Otolaryngology Coding Alert

Increase specificity starting this October with the debut of several codes.

If you-ve been waiting for a better way to describe mucositis, bronchospasm, or the reason for your patient's hearing exam, help is finally on the way--several new diagnosis codes representing these conditions will take effect on Oct. 1.

We-ve got a sneak peek at the new 2007 ICD-9 codes, and because payers do not allow a grace period for implementing the new codes, you need to get acquainted with them and update your superbills and your billing software by Sept. 30.

Describe Hearing Exams With New V Code
 
The new edition of ICD-9 will introduce V72.11 (Encounter for hearing examination following failed hearing screening), which will help ENT practices code for children who fail their hearing screenings in school, come to the ENT for further testing, but end up with no positive results on the audiometry, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHBME, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J. -This V code will be the appropriate code to use as of Oct. 1, 2006,- she says.

Remember: Coders sometimes mistakenly believe that they cannot use V codes as primary diagnoses, but this is a myth. Coders are counting on insurers to allow V72.11 as a payable primary code.

The new edition of the ICD-9 manual has also added two sensorineural hearing loss codes:

- 389.15--Sensorineural hearing loss, unilateral
- 389.16--Sensorineural hearing loss, asymmetrical.

ICD-9 Makes Mucositis Coding More Specific

You can now benefit from a fifth digit in the 478.1 series (Other diseases of nasal cavity and sinuses), and other new mucositis codes:

- 478.11--Nasal mucositis (ulcerative)
- 478.19--Other disease of nasal cavity and sinuses
- 528.00--Stomatitis and mucositis, unspecified
- 528.01--Mucositis (ulcerative) due to antineoplastic therapy
- 528.02--Mucositis (ulcerative) due to other drugs
- 528.09--Other stomatitis and mucositis (ulcerative)
- 538--Gastrointestinal mucositis (ulcerative).

The addition of these codes will help ENTs who treat patients who develop ulcerative mucositis, which often comes on as a side effect of cancer treatment.

Look for Bronchospasm, Postnasal Drip Codes

ICD-9 2007 also separates out acute bronchospasm and identifies it as a separate and distinct condition, using new code 519.11 (Acute bronchospasm). Coders are now  forced to identify acute bronchospasm as a general acute component of another condition (for example, acute exacerbation of bronchiolitis, emphysema, bronchitis, COPD, etc.) or lump it into the general category (519.19, Other diseases of trachea and bronchus) if no other disease process is present.

Another new code your practice may find useful is 784.91 (Postnasal drip). This condition can be a big cause of irritation for patients, so ENTs should be pleased to see this new code.

ICD-9 rounds out the otolaryngology-specific codes with 784.99 (Other symptoms involving head and neck) and V72.19 (Other examination of ears and hearing).

Get to Know the New Pain Codes

Until the introduction of the new pain section (338.x), you-ve never had a way to describe -significant- pain. The new code series will be useful to more accurately report patients- pain, says Susan Vogelberger, CPC, CPC-H, CMBS, owner and president of Healthcare Consulting & Coding Education LLC (HCCE) in Boardman, Ohio.

The new pain codes are:

- 338.0--Central pain syndrome
- 338.11--Acute pain due to trauma
- 338.12--Acute post-thoracotomy pain
- 338.18--Other acute postoperative pain
- 338.19--Other acute pain
- 338.21--Chronic pain due to trauma
- 338.22--Chronic post-thoracotomy pain
- 338.28--Other chronic postoperative pain
- 338.29--Other chronic pain
- 338.3--Neoplasm-related pain (acute) (chronic)
- 338.4--Chronic pain syndrome.

Signal Dressing-, Suture-Related Visits With V58.3x
 
The ICD-9 guidebook will also unveil several new V codes to describe surgical wound and suture procedures:

- V58.30--Encounter for change or removal of nonsurgical wound dressing

- V58.31--Encounter for change or removal of surgical wound dressing

- V58.32--Encounter for removal of sutures.

-These diagnoses will be useful, although the procedures used with these codes may be included in the global surgery package and not payable,- Vogelberger says. -And that's OK because diagnosis codes are used to track patient care and provide medical necessity, not just to get a claim paid. These statistics are used for performance measurement to develop and shape our healthcare in the future.-