Medicare Compliance & Reimbursement

Clarifications, not new codes, highlight ICD-9 changes.

If you're a physician treating a patient with septic shock, make sure the condition is a secondary diagnosis on the encounter form.

Why? The Centers for Medicare and Medicaid Services has released a clarification on rules regarding diagnosis coding for patients with septic shock. The clarification explains that a physician's office should never report any codes from ICD-9 subcategory 995.9 (Sepsis) as the principal diagnosis. Instead, the physician must assign the underlying systemic infection code first.

That's just one of the changes in the April 1 revision to the ICD-9 guidelines. CMS didn't issue any new ICD-9 codes for April, but it did shake up the rules a little. To wit, CMS says physicians can't bill for septic shock unless they've documented sepsis, and an external cause-of-injury code is not needed with sepsis codes. Find A Primary Diagnosis To Accompany Sepsis If the doctor removes organs prophylactically because of a genetic predisposition to cancer, use a code from subcategory V50.4x (Prophylactic organ removal) as the principal or first code, followed by the genetic predisposition code and the family history code.

The update also clarifies coding for Type I and Type II diabetes, insulin pump malfunction, postoperative cerebrovascular accident, chronic obstructive pulmonary disease and genetic carrier or susceptibility status.