Medicare Compliance & Reimbursement

If you've got high hopes that you'll have a lot of new ICD-9 codes to use starting this fall, CMS delivers, with 141 new diagnosis codes debuting on Oct. 1.

CMS published the full listing of ICD-9 codes in the May 22 Federal Register but here's the heads-up on some changes you'll want to keep in mind.

Most of the new codes 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, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner 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). However, orthopedic coders had hoped for a wider range of codes, says Leslie A. Follebout, CPC, COSC, PCS, coding manager at Peninsula Orthopaedic Associates in Salisbury, Md.

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 5th 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, such as diagnosis 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. Sequence the condition or nature of the late effect first, then sequence the late effect code. If the emotional/behavioral signs and symptoms are inherent in an established diagnosis, do 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.

With 141 new codes to learn once Oct. 1 rolls around, we can't list all the changes here. But since it's never too early to familarize yourself with changes and begin to work toward implementing them in your system, read on for some new-code highlights you might be glad to see for your claims.

Infection: You'll find 12 new infection codes such as:

• 670.10-670.14 -- Puerperal endometritis

• 670.20-670.24 -- Puerperal sepsis

• 670.30-670.34 -- Puerperal septic thrombophlebitis

• 670.80-670.84 -- Other major puerperal infection

Gastro: The new edition of ICD-9 codes expands several coding options for gastro conditions:

• 756.73 -- Gastroschisis

• 569.71 -- Pouchitis

• 569.79 -- Other complications of intestinal pouch

• 569.87 -- Vomiting of fecal matter

• 789.7 -- Colic

Oncology: One of the biggest ICD-9 expansions deals with cancer diagnoses. Three new categories include:

• 209.31-209.36 -- Merkel cell carcinoma

• 209.70-209.74 -- Secondary neuroendocrine tumor

• 285.3 -- Antineoplastic chemotherapy induced anemia

Venous codes: Vein coders will notice scores of additions for their specialty, such as the following:

• 453.50-453.79 -- Chronic venous embolism and thrombosis

• 453.81-453.89 -- Acute venous embolism and thrombosis

Poisoning: You'll find a dozen new poisoning codes to select from, with a few being:

• 969.00 -- Poisoning by antidepressant, unspecified

• 969.01 -- Poisoning by monoamine oxidase inhibitors

• 969.71 -- Poisoning by caffeine

• 969.72 -- Poisoning by amphetamines.