Home Health ICD-9/ICD-10 Alert

Don't forget to update your memory loss coding practices.

With 166 new codes coming your way when ICD-9 2012 goes into effect on Oct. 1, you'll have a lot of changes to keep up with. Get our experts' take on which codes will most impact the way you work.

There are several new codes that may or may not become case mix codes but will likely be seen in home health, says Judy Adams, RN, BSN, HCS-D, COS-C with Adams Home Care Consulting in Chapel Hill, N.C.

E coli: ICD-9 2012 brings four more specific codes for escherichia coli (E.coli) at 041.41-041.49

Pseudobulbar affect: New code 310.81 (Pseudobulbar affect) is another code that will be useful in home health. Use 310.81 to report involuntary laughing or crying associated with conditions such as ALS, late effect CVA, MS and late effects of traumatic brain injury.

Update: There's been an addition to the official coding guidelines for coding late effects, points out Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates and CoDR -- Coding Done Right in Denton, Texas. The updated guidelines advise that "Coding of late effects generally requires two codes sequenced in the following order: The condition or nature of the late effect is sequenced first. The late effect code is sequenced second."

"Exceptions to the above guidelines are those instances where the late effect code has been expanded (at the fourth and fifth-digit levels) to include the manifestation(s) or the classification instructs otherwise," the guidelines continue. "Remember that the coding guidelines are complementary to the content of the volumes themselves, so the instructions in the book sometimes trump the guidelines," Selman-Holman says.

This instruction is especially important for understanding the note at 310.81 (Pseudobulbar affect). The instruction to "code first" mentions late effect of traumatic brain injury (907.0). That late effect code is usually coded after the condition produced, Selman-Holman says. In this case, you'll follow the sequencing guidelines listed with the code itself.

Look to new code 310.89 (Other specific nonpsychotic mental disorders following organic brain damage) to report the kind of mild memory disturbance you currently code with 310.8 (Other specified nonpsychotic mental disorders following organic brain damage).

So often, home health referrals mention "mild memory disturbance" now there's a specific code to report for these patients. The new code for mild memory loss will help support extended care for a patient because "he just doesn't get it," says Therese Rode, RHIT, HCS-D, senior coding manager with Inova VNA Home Health in Falls Church, Va.

The 2012 update adds seven new more specific codes for glaucoma at 365.05 (Glaucoma; open angle with borderline findings, high risk), 365.06 (Glaucoma; primary angle closure without glaucoma damage), and 365.70-365.74 as well as a new vitreomacular adhesion(379.27) code. You'll add a 365.7x code to indicate the stage of glaucoma any time you list a code for glaucoma. The more common one will be 365.70 (Glaucoma stage, unspecified). These may not become case mix codes themselves, but may be used in home health as the specific eye disorder that results in reporting a low vision diagnosis from current case mix diagnosis range 369.x (Blindness and low vision), Adams says.

The new glaucoma codes include a note requesting you to use an additional code to identify the glaucoma stage, notes Rode. We'll likely see a lot of 365.70 (Glaucoma stage, unspecified) in home health because physicians don't often include this detail. "You're lucky to get 'Glaucoma,'" Rode says.

Update: The new official coding guidelines instruct you to list an additional code from subcategory 365.7.x, (Glaucoma stage) to identify the glaucoma stage when you're coding for types of glaucoma classified to subcategories 365.1-365.6. But 365.7x codes can't be assigned as a principal or first-listed diagnosis. The guidelines also advise that when coding for bilateral glaucoma with different stages, you'll use one code for the glaucoma and two for the stages, which is similar to the way you would code bilateral ulcers with different stages, Selman-Holman says.

Cardio: While none of the new cardiac/circulatory codes are case mix codes, 414.4 (Coronary atherosclerosis due to a calcified coronary lesion) and the new hypertropic cardiomyopathy codes at 425.11 and 425.18 may be useful in home health, Adams says.

Bariatric Surgery Complications: Given the number of patients that are undergoing bariatric surgery, New codes 539.01 (Infection due to gastric band procedure) and 539.09 (Other complications of gastric band procedure) as well as codes in the new subcategory for infection and other complications of other bariatric procedures -- 539.81 (Infection due to other bariatric procedure) and 539.89 (Other complications of other bariatric procedure) may be of interest to home health agencies particularly with the non-Medicare patients, Adams says.

Editor's note: Watch for details on new codes that will help you to code bladder disorders, complications and more in the next issue of Home Health ICD-9 Alert.