Home Health & Hospice Week

New potential case mix codes will offer increased specificity

ICD-10 is coming fast, but until then you'll still need to pay attention to ICD-9 updates. Don't forget these coming diagnosis codes that home care providers will start using Oct. 1.

Several of the new ICD-9 codes fall under categories with current case mix codes. These include newly expanded 287.4 (Secondary thrombocytopenia), which now includes 287.41 (Posttrans-fusion purpura), and 287.49 (Other secondary thrombocytopenia).

This change will allow precise reporting of posttransfusion purpura (PTP), which usually arises five to 12 days after transfusion of blood components, noted Mikhail Menis of the Food & Drug Administration at the September 2009 ICD-9-CM Coordination and Maintenance Committee meeting.

Four new aortic ectasia codes also fall under a current case mix category. But, not all of 447 is case mix so it is anybody's guess whether ectasia makes the cut, says coding expert Lisa Selman-Holman of Selman-Holman & Associates and CoDR -- Coding Done Right in Denton, Texas.

"Ectasia" means dilation or enlargement, and aortic ectasia typically refers to enlargement that is milder than an aneurysm. But ICD-9 2010 does not distinguish ectasia from aneurysm, indexing aortic ectasia to 441.9 (Aortic aneurysm of unspecified site without mention of rupture) and 441.5 (Aortic aneurysm of unspecified site, ruptured).

The 2011 codes are specific to aortic ectasia and differ based on anatomic site:

• 447.70 -- Aortic ectasia, unspecified site

• 447.71 -- Thoracic aortic ectasia

• 447.72 -- Abdominal aortic ectasia

• 447.73 -- Thoracoabdominal aortic ectasia.

The update will bring a new code, 724.03 (Spinal stenosis, lumbar region, with neurogenic claudication). The code refers to lumbar spinal stenosis, which is a narrowing of the spinal canal, according to the Sept. 16-17, 2009, ICD-9-CM Coordination and Maintenance Committee meeting proposal. Neurogenic claudication "is a commonly used term for a syndrome associated with significant lumbar spinal stenosis leading to compression of the cauda equina (lumbar nerves)," the proposal states.

The 724 codes are case mix and this new expansion will likely be case mix too, Selman-Holman says. But the 724 codes are Ortho 2 case mix codes, so there usually are no points available.

ICD-9 2010 includes 724.02 (Spinal stenosis, other than cervical; lumbar region). Andelle Teng, a spine and orthopedic surgeon in Washing-ton, requested a code addition to differentiate patients with and without neurogenic claudication because "with" is a possible surgical condition. The 2011 proposal revises 724.02 to "Spinal stenosis, lumbar region, without neurogenic claudication," in contrast to the 724.03 proposal for patients with claudication.

You'll find that ICD-9 2011 adds specificity to fecal-related diagnoses with the following five new codes:

• 560.32 -- Fecal impaction

• 787.60 -- Full incontinence of feces

• 787.61 -- Incomplete defecation

• 787.62 -- Fecal smearing

• 787.63 -- Fecal urgency.

"The new fecal incontinence code (787.60) is a change that we will have to remember," says Selman-Holman. Fecal incontinence impacts the plan of care at times -- especially when the patient has a pressure ulcer in the buttock area. Fecal incontinence may also be coded to support the answer to M1620 Bowel Incontinence Frequency on the OASIS C. The new code for fecal impaction excludes constipation, Selman-Holman says.

Case mix tip: The 787.xx category is case mix, so this new code is likely to be case mix, Selman-Holman says. Medicare usually introduces changes to the case mix code in September.