Part B Insider (Multispecialty) Coding Alert

Many new codes abound in final update to proposed ICD-9-CM code set.

If you've felt that your skin cancer diagnoses could use abit more specificity, ICD-9 will deliver this October if the proposed list of new, deleted, and revised diagnosis codes becomes final.

The list of ICD-9 changes was recently posted to the CMS Web site, and includes the final full set of changes that the agency will make to ICD-9 codes. After the new codes take effect on Oct. 1, CMS will only add new ICD- 9 codes on an emergency basis as it prepares to switch over the diagnosis coding system to ICD-10.

Seek Out Skin Cancer Changes

You'll find a significant expansion to the 173.x (Other malignant neoplasm of skin) categories, including changes to 173.0x (...Skin of lip), 173.1x (...Eyelid, including canthus), 173.2x (...Skin of ear and external auditory canal), 173.3x (...Skin of other and unspecified parts of face), 173.4x (...Scalp and skin of neck), 173.5x (...Skin of trunk, except scrotum), 173.6x (Skin of upper limb, including shoulder), 173.7x (...Skin of lower limb, including hip), 173.8x (Other specified sites of skin), and 173.9x (Skin, site unspecified).

Among these changes, for example, you'll find the following new codes to delineate various types of skin cancers:

• 173.60 --Unspecified malignant neoplasm of skin of upper limb, including shoulder
• 173.61 -- Basal cell carcinoma of skin of upper limb, including shoulder
• 173.62 -- Squamous cell carcinoma of skin of upper limb, including shoulder
• 173.69 -- Other specified malignant neoplasm of skin of upper limb, including shoulder.

The changes in the other skin cancer categories referenced above follow this pattern, with the fifth digit of "0" referring to an unspecified malignant neoplasm, "1" denoting a basal cell cancer, "2" referring to a squamous cell carcinoma," and "9" describing another specified malignant neoplasm.

Take Note of Expanded Dementia Dx

You'll also see more specificity when it comes to coding unspecified dementia. The following two codes will expand that section of your ICD-9 manual:

• 294.20 -- Dementia, unspecified, without behavioral disturbance
• 294.21 -- Dementia, unspecified, with behavioral disturbance

ICD-9 Updates Pelvic Fracture Coding

You'll benefit from revisions and updates to ICD-9's pelvic fracture section (808.4x), which include the following changes:

• 808.43 (revised code) -- Multiple closed pelvic fractures with disruption of pelvic circle
• 808.44 (new code) -- Multiple closed pelvic fractures without disruption of pelvic circle
• 808.53 (revised code) -- Multiple open pelvic fractures with disruption of pelvic circle
• 808.54 (new code) -- Multiple open pelvic fractures without disruption of pelvic circle

Envision Glaucoma Updates

Your ICD-9 manual will also boost its glaucoma offerings with the following changes proposed to take effect on Oct. 1 of this year:

Revised code:

• 365.01 -- Open angle with borderline findings, low risk

• 365.05 -- Open angle with borderline findings, high risk
• 365.06 -- Primary angle closure without glaucoma damage
• 365.70 -- Glaucoma stage, unspecified
• 365.71 -- Mild stage glaucoma
• 365.72 -- Moderate stage glaucoma
• 365.73 -- Severe stage glaucoma
• 365.74 -- Indeterminate stage glaucoma

To read the complete list of proposed changes to the ICD-9 code set, visit www.cms.gov/AcuteInpatientPPS/IPPS2012/itemdetail.aspfilterType=none&filterByDID=9&sortByDID=1&sortOrder=ascending&itemID=CMS1246728&intNumPerPage=10.