Part B Insider (Multispecialty) Coding Alert

Dysphagia, genetic history codes gain fifth digits

You-ll have 54 new lymphoma codes to master starting in September.

You should make sure your physician's documentation specifies the type of lymphoma as well as the body part it affects. That information will be essential next fall.

The new ICD-9-CM diagnosis codes include lymphoma codes for:

- marginal zone lymphoma (200.30-200.38),

- mantle cell lymphoma (200.40-200.48),

- primary central nervous system lymphoma (200.50-200.58),

- anaplastic large cell lymphoma (200.60-200.68),

- large cell lymphoma (200.70-200.78), and

- peripheral T-cell lymphoma (202.70-202.78).

For each of these categories, you can specify whether the lymphoma is in the head, face or neck; the intrathoracic lymph nodes; the intra-abdominal lymph nodes; upper limb; lower limb; intrapelvic; spleen; or multiple sites.

Each type of lymphoma requires a very different treatment, notes independent consultant Margaret Hickey in New Orleans. So with these new, more specific diagnosis codes, you-ll have to be more careful to align each drug with the appropriate diagnosis code.

The Centers for Disease Control & Prevention (CDC) released the new ICD-9 codes for 2008. They take effect in September, with no grace period. Some more codes may be added to the list between now and September, but most of 2008's new additions are already available.

Some other ICD-9 changes include:

- You can stop using 787.2 for all dysphagia claims. The 2008 update deletes that code and replaces it with five-digit codes (787.20-787.29). These will let you specify whether the dysphagia is oral phase, oropharyngeal phase, pharyngeal phase or pharyngoesophageal phase.

- Also, V84.8 (Genetic susceptibility to other disease) is going away, replaced with V84.81 (Genetic susceptibility to multiple endocrine neoplasia [MEN]) and V84.89 (...other disease). And there are half a dozen new -family history- codes, covering malignant neoplasms, cardiovascular diseases and endocrine neoplasia.

- Likewise, say goodbye to myotonic disorders code 359.2, and greet new five-digit myotonic disorder codes 359.21-359.29.

- You-ll have four new codes for female genital carcinoma (233.30-233.39) and multiple endocrine neoplasia in men (258.01-258.03).

- There are eight new herpes-related diagnosis codes (058.10-058.89). They allow you to specify types of infection between herpes 6, 7 or 8, plus herpes-related encephalitis.

- The new update revises 005.1 (Botulism food poisoning) and adds two new botulism codes: 040.41 (infant) and 040.42 (wound).

- Also, a handful of codes are revised, including 389.14 (Central hearing loss) and 389.18 (Sensor-ineural hearing loss, bilateral).