Home Health & Hospice Week

Some codes may result in higher home health agency payments under the prospective payment system (see Eli's HCW, Vol. XIX, No. 29, p. 229). Others will lead to better record-keeping and documentation.

Starting this fall, you'll need to code with a higher degree of specificity when it comes to reporting fluid overload. 2010's 276.6 (Fluid overload) will expand to include the following:

• 276.61 -- Transfusion associated circulatory overload

• 276.69 -- Other fluid overload.

Transfusion-associated circulatory overload (TACO), a heart-related condition, "is a circulatory overload following transfusion of blood or blood components," said Mikhail Menis of the Food & Drug Administration, who presented the proposal for this change at the September 2009 ICD-9-CM Coordination and Maintenance Committee meeting. The patient may experience "acute respiratory distress, increased blood pressure, pulmonary edema secondary to congestive heart failure, positive fluid balance, etc., during or within six hours of transfusion."

The new code 276.69 includes fluid retention. Another related addition at 782.3 (Edema) excludes fluid retention.

Codes in the 488.0x (Influenza due to identified avian influenza virus) and 488.1x (Influenza due to identified novel H1N1 influenza virus) subcategories will provide greater specificity, come October. The cooperating parties figured out that these sub-categories didn't provide the level of detail that category 487 (Influenza) does; so they have expanded the codes at 488.0 and 488.1. That means six new influenza with pneumonia codes for the 2011 ICD-9 update:

1) 488.01 -- Influenza owing to identified avian influenza virus with pneumonia

2) 488.02 -- Influenza owing to ... avian influenza virus with other respiratory manifestations

3) 488.09 -- Influenza owing to identified avian influenza virus with other manifestations

4) 488.11 -- Influenza owing to identified novel H1N1 influenza virus with pneumonia

5) 488.12 -- Influenza owing to identified novel H1N1 influenza virus with other respiratory manifestations

6) 488.19 -- Influenza owing to identified novel H1N1 influenza virus with other manifestations.

Tip: If you've previously wondered how to code for encephalopathy as a late effect of H1N1, 488.19 is your code.

You'll find two new codes for patients who have previously had a pancreatectomy: V88.11 (Acquired total absence of pancreas) and V88.12 (Acquired partial absence of pancreas).

These codes will help provide additional information about patients with low insulin (251.3,Postsurgical hypoinsulinemia following pancreatectomy).

But until Oct. 1, you should continue using V45.79 (Other acquired absence of organ) to describe this condition.

Post-traumatic seizures are acute, symptomatic seizures following a head injury. In a Centers for Disease Control & Prevention release, the ICD-9-CM Coordination and Maintenance committee explains that "a unique code for this type of seizure is important because these patients need to be followed for treatment as well as prognostic and epidemiologic considerations."

Result: The creation of 780.33 (Post traumatic seizures) will further specify this type of seizure. Currently, you must look to the 780.3x (Convulsions) subcategory in order to report a patient's symptoms.

Bottom line: Rely on documentation to determine whether to also code one of the late effects ICD-9 codes, such as 907.0 (Late effect of intracranial injury without mention of skull fracture), as a secondary diagnosis.