Medicare Compliance & Reimbursement

Check out your diagnosis coding finesse with 5 quick ICD-9 cod

Although the new edition of the ICD-9 manual is entitled, "ICD-9 2009," Medicare carriers required you to begin using the new codes as of Oct. 1. If you're still unsure about which codes have expired and which are new, answer the following five true or false questions:

Did Headache Codes Change?
Question 1: Your patient presents with a cluster headache that has recurred off and on for six months. The physician has prescribed medications in the past but the patient is back for another evaluation due to the chronic nature of the headache.
True or False? You'll report 784.0 (Headache) for this encounter.

Is Fifth Digit Required?
Question 2: Your physician diagnoses a patient with a relapse of chronic monocytic leukemia.
True or False: You should report this diagnosis with 206.1 (Monocytic leukemia; chronic).

Look for Plantar Wart Code
Question 3: Your practice saw a patient and your physician diagnosed her with a plantar wart on the bottom of her foot.
 True or False? You should report 078.12 (Plantar wart) for this patient's condition.

Know Pap Smear Digits
Question 4: Your physician performed a vaginal Pap smear which showed atypical squamous cells of undetermined significance.
True or False? You should report 795.1 (Abnormal Papanicolaou smear of vagina and vaginal HPV) for this patient's condition.

Get Pneumonia Dx on Track
Question 5: Your physician treats a patient in the hospital and diagnoses the patient with pneumonia. The patient's condition is severe enough that she requires ventilator assistance to breathe.
True or False? You should report the patient's condition with diagnosis code 997.31 (Ventilator associated pneumonia).

ANSWERS
 Answer 1: False. The new edition of ICD-9 created dozens of new headache codes, so you're no longer left using 784.0 (Headache) for all of your headache coding needs. Instead, you'll report 339.02 (Chronic cluster headache) for this visit, says Janet Woods, coder with Neurology Associates in Chicago.

You'll note that the ICD-9 manual now also includes additional specific headache codes such as 339.81 (Hypnic headache), 339.83 (Primary cough headache), and 339.85 (Primary stabbing headache) to improve precision on your claims.

 "The addition of the 339.x series is going to be huge for all of us out there in the neurology world this year," Woods says. "The only hitch is that you might have to go back and confirm specific headache diagnoses with your physician because he may not be accustomed to differentiating between things like episodic and chronic headaches," she says.

Answer 2: False. The latest edition of the ICD-9 manual did not change the diagnosis code or descriptor for 206.1 (Monocytic leukemia; chronic); however, carriers do now require a fifth digit for this code. Therefore, you'll report 206.12 (Monocytic leukemia; chronic; in relapse) to describe the patient's condition accurately.

Answer 3: True. Although in the past you had to lump plantar warts under other specified code 078.19 (Other specified viral warts), the new edition of the
ICD-9 manual offers the new code 078.12 (Plantar wart) to practices.

Catch this: If you spot verruca plantaris in chart notes, equate this with plantar warts. The formal Latin term "verruca plantaris," which is an infection caused by human papilloma virus (HPV), will be moved from under 078.19 to under 078.12.

Answer 4: False. If you report 795.1 (Abnormal Papanicolaou smear of vagina and vaginal HPV), "your carrier will deny the claim because as of Oct. 1, 795.1 is considered a truncated code," says Jay Neal, a coding and billing consultant in Atlanta. Instead, you'll report 795.11 (Papanicolaou smear of vagina with atypical squamous cells of undetermined significance [ASC-US]).
Keep in mind: The new ICD-9 manual added nine additional Pap smear codes as well.

Answer 5: True. Unlike in the past, when you had to use the generic code 997.3 (Respiratory complications) for this type of pneumonia, new pneumonia code 997.31 (Ven-tilator associated pneumonia) can better describe the source of the patient's pneumonia in this situation.

The new ICD-9 manual also added an additional code in the 997.3 category -- 997.39 (Other respiratory complications), which includes conditions such as pneumonia that resulted from a procedure.