Medicare Compliance & Reimbursement

You may have to leave your 784.0 comfort zone in October ICD-9 2009 may include more new codes than you've seen in a decade, and the almost two dozen new headache codes could make your head spin. But don't reach for the aspirin just yet -- here are insider tips to help you prepare and ease your pain before it even starts. Code 784.0, Meet 339.XX The lowdown: CMS just released the preliminary 2009 ICD-9 new diagnosis code list. The changes aren't official yet, but this rundown will give you a leg up on the changes that will most likely take effect Oct. 1, 2008. The biggest shake-up: ICD-9 2009 may change your options so that 784.0 (Headache) will no longer be your go-to headache code. According to ICD-9 2008, this catchall code covers facial pain and any "not otherwise specified" head pain. But a new 2009 339.XX series could cover other headache syndromes, which will make your diagnosis coding that much more accurate. "My physicians are more specific in their notes, so I welcome the more specific coding," says Angie Medrano, CPC, coder with Children's Hospital Neurology Foundation in Boston. "I do find more specific codes helpful, especially when it is called for in the payer policies," says Lonna Maile, coding manager with Hawaii Pacific Health. The challenge for coders is educating the physician on the need for accurately documenting diagnoses to the highest specificity, Maile says. Helpful advice: You'll need to work with your pain management specialist to be sure documentation matches up with the new coding choices, or you could be stuck reporting "unspecified" codes when your payers' policies require something more specific. Tip: Once the codes become official, consider giving your pain management specialist a list of the new codes so he'll know what information you need to choose the most specific code. Break Up Cluster Headaches New subcategory 339.0X (Cluster headaches and other trigeminal autonomic cephalgias) will cover a variety of cluster headaches and headaches affecting one side of a subject's head. These include the following: • 339.00 -- Cluster headache syndrome, unspecified • 339.01 -- Episodic cluster headache • 339.02 -- Chronic cluster headache • 339.03 -- Episodic paroxysmal hemicrania • 339.04 -- Chronic paroxysmal hemicrania • 339.05 -- Short lasting unilateral neuralgiform headache with conjunctival injection and tearing • 339.09 -- Other trigeminal autonomic cephalgias. Note: Code 339.00 also includes cluster headache not otherwise specified (NOS), ciliary neuralgia, histamine cephalgia, lower half migraine, and migrainous neuralgia, while 339.03 includes paroxysmal hemicrania not otherwise specified, says Stephen D. Silberstein, MD, FACP, past president of the American Headache Society, director of the Jefferson Headache Center and neurology professor at Thomas Jefferson University Hospital in Philadelphia, [...]