Internal Medicine Coding Alert

Your nervousness ICD-9 code splits out irritability.

Before jumping at the chance to use three new symptom codes, make sure your internist hasn't established a related definitive diagnosis.

"Think of the 797-799 (Ill-defined and unknown causes of morbidity and mortality) codes as the misfits that didn't fit elsewhere," says Donna Walaszek, CCS-P, a medical billing specialist in Northampton, Mass. When he provider makes a more specific diagnosis, you typically would assign a diagnosis from the appropriate chapter of the ICD-9 book. Bearing that in mind, you'll soon have an opportunity to better represent irritability and nervousness than with the current code for nervousness (799.2, which will become invalid as of Oct. 1, 2009). "New codes in 2010, 799.21 (nervousness), 799.22 (irritability), and 799.23 (impulsiveness), provide a more definitive representation for these presenting signs and symptoms," Walaszek says.

Example: A patient presents with an upset stomach due to nervousness. You should code from Chapter 9 (Diseases of the Digestive System) for the upset stomach (536.8), Walaszek says. "I believe most would code from Chapter 16 (Symptoms, Signs, and Ill-Defined Conditions), nervousness (799.21) as a secondary diagnosis."