Home Health & Hospice Week

If you thought the 2012 ICD-9 updates would be minimal because of the focus on transitioningto ICD-10 in 2013, you're in for a surprise. As of Oct. 1, you'll have more changes than in previous years: 166 new codes to grapple with, along with 168 revisions and 88 deletions.

"There are a lot of changes for this last year of regular updates to ICD-9-CM," says coding expert Judy Adams with Adams Home Care Consulting in Chapel Hill, N.C.

Fast track: Many of the new codes were first introduced at the March 2011 ICD-9 Coordination and Maintenance Committee meeting, says attendee Therese Rode, senior coding manager with Inova VNA Home Health in Falls Church, Va. While code suggestions can often take years to become reality, the speedy approval cycle this year is likely due to the plan for limited changes next year as the implementation date for ICD-10 draws nearer, she says.

The final decision as to which new codes will be added to the home health PPS case mix list is determined in the annual PPS update, Adams says. However, there are several new codes within categories that are currently case mix, so it's likely these new codes will become case mix as well:

• Neoplasm of the skin: There are 40 new five-digit codes in category 173.x (Other and unspecified malignant neoplasm of the skin). These new codes specify particular sites such as lip, eyelid, ear, other parts of face, scalp and skin of neck, trunk, upper limb, lower limb, other specific sited of skin, and skin, site unspecified, Adams says.

The new fifth digits differentiate between basal cell carcinoma and squamous cell carcinomas of the skin. These same differentiations are found in ICD-10.

Category 173 is already a case mix diagnosis in the Neoplasm category, so all of these codes likely will be case mix as well as proxies for earning non-routine supply points in home health, Adams says.

• Thalassemia: There are six new five-digit codes for specific forms of thalassemia replacing current code 282.49 (Other thalassemia). These more specific codes can be expected to be case mix diagnoses since category 282 (Hereditary hemolytic anemias) is already in the Blood Disorder case mix category, Adams says.

However, the number of patients with these conditions seen in home health is likely to be limited, she says. Thalassemia is a rare condition passed down through families resulting in destruction of redblood cells.

• Pancytopenia: Three more specific fivedigit codes related to pancytopenia at 284.1x (Pancytopenia) will also likely be case mix, since category 284 is already case mix in the Blood Disorder category, Adams says.

• Dementia: New codes 294.20 (Dementia, unspecified, without behavioral disturbance) and 294.21 (Dementia, unspecified, with behavioral disturbance) are a welcome addition because they allow home health coders to report dementia not related to another disease process like Alzheimer's, says certified coder Jennifer Warfield, education director with PPS Plus Software in Biloxi, Miss. These new codes also allow you to differentiate whether the patient exhibits behavioral disturbances, Warfield says. These codes will replace 294.8 (Dementia NOS).

Another change to the dementia codes is the addition of the underlying disease of Parkinson's to the 294.1x (Dementia in conditions classified elsewhere) subcategory and the removal of wandering from the code. New code V40.31 (Wandering in diseases classified elsewhere) indicates wandering for those with dementia and it is a new "use additional code" note at 294.11 (Dementia in conditions classified elsewhere with behavioral disturbance) and 294.21 (Dementia, unspecified, with behavioral disturbance), says coding expert Lisa Selman-Holman of Selman-Holman & Associates and CoDR -- Coding Done Right in Denton, Texas.

While the Centers for Medicare & Medicaid Services will have to designate this new subcategory as a case mix diagnosis, it's reasonable to believe CMS will add these new dementia codes as case mix diagnoses in the Psych 2 category under PPS, Adams says.

• Fractures: Two new codes, 808.44 (Multiple closed pelvic fractures without disruption of pelvic circle) and 808.54 (Multiple open pelvic fractures without disruption of pelvic circle), along with revised codes 808.43 (Multiple closed pelvic fractures with disruption of pelvic circle) and 808.53  (Multiple open pelvic fractures with disruption of pelvic circle), will probably be case mix diagnoses in Ortho 1 category since all of the 808 (Fracture of pelvis) category is case mix, Adams predicts.

The pelvic fracture codes were catch-alls previously, Warfield says. The new codes add specificity and allow you to indicate whether the fracture involves the disruption of the pelvic ring. Another improvement that these codes will bring about is to allow you to list one single code when the patient has multiple pelvic fractures, Rode tells Eli.

New non-case-mix ICD-9 codes will also bring coding changes, including how you'll code memory disturbance and bladder disorders, plus new V codes.