Otolaryngology Coding Alert

New ICD-9 codes went into effect last month -- make sure you aren't behind the curve.

October 1 has come and gone, and that means you need to be up and running with the latest ICD- 9 changes. Are you wondering where you should focus your time and energy? The following tips on the new codes that impact otolaryngology will help you determine whether you're on the right track, or if you should work on your 2011 diagnosis coding know-how.

New Flu Codes Make Appearance

ENT practices that treat the flu are in luck--the codes in the 488.0x (Influenza due to identified avian influenza virus) and 488.1x (Influenza due to identified novel H1N1 influenza virus) subcategories provide greater specificity now.

In the past, these sub-categories didn't provide the level of detail that category 487 (Influenza) does; so the ICD-9 Coordination and Maintenance Committee expanded the codes at 488.0 and 488.1. That means six new influenza with pneumonia codes for the 2011 ICD-9 update:

• 488.01 -- Influenza owing to identified avian influenza virus with pneumonia
• 488.02 -- Influenza owing to identified avian influenza virus with other respiratory manifestations
• 488.09 -- Influenza owing to identified avian influenza virus with other manifestations
• 488.11 -- Influenza owing to identified novel H1N1 influenza virus with pneumonia
• 488.12 -- Influenza owing to identified novel H1N1 influenza virus with other respiratory manifestations
• 488.19 -- Influenza owing to identified novel H1N1 influenza virus with other manifestations.

"Some patients may go straight to their ENT at the first sign of sinus trouble, and might think they have allergies or sinus issues when in actuality they may be dealing with the flu," says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC with CRN Healthcare Solutions in Tinton Falls, NJ. "Therefore, these flu diagnoses could be applicable to otolaryngology practices.

New Body Mass Index Codes Are in Effect

Effective last month, you can no longer report V85.4 (Body Mass Index 40 and over, adult).

Instead, you should be using one of the following new V codes in its place:

• V85.41 -- Body Mass Index 40.0-44.9, adult
• V85.42 -- Body Mass Index 45.0-49.9, adult
• V85.43 -- Body Mass Index 50.0-59.9, adult
• V85.44 -- Body Mass Index 60.0-69.9, adult
• V85.45 -- Body Mass Index 70 and over, adult.

"Otolaryngologists may use the new BMI codes for several reasons," Cobuzzi says. "First, you might list the patient's BMI as a secondary or tertiary code when treating a patient with snoring issues," she says. "Plus, the BMI V codes might be used as secondary diagnoses to justify the use of modifier 22 (Increased procedural services) on a complicated surgery."

Keep in mind: When a V code is your only option, you can report it as the primary diagnosis. Although when you use a BMI diagnosis as a primary ICD-9 code, it may be difficult to collect reimbursement from some insurance companies.

Look for Jaw Pain Codes

You'll find new code 784.92 (Jaw pain) in effect now and throughout 2011.

According to notes made by the ICD-9-CM Coordination and Maintenance Committee in Sept. 17, 2009, "it was suggested to somehow differentiate temporomandibular joint disorders and this code, perhaps using an excludes note."