Home Health & Hospice Week

ICD-9 2009 brings 300 new or revised diagnosis codes. Which changes will most affect home health coders?

Expert coder Trish Twombly, director of coding with Foundation Management Services in Denton, Texas shares her "Top 10" list of codes that will impact home health:

1. New category 249.xx (Secondary diabetes mellitus) to indicate diabetes that is the result of a-nother specific disease process, or that develops when pancreatic tissue which is responsible for producing insulin is absent because it is destroyed by disease.

As of Oct. 1, ICD-9-CM includes a new category of codes just for secondary diabetes. Codes in the 249.xx category are similar to the 250.xx (Dia-betes mellitus) codes. However, you should note two big differences.

No case mix points: While diabetes codes in the 250.xx range can bring your agency additional case mix points, the 249.xx secondary diabetes codes aren't case mix codes, says coder Lisa Sel-man-Holman, consultant and principal of Selman-Holman & Associates and CoDR -- Coding Done Right in Denton, Texas.

In a surprise move, CMS did not include the 249 codes in the updated case mix list, Selman-Holman says. But secondary diabetes requires the same care and creates the same problems that diabetes coded with 250 causes.

However, CMS did add 249 to the pseudo-code appendix Table 3 Part 1, which means that you may gain points for certain manifestations of secondary diabetes, Selman-Holman says. For example, conditions such as peripheral autonomic neuropathy (337.1) and polyneuropathy (357.2) gain points when coded as manifestations after the 249 etiology.

No type I or type II: With codes in the 250.xx category, the fifth digit is used to indicate which type of diabetes the patient has -- type I or type II -- as well as whether the diabetes is indicated as uncontrolled. But with the new 249.xx secondary diabetes codes, the fifth digit simply indicates whether or not the diabetes is stated as uncontrolled -- there's no type I or type II.

The guidelines for choosing between "not stated as uncontrolled" and "uncontrolled" are the same for 249 as they are with 250, Selman-Holman says. The physician must state the diabetes is uncontrolled or out of control before you can use the fifth digit for uncontrolled.

2. 707.20-707.25 (Pressure ulcer stages). Home health coders likely report lots of patients with pressure ulcers, so they'll need to frequently use the new additional codes to show pressure ulcer staging. To make sure you're using these new pressure ulcer staging codes correctly, read Chapter 12 in the new Official Coding Guidelines effective Oct. 1 very carefully, advises certified coder Judy Adams with LarsonAllen in Charlotte, N.C.

3. New combination codes for Staph aureus -- 041.11 (Methicillin susceptible Staphylococcus aureus) and 041.12 (Methicillin resistant Staphylo-coccus aureus).

4. New neoplasm codes in new category 209 (Neuroendocrine tumors). The malignant versions are case mix codes that garner additional reimbursement under the prospective payment system.

5. New fifth digit "2" to indicate "in relapse" for leukemia codes in categories 203.xx-208.xx.

6. New complication code 998.33 (Disrupt-ion of traumatic injury wound repair).

7. and 8. New history V codes V13.51 (Per-sonal history of pathologic fracture) and V13.52 (Personal history of stress fracture).

9. V code V46.3 (Wheelchair dependence).

10. Revised code V45.11 (Renal dialysis status). Previously, you could report that a patient was receiving renal dialysis with V45.1 (Renal dialysis status), but now this code requires five digits.

Caution: Sending claims with the old code could lead to denials.

Note: For more information on new codes, subscribe to Eli's Home Health ICD-9 Alert at http://www.elihealthcare.com or by calling 1-800-874-9100.