Otolaryngology Coding Alert

Your struggle for medically necessary rhinoplasty pay may be one step easier, thanks to one more diagnosis you-ll soon be able to add to your late nasal fracture treatment repair roster.

In addition, you finally get a specific way to report history of MRSA and an easier way to report the condition, plus numerous new headache and secondary diabetes categories codes all coming to you Oct. 1.

Get ready with this rundown of top ICD-9 2009 changes.

One code will be especially helpful for a patient who needs a rhinoplasty (such as 30400, Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip) to repair the nose after a car accident, etc., says Julie Keene, CPC, an otolaryngology coding and reimbursement specialist at University ENT Specialists in Cincinnati. "We usually have to do a pre-determination anyway, but we always have to give diagnosis codes."

In October, you-ll be able to indicate the patient has a history of traumatic fracture with V15.51 (Other personal history presenting hazards to health; traumatic fracture). "Though a history of a traumatic fracture may not put a patient at increased risk for future fractures, the fact that a bone was traumatically fractured in the past may also affect future treatment," according to the agenda notes from the ICD-9-CM Coordination and Maintenance Committee Meeting on March 22-23, 2007.

Do this: Add V15.51 to your options when treating patients for medical conditions linked to previous fractures. Group it with 905.0 (Late effect of fracture of skull and face bones) and 738.0 (Acquired deformity of nose) to give the insurer additional information that the patient had a previous nasal fracture and that the current problem is directly linked to it.

Watch out: ICD-9 2009 also creates a new code for personal history of pathologic fracture (V13.51). "The physician needs to define pathological or traumatic," notes Annette Grady, CPC-Ortho, CPC-H, CPC-I, CPC-P, CCS-P, PCS, FCS, senior compliance auditor with The Coding Network.

Catch this: "A traumatic fracture usually results from traumatic injury to the bone, causing the continuity of bone tissues or bony cartilage to be disrupted or broken," Grady says. In contrast, "pathologic fractures may be the result of osteoporosis, metastatic tumor of the bone, osteomyelitis, Paget's disease, disuse atrophy, hyperparathyroidism, and nutritional or congenital disorders," she explains.

You-ll have a streamlined way to report methicillin-resistant staphylococcus aureus (MRSA) this fall. MRSA is a very antibiotic-resistant condition that can have serious health implications and seems to be becoming more prevalent, says Jennifer Swindle, RHIT, CCS-P, CPC, CPC-E/M, CPC-FP, CCP, coding/compliance director for PivotHealth, LLC in Brentwood, Tenn.

Current way: ICD-9 2008 contains no specific MRSA code. Therefore, you have to use the infectious disease code (041.11, Bacterial infection in conditions classified elsewhere and of unspecified site; staphylococcus aureus) plus V09.0 (Infection with microorganisms resistant to penicillins) to indicate the bacteria are meth-resistant.

Problem: Because the resistance code isn't specific to MR or SA and isn't linked to the SA organism code (041.11), MRSA data collection can be skewed, relayed Rebecca Gomez, MD, MPH, with the Division of Healthcare Quality Promotion Centers for Disease Control and Prevention in her proposal for MRSA-specific codes. "National surveys contain a limited number of ICD-9 fields. Organism codes and resistance codes may be deleted."

Simpler method: Starting Oct. 1, you-ll be able to report MRSA with either

ICD-9 2009 will also revise the primary organism codes you currently use for MRSA to indicate methicillin-susceptible S. aureus (MSSA). Code 038.11 will refer to MSSA septicemia; and 041.11 will include MSSA "in conditions classified elsewhere and of unspecified site."

You-ll also have two V codes for MRSA. To indicate a patient is a carrier or suspected carrier of MRSA, use V02.53. For personal history of MRSA, report V12.04.

Code 12.04's introduction allows physicians to more accurately capture a patient's "health status," Swindle says. Such a status not only "helps identify the patient's overall health but also potentially his susceptibility."

You currently have to report with an unspecified code, such as V12.09 (Personal history of other specified infectious and parasitic disease), Swindle notes. While this V code does capture a history of a condition, the new code will allow you to capture the specific condition.