Home Health ICD-9/ICD-10 Alert

Don't list new fecal impaction code for all patients with constipation.

As the ICD-9 code set changes and expands each year, there's always hope for new codes to make the case mix list. The 2011 changes don't disappoint.

While the 2011 ICD-9 update brings three new codes to the case mix list, their inclusion is no big surprise, says Lisa Selman-Holman, JD, BSN, RN, HCSD, COS-C, consultant and principal of Selman-Holman & Associates and CoDR -- Coding Done Right in Denton, Texas.

1. Fecal Impaction: The new code for fecal impaction (560.32) made the case mix list. The entire 560.3 subcategory is already on the case mix list, Selman-Holman points out. Be careful to limit the coding of 560.32 to those situations where fecal impaction is actually documented and don't assign the code for just constipation, she says.

2. Purpura and other hemorrhagic conditions: New codes in existing case mix category 287.x (Purpura and other hemorrhagic conditions) including 287.41 (Posttransfusion purpura) and 287.49 (Other secondary thrombocytopenia) are case mix as well, Selman-Holman says. These two codes were added so that there could be a specific code for posttransfusion purpura, but these case mix changes will have little impact for home health as posttransfusion purpura is uncommon and usually fatal.

3. Neurogenic claudication: Lumbar stenosis now includes a fifth digit to indicate neurogenic claudication (724.03). 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), Selman-Holman says. Symptoms experienced are buttock and lower extremity cramping, pain, and fatigue. If the stenosis at a single level becomes severe enough, or if the nerves are being compressed by multiple levels of stenosis, then a patient can become symptomatic and then  xperience neurogenic claudication.

The new neurogenic claudication code is part of a category that is already designated as case mix but it will have little impact because the 724 codes are Ortho 2 codes, Selman- Holman says. To earn points for an Ortho 2 diagnosis, the patient must have infusion therapy or parenteral therapy. 

Aortic Ectasia Scores No Points

The only other possible case mix change didn't end up making the cut, Selman-Holman says. New code subcategory 447.7 for aortic ectasia is not a case mix code. Some -- but not all -- codes in the 447 category are case mix in the Skin 2 category. Aortic ectasia includes diffuse and irregular dilation of the aorta that is less than 3 cm in diameter.

In one study, close to 20 percent of the patients with ectatic aorta in the abdomen over time developed abdominal aortic aneurysm, Selman-Holman says. Previously the condition was coded as aortic aneurysm. Medicare routinely only makes codes case mix when derived from previous case mix codes, she says. The code for aortic aneurysm is not case mix.