Internal Medicine Coding Alert

New ICD-9 codes also stress anaphylactic 'reactions' only, not 'shock'.

New and revised ICD-9 diagnosis codes are coming soon, so take time now to brush up on expected changes to anaphylactic reactions and personal history choices. Changes go into effect October 1, with no grace period.

Make the Shift From 'Shock' to 'Reaction'

If your internist ever diagnoses a patient with anaphylactic shock due to peanuts, milk products, or other foods, check out the changes to codes 995.60-995.69. The new version of ICD-9 will change the descriptors from addressing "anaphylactic shock" to "anaphylactic reaction." The new codes read as follows:

• 995.60 -- Anaphylactic reaction due to unspecified food
• 995.61 -- Anaphylactic reaction due to peanuts
• 995.62 -- Anaphylactic reaction due to crustaceans
• 995.63 -- Anaphylactic reaction due to fruits and vegetables
• 995.64 -- Anaphylactic reaction due to tree nuts and seeds
• 995.65 -- Anaphylactic reaction due to fish
• 995.66 -- Anaphylactic reaction due to food additives
• 995.67 -- Anaphylactic reaction due to milk products
• 995.68 -- Anaphylactic reaction due to eggs
• 995.69 -- Anaphylactic reaction due to other specified food.

Explanation: The current ICD-9 codes already encompass both shock and reaction. "My guess is this is an editorial change to make the codes intuitively more inclusive," says Kent J. Moore, manager of healthcare delivery and financing systems for the American Academy of Family Physicians (AAFP) in Leawood, Kan. "It's easier to understand 'reaction' including 'shock' than vice versa. The reporting isn't changing -- only the code descriptors."

Code 995.0 also undergoes a change from "Other anaphylactic shock, not elsewhere classified" to "Other anaphylactic reaction." Report 995.0 for anaphylactic reactions not specified elsewhere (in the 995.6x series or 999.4) or for reactions due to adverse effects of a correct medicinal substance properly administered (such as penicillin). "In a sense, this will be the code of last resort when it comes to coding anaphylactic reactions," Moore says.

New additions: Changes to diagnoses for anaphylactic reaction extend to new codes as well. Add 999.41 (Anaphylactic reaction due to administration of blood and blood products), 999.42 (Anaphylactic reaction due to vaccination), and 999.49 (Anaphylactic reaction due to other serum) to your superbill choices.

Get Familiar With New Personal, Family History Options

Seven new V codes will help your physician better pinpoint conditions a patient might have as part of her personal or family medical history. Your new choices are:

• V12.21 -- Personal history of gestational diabetes
• V12.29 -- Personal history of other endocrine, metabolic, and immunity disorders
• V12.55 -- Personal history of pulmonary embolism
• V13.81 -- Personal history of anaphylaxis
• V13.89 -- Personal history of other specified diseases
• V19.11 -- Family history of glaucoma
• V19.19 -- Family history of other specified eye disorder.

If you code for internists who provide maternity care, also check out new diagnoses V23.42 (Pregnancy with history of ectopic pregnancy) and V23.87 (Pregnancy with inconclusive fetal viability).

Keep Track of the Timeline

With ICD-10 implementation set for October 2013, the ICD-9 Coordination and Maintenance Committee has implemented a partial freeze of ICD-9 and ICD-10 codes in the interim. The approved schedule will be:

• The last regular, annual updates to both ICD-9-CM and ICD-10 code sets will be made on October 1, 2011.
• On October 1, 2012, there will be only limited code updates to both the ICD-9-CM and ICD-10 code sets to capture new technologies and diagnoses.
• On October 1, 2013, there will be only limited code updates to ICD-10 code sets to capture new technologies and diagnoses.
• On October 1, 2014, regular updates to ICD-10 will begin.