Home Health ICD-9/ICD-10 Alert

Some new codes offer a peek at what's to come with ICD-10.

There are fewer proposed new ICD-9 codes coming this Oct. 1 than there were last year, but there's plenty of room for case mix impact.

Of the 141 new diagnosis codes, "several have the potential to become home health case mix diagnoses because they are in -- or sandwiched between -- current case mix codes," says Judy Adams, RN, BSN, HCS-D, COS-C, president and CEO of Adams Home Care Consulting in Chapel Hill, N.C.

Good news: Most of the new codes will offer additional specificity to existing diseases, which can help you code more accurately.

"Any time we get diagnosis codes that provide additional specificity, I think that is great," says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, of MJH Consulting in Denver.

You'll find new codes in most categories, ranging from oncology (such as the 209.31-209.36 series, Merkel cell carcinoma) to orthopedics (813.46-813.47, Torus fracture).

You'll also find an expansion of the 799.2 (Nervousness) section, with new codes for irritability (799.22), impulsiveness (799.23), and demoralization and apathy (799.25), among others.

"The new 5th-digit ICD-9 codes can be used to report emotional and/or behavioral symptoms," Hammer says.

Tip: "If these symptoms are associated as a late effect to a traumatic brain injury (TBI), the new ICD-9 code(s) could be paired with the appropriate late-effect code, 905.0 (Late effect of fracture of skull and face bones) or 907.0 (Late effect of intracranial injury ...)," Hammer suggests.How to do it: Coding late effects generally requires two codes, Hammer says. The condition or nature of the late effect is sequenced first; the late-effect code is sequenced second. But if the emotional/behavioral signs and symptoms are inherent in an established diagnosis, you should not code them separately.