MDS Alert

Check out these new codes for cognitive problems.

If you're hoping the new slate of diagnosis codes includes ones that may help you improve diagnosis coding for nursing home residents, you're in luck. Here are some highlights: The ICD-9 manual will add a new Cognition category with the addition of the following seven codes:

• 799.50 -- Unspecified signs and symptoms involving cognition

• 799.51 -- Attention or concentration deficit

• 799.52 -- Cognitive communication deficit

• 799.53 -- Visuospatial deficit

• 799.54 -- Psychomotor deficit

• 799.55 -- Frontal lobe and executive function deficit

• 799.59 -- Other signs and symptoms involving cognition.

You'll find a new code 784.92 (Jaw pain) effective Oct. 1. According to notes made by the ICD- 9-CM Coordination and Maintenance Committee in Sept. 17, 2009, "it was suggested to somehow differentiate temporomandibular joint disorders and this code, perhaps using an excludes note."

ICD-9 will also offer new code 724.03 (Spinal stenosis, lumbar region, with neurogenic claudication).

"They've expanded the body mass index (BMI) codes to demonstrate higher BMIs with five new codes," notes Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENT C, CHCC, with CRN Healthcare Solutions in Tinton Falls, N.J. Whereas in the past, you had just one V code to represent a BMI index over 40 (V85.4), the new edition of ICD-9 will offer additional categories, ranging from a BMI of 40.0 to 44.9 (V85.41) through a BMI of 70 and over (V85.45). The "V85 codes aren't always assigned in long-term care but certainly may be applicable," says Charlotte Lefert, RHIA, coding and reimbursement strategy facilitator in the LTC Community of Practice for the American Health Information Management Association, and a health information management consultant in Madison, Wis.

You'll no longer be able to report 787.6 (Incontinence of feces), because ICD-9 will delete it effective Oct. 1, and replace it with the following new, expanded code set:

• 787.60 -- Full incontinence of feces

• 787.61 -- Incomplete defecation

• 787.62 -- Fecal smearing

• 787.63 -- Fecal urgency.

In addition, check out these codes which are also pertinent to long-term care, Lefert suggests:

• 275.01 -- Hereditary hemochromatosis

• 275.02 -- Hemochromatosis due to repeated red blood cell transfusions

• 275.03 -- Other hemochromatosis

• 275.09 -- Other disorders of iron metabolism

• 276.61 -- Transfusion associated circulatory overload

• 276.69 -- Other fluid overload

• 278.03 -- Obesity hypoventilation syndrome

The final codes are published in the Federal Register in August. There are times when you'll see codes added or a proposed code deleted, Lefert tells MDS Alert. To read the complete Federal Register article, visit www.cms.gov/AcuteInpatientPPS/IPPS2010/list.asp .