Part B Insider (Multispecialty) Coding Alert

Compartment syndrome, drug allergies covered by new codes

You can stop using "unspecified" diagnosis codes for several common syndromes starting Oct. 1.

The Centers for Medicare & Medicaid Services issued its inpatient prospective payment system (IPPS) rule, including a list of new ICD-9-CM diagnosis codes that take effect in October. The list doesn't include codes approved at the late March meeting of the ICD-9 Coordination and Maintenance Committee, including secondary diabetes. (See PBI, Vol. 7, No. 9.)

New: The largest update to the ICD-9 codes is the addition of a new section (649.x), dealing with complications with pregnancy, childbirth, or the puerperium.

Many of these codes deal with complications from obesity (649.10-649.14) or bariatric surgery status (649.20-649.24). These additions reflects medical advances, says Suzan Hvizdash, medical auditor for University of Pittsburgh Physicians. Several women who could not become pregnant because of obesity now can, either thanks to bariatric surgery or thanks to improved fertility treatments.

The update also includes pregnancy complications due to tobacco use (649.00-649.04), coagulation defects (649.30-649.34) and epilepsy (649.40-649.44).

Other important ICD-9 changes:

• You won't have to use unspecified code 238.7 (Other lymphatic and heatopoietic tissues) for myelodysplastic syndrome any longer. Next year that condition will have four codes (238.72-238.75), plus codes for thrombocythemia (238.71) and myelofibrosis with myeloid metaplasia (238.76).

• Neutropenia was covered under agranulocytosis (288.0), but now it has its own codes (288.00-288.09), including cyclic neutropenia (288.02) and drug-induced neutropenia (288.03). The update also adds 11 other codes for white blood cell count disorders (288.4-288.69).

• The 323.x section (encephalitis, myelitis, and encephalomyelitis) offers more specifics, including several types of myelitis and encephalomyelitis.

• Next year's ICD-9 codes include a new section (338.x) for different types of pain, including central pain syndrome, and acute and chronic pain due to trauma, thoracotomy or postoperative stress.

• 528.00 (stomatitis and mucositis, unspecified) breaks out into four codes, including two for mucositis due to antineoplastic therapy (528.01) and due to other drugs (528.02).

• Four new codes (729.7x) cover nontraumatic compartment syndrome of various body sites. Another five new codes (958.9x) cover traumatic compartment syndrome of various body sites, plus unspecified compartment syndrome.

• Unspecified drug adverse effect code 995.2 becomes six codes for unspecified effects of anesthesia, insulin and other specifics.

• 20 new "V" codes include a change or removal of wound dressings or sutures (V58.30-V58.32), pediatric body mass index (V85.51-V85.54), and a few genetic screening codes.
Editor's note: E-mail charlie@partbinsider.com for a complete list of the new ICD-9 codes.