Part B Insider (Multispecialty) Coding Alert

New ICD-9 codes offer more specificity on HCKD, prostate disease and SIRS

You can get more specific with your epilepsy coding, thanks to next year’s ICD-9 updates.

Starting Oct. 1, the codes for partial epilepsy (345.40-345.51) have revised descriptors. You’ll use 345.4x for localization-related partial epilepsy and epileptic syndromes with complex partial seizures, either with (345.41) or without (345.40) mention of intractable epilepsy.

The descriptors for 345.5x are similar, except that those codes cover simple partial seizures, either with (345.51) or without (345.50) mention of intractable epilepsy.

Also, when you code for other forms of epilepsy and recurrent seizures (345.8x), you can specify with (345.81) or without (345.80) mention of intractable epilepsy.

Good news: Neurologists have criticized the existing epilepsy codes because they don’t provide enough specificity on issues such as complex or partial seizures, or the presence or absence of intractable epilepsy. These new changes address some of those issues, and will make it easier for coders to interpret a physician’s notes, says Jin Hahn, a professor of neurology at Stanford University.

What to do: Educate your physician to make sure he or she is specifying whether the seizures are complex or partial, and whether the patient has intractable epilepsy.

Other revisions to the existing codes in next October’s ICD-9 update include:

• Hypertensive chronic kidney disease (HCKD) codes 403.00-404.93 now allow your physician to specify whether the patient’s chronic kidney disease is still in stage I through IV, or has reached stage V or has become end stage renal disease (ESRD). Before, you could only specify hypertensive kidney disease with or without chronic
kidney disease.

Also, now you can specify whether the HCKD is malignant, benign or unspecified.

There’s also a set of codes for hypertensive heart and chronic kidney disease, with or without heart failure. These also allow you to specify stage I through IV HCKD, or stage V HCKD or ESRD, and whether the HCKD is malignant, benign or unspecified.

• Prostate disease codes 600.00-600.91 now include more details. Instead of specifying whether the patient has urinary obstruction, you can specify urinary obstruction “and other lower urinary tract symptoms.” Also, in addition to benign hypertrophy of prostate, you can now code for benign localized hyperplasia of prostate (600.20-600.21) and unspecified hyperplasia of prostate (600.90-600.91).

• Systematic inflammatory response syndrome (SIRS) (995.91-995.94) now includes two codes just for sepsis (995.91) and severe sepsis (995.92), and just two codes for SIRS without (995.93) and with (995.94) acute organ dysfunction.