MDS Alert

Some of the new codes may help you with ICD-10.

The MDS 3.0, RUG-IV, and ICD-10 may be looming on the horizon, but your MDS team has a more immediate change ahead: the annual ICD-9 update, which goes into effect on Oct. 1, 2009.

The Centers for Medicare & Medicaid Services has issued 141 new diagnosis codes for you to use starting on that date. Most of the new codes will offer additional specificity to existing diseases, which can help you code more accurately. "Any time we get diagnosis codes that provide additional specificity, I think that is great," says Marvel J. Hammer of MJH Consulting in Denver.

You'll find new codes in most categories, ranging from oncology (such as the 209.31-209.36 series, Merkel cell carcinoma) to orthopedics (813.46- 813.47, Torus fracture).

Tip: Using the new codes, a Merkel Cell carcinoma should be coded based on the specific anatomical site, says Shelley Safian, MAOM/HSM, CCS-P, CPC-H, CPC-I, CHA, a long-term care coding expert in Winter Park, Fla. You'll also find an expansion of the 799.2 (Nervousness) section, with new codes for irritability (799.22), impulsiveness (799.23), and demoralization and apathy (799.25), among others.

"The new fifth digit ICD-9 codes can be used to report emotional and/or behavioral symptoms," Hammer says. "If these symptoms are associated as a late effect to a traumatic brain injury (TBI), the new ICD-9 code(s)  could be paired with the appropriate late effect code, 905.0 (Late effect of fracture of skull and face bones) or 907.0 (Late effect of intracranial injury ...)."

Coding late effects generally requires two codes, Hammer says. The condition or nature of the late effect is sequenced first, and the late effect code is sequenced second. But if the emotional/behavioral signs and symptoms are inherent in an established diagnosis, you should not code them separately. "Additionally, these new codes  parallel the ICD-10-CM codes found in the R45.X Symptoms and Signs Involving Emotional State section, allowing for easier mapping when providers convert to ICD-10 in 2013," Hammer says.

Here are a few more new code highlights of particular interest to nursing facilities:

Gout: "Category 274.0 used to just be gout but has been expanded to fifth digits in order to specify unspecified acute and chronic gouty arthropathy with or without tophus," says Charlotte Lefert, RHIA, coding strategy facilitator for the LTC Community of Practice for the American Health Information Management Association.

Late-effects of CVA: "There are two new codes that include residual late effects. One is 438.13 for dysarthria, and 438.14, fluency disorder," says Lefert. Speech therapy will find it helpful to have a little more specificity available for coding the conditions, Lefert predicts.

Resident on chemo? Look for a new code, 285.3, for antineoplasticinduced anemia, advises Lefert. This is a good one to be aware of because you used to have to use two codes to convey that the anemia is due to the chemotherapy, she notes.