Pathology/Lab Coding Alert

Plus, 999.4x changes 'shock' to 'reaction.'

If your lab bills transfusion medicine services, pathology exams for certain cysts, or blood tests for hemorrhagic disorders, we have some news to get your 2012 ICD-9 coding up to speed.

The proposed codes will take effect on Oct. 1, and constitute the last full set of ICD-9 changes before the switch to ICD-10 diagnosis coding on Oct. 1, 2013.

Recognize Cyst Differences

ICD-9 2012 creates two new codes for common hair-follicle cysts -- 704.41 (Pilar cyst) and 704.42 (Trichilemmal cyst). Pilar cysts are often confused with sebaceous cysts despite having distinct characteristics.

For instance: Pilar cysts form with keratinizing epithelium associated with a hair follicle. These cysts don't have a granular layer, which is characteristic of sebaceous cysts.

The ICD-9 update will add an "excludes" statement for new codes 704.41 and 704.42 under 706.2 (Sebaceous cyst).

Clarify Serum Reactions With New 999 Codes

If you ever bill transfusion medicine codes (86850-86999), you can't afford to miss ICD-9 revisions that will change how you code serum reactions. The code update will invalidate 999.4 (Anaphylactic shock due to serum) and 999.5 (Other serum reaction, not elsewhere classified) and replace them with the following new codes:

• 999.41 -- Anaphylactic reaction due to administration of blood and blood products
• 999.42 -- ... vaccination
• 999.49 -- ... other serum
• 999.51 -- Other serum reaction due to administration of blood and blood products
• 999.52 -- vaccination
• 999.59 -- Other serum reaction

Distinguish anaphylaxis trigger: The current ICD-9-CM code 999.4 is not transfusion specific, according to Mikhail Menis, PharmD, MS, of the Center for Biologics Evaluation & Research (CBER) at the Food and Drug Administration (FDA) in his presentation at the ICD-9-CM Coordination and Maintenance Committee meeting (proposals, summaries, and presentation slides available at www.cdc.gov/nchs/icd/ icd9cm_maintenance.htm). Creating new codes 999.41 and 999.42 will help distinguish anaphylaxis due to transfusion or vaccination, for instance. ICD-9 2012 provides similar distinctions in new codes 999.5x.

The new codes "will improve the precision of recording transfusion associated adverse reactions and enhance the ability to conduct active surveillance of transfusion safety," says Menis.

Shock too narrow: An anaphylactic reaction is a type of allergic hypersensitivity resulting in symptoms such as hives, wheezing, and possibly a drop in blood pressure, which is anaphylactic shock. ICD-9 has used the term anaphylactic shock to include all anaphylactic reactions in the past, which has resulted in some confusion among clinicians. That's why ICD-9 2012 changes the terminology for 999.4x and other codes such as 995.0 (Other anaphylactic reaction) from "anaphylactic shock" to the broader term, "anaphylactic reaction."

Labs will also benefit from a new "V" code that will help your anaphylaxis coding with V13.81 (Personal history of anaphylaxis).

Look to New Lupus Code

You should plan for ICD-9 2012 to expand current four-digit code 286.5 (Hemorrhagic disorder due to intrinsic circulating anticoagulants) into a new range of five-digit codes:

• 286.52 -- Acquired hemophilia
• 286.53 -- Antiphospholipid antibody with hemorrhagic disorder
• 286.59 -- Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors.

The changes allow for more specific identification and will help track "trials on the cause, self-correction, and pharmaceutical treatment of these disease types of hemophilia," explains Kelly C. Loya, CHC, CPC-I, CPhT, managing consultant with Sinaiko Healthcare Consulting Inc.

You'll most often see 286.53 used to report the hemorrhagic disorder with an antibody known as lupus anticoagulant or systemic lupus erythematosus. Labs that test for this antibody may report the test as 85598 (Phospholipid neutralization; hexagonal phospholipid).

To read the complete list of diagnosis codes for 2012, visit www.cms.gov/AcuteInpatientPPS/IPPS2012 and click on "FY 2012 Proposed Rule and Correction Notice Tables," then download Tables 6A-6F.