Medicare Compliance & Reimbursement

Use these tactics to help your physician's documentation line up with new specific coding options.

You can get a head start on the mental shift from ICD-9 2007 to ICD-9 2008 today with this preview of the codes you'll soon be using for brain imaging, swallowing studies, and more.

Note: Consider these changes tentative until ICD-9 releases the final list, which may include more changes.

Remember: You must begin using ICD-9 2008 codes for services on Oct. 1, 2007. 1. Forget 331.3 For INPH The preliminary list of 2008 ICD-9 codes includes 331.5 (Idiopathic normal pressure hydrocephalus [INPH]).

"Normal pressure hydrocephalus is a relatively common finding in head imaging studies, but ICD-9 has not contained a specific code for this condition," says radiology coding expert Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, GA.

The most appropriate code for the condition in ICD-9 2007 is 331.3 (Communicating hydrocephalus).

With the addition of 331.5, providers will be able to show the specific type of documented hydrocephalus, Miller says.

A separate code for this clinically treatable, distinct hydrocephalus form is especially important because it is common in the elderly population, which is increasing, says Michael A. Williams, MD, with the adult hydrocephalus program at Johns Hopkins, in his presentation to the ICD-9 committee: "Support for Creation of an ICD-9 Code for Normal Pressure Hydrocephalus."

Resource: You can find behind-the-scenes information on the new codes in the ICD-9-CM Coordination and Maintenance Committee minutes, online at www.cdc.gov/nchs/about/otheract/icd9/maint/maint.htm, Miller says. 2. Point Out Increased CTO Procedure Complexity Interventional radiologists have to put in extra work to help patients with chronic total occlusion (CTO), and you'll soon have a code that will clue payors in to the added complexity of the procedure right away: 440.4 (Atherosclerosis; chronic total occlusion of artery of the extremities).

"Chronically occluded vessels are very difficult or impossible to cross with a guide wire," Miller says. The physician has to get a guide wire across the lesion before placing a balloon catheter to dilate the lesion, and there are a variety of new devices available to get through the blockage, she adds. 3. Chew On 6 New Dysphagia Codes "Radiologists do several types of exams designed to study the swallowing function," Miller says. And the swallowing process has several phases as the food bolus moves from the mouth to the pharynx to the esophagus, she says.

ICD-9 2007 offered only one dysphagia code, 787.2 (Dysphagia), so you could not identify the malfunctioning part of the cycle with your code, she says.

The preliminary ICD-9 2008 list shows many codes that will help you report the condition with greater specificity:

• 787.20--Dysphagia, unspecified
• 787.21--Dysphagia, oral phase 
• 787.22--Dysphagia, oropharyngeal phase
• 787.23--Dysphagia, pharyngeal phase
• 787.24--Dysphagia, pharyngoesophageal phase
• 787.29--Other [...]