Home Health ICD-9/ICD-10 Alert

Coding changes will require better communication with physicians than ever before.

Don't get too comfortable with 2005 ICD-9 codes - they're about to change.

In recent years diagnosis coding has moved toward capturing more distinctions within diseases, and the 2006 update to the ICD-9-CM codes - effective Oct. 1 - continues that process.

Example: Instead of just stating chronic renal failure or end-stage renal disease, the new codes will now require physicians diagnosing chronic kidney disease to specify where it falls in stages I through V (585.1-585.5).
 
The move toward greater specificity "means that not only are the coders concerned with the impact of the changes, but the physicians need more education as well," says Marcella Bucknam, HIM Coordinator with Clarkson College in Omaha, NE. The kidney disease coding requirements will call for "more and better documentation by physicians," otherwise coders won't be able to code accurately.

Adding specificity to diagnosis coding "is very much a conscious effort," says Amy Blum with the National Center for Health Statistics at the Centers for Disease Control and Prevention, which designs the ICD-9 codes. In the case of kidney disease, the NCHS planned simply to have a specific focus on end stage renal disease (ESRD), but ended up incorporating stages of the disease as the most current knowledge dictates.

More changes: Starting in October physicians will have to be more specific about dehydration. They will need to distinguish between unspecified volume depletion (276.50), dehydration (276.51) and hypovolemia (276.52).

Clinicians dealing with prosthetics and orthotics will welcome new codes for complications and infections around prosthetic joints and orthopedic devices (996.40-996.49).

The October update includes new codes for nonproliferative diabetic neuropathy from mild to severe, or "NOS" (362.03-362.07) as well as codes for "overweight" (278.02) and new V codes for body mass index (V85.0-V85.4).

And the 2006 update includes a set of V codes for a personal or family history of diseases such as pneumonia or osteoporosis (V12.64-V13.03 and V17.81-V18.9).
 
Finally, if you can't find the proper code and it drives you to tears, you may be able to use 780.95 (Excessive crying) to describe your own condition, jokes Cindy Parman with Coding Strategies in Powder Springs, GA.
 
Don't sleep through this: Many new ICD-9 codes have to do with sleep and breathing disorders. The update revises sleep apnea codes 780.51-780.57 to clarify that they cover only "unspecified" apnea cases. For other cases, you'll have to deal with 327.01-327.29, which go into much more detail about types and causes of insomnia, hypersomnia, sleep apnea and other breathing issues. Sleep disorders may play into other conditions, so tracking them should be helpful, notes Parman. 

Editor's Note: For a list of the 2006 changes go to Table 6A at www.cms.hhs.gov/providerupdate/regs/cms1500p.pdf.