We understand that patients with avian influenza virus and novel H1N1 influenza virus may develop bacterial pneumonia, so it is important to capture the specific type of pneumonia," she said.

Changes to the fluency disorder ICD-9 codes are also on the horizon. New code titles will help distinguish childhood onset fluency disorder, adult onset fluency disorder, and -- here's where it gets interesting for home care -- fluency disorder subsequent to brain lesion or disease.

You'll probably remember that 438.14 (Late effects of cerebrovascular disease, fluency disorder) was implemented on Oct. 1, 2009. The plan for 2010 is to modify the inclusion term "Stuttering" at 438.14 to read "Stuttering due to late effect of cerebrovascular accident." The 438 codes are all case mix codes, says coding expert Lisa Selman-Holman, consultant and principal of Selman-Holman & Associates and CoDR -- Coding Done Right in Denton, Texas. The specifics on speech difficulties and swallowing difficulties usually come from the speech language pathologists, so you'll need to educate their speech therapists on the new choices.

Other related changes include revising 307.0 to read "Stuttering; Adult onset fluency disorder" and adding new code 315.35 (Childhood onset fluency disorder).

Currently, you have specific codes for complications of all sorts of artificial stomas, but not for a cystostomy. If you're trying to code for an infected cystostomy, you've got 997.5 (Urinary complications) or 996.39 (Mechanical complication of other genitourinary device, implant, and graft), but these codes don't specify that the complication is with the cystostomy or that there is an infection.

For 2011, you can look forward to four new codes that will correct this problem:

• 596.81 -- Infection of cystostomy Use additional code to specify type of infection

• 596.82 -- Mechanical complication of cystostomy

Malfunction of cystostomy

• 596.83 -- Other complication of cystostomy

Fistula

Hernia

Prolapse

• 596.89 -- Other specified disorders of bladder

Calcified

Contracted

Hemorrhage

Hypertrophy

The complication codes for cystostomy will clear up a lot of confusion, Selman-Holman says. The 997.5 code never seemed to fit the situation.

Keep in mind: Routine care code V55.5 gains up to 23 points in some equations in the HHRG and gains points toward non-routine supplies, Selman-Holman says. If CMS remains true to its other V55.x and complications decisions, the new complication codes will not make the case mix list.

For example, V55.0 (Attention to tracheostomy) is a case mix code, but its complication code isn't.

Confusion abounds about coding aspiration pneumonia resulting from a procedure. Code 997.39 (Other respiratory complications) includes aspiration pneumonia complicating a procedure, but there is a "use additional code" note at the beginning of the category to identify the complication. This left coders with a quandary. Should you pair 507.0 (Pneumonitis due to inhalation of food or vomitus) with code 997.39? Or should you report just 997.39 since aspiration pneumonia is an inclusion term.

The proposal for 2011 is to add a new code and modify the instructional notes at categories 507 and 997 to assist coders in selecting the correct codes for this complication. So you'll see the following new and modified codes:

• 507 (Pneumonitis due to solids and liquids) Add Excludes: postprocedural pneumonitis (997.32)

• 997.32 (Postprocedural aspiration pneumonia) Chemical pneumonitis resulting from a procedure Mendelson's syndrome resulting from a procedure

• 997.39 (Other respiratory complications) Delete Mendelson's syndrome resulting from a procedure

Delete Pneumonia (aspiration) resulting from a procedure

What's ahead: These codes appeared in the Federal Register as part of the proposed Hospital Inpatient PPS rule, but home care organizations won't know the final list of new and changed codes for a few months.