Pathology/Lab Coding Alert

Don't lose medical-necessity clout by missing new codes. If you don't get your 2009 ICD-9 code changes down pat, you might find yourself in the wrong category for diabetes and pleural effusion diagnoses. Let our experts walk you through these and other ICD-9 changes that go into effect on Oct. 1. Note: These codes appear in a proposed rule published in the April 30 Federal Register. ICD-9 may announce more changes, so look to Pathology/Lab Coding Alert for more details in the coming months. Learn New Leukemia Relapse Codes You-ll find 27 new leukemia codes in categories 203.x (Multiple myeloma and immunoproliferative neoplasms) to 208.x (Leukemia of unspecified cell type). The new codes help distinguish leukemia in relapse, which may require different interventions. With these new codes, you-ll need to keep a close watch on fifth digits, says Dianne Wilkinson, RHIT, compliance auditor with West Tennessee Healthcare in Jackson. ICD-9 2009 updates the leukemia codes by adding a new fifth digit -- 2 (in relapse) --for codes 203.02 through 208.92. ICD-9 also changes the wording of fifth- digit 0 (without mention of having achieved remission) to clarify the intent. What it means to you: Although your pathologists may diagnose leukemia based on cytology, you-ll need to be aware that relapse or remission information the clinician supplies may impact diagnosis code assignment. Don't Miss Secondary Diabetes The proposed ICD-9 changes introduce a new category to describe a patient who has diabetes caused by another condition -- 249.x (Secondary diabetes mellitus). The 20 new codes parallel existing category 250.x (Diabetes mellitus) codes with the same fourth-digit manifestations, such as 1 (ketoacidosis). Watch the fifth digit: You must report category 249 codes to the fifth digit to indicate the patient's level of diabetes control -- 0 (not stated as uncontrolled, or unspecified) or 1 (uncontrolled). What it means to you: Physicians often order lab tests based on diabetes complications, and your lab must be ready to use these new ICD-9 codes if you want to show medical necessity for the tests. "We-re seeing more and more secondary diabetes cases, so these codes will be useful," says Randall Karpf with East Billing in East Hartford, Conn. Specify Androgen Insensitivity When physicians order lab tests for the diagnosis and treatment of endocrine abnormalities and abnormal genitalia, you-ll have to be ready to use the following proposed ICD-9 additions to show medical necessity: - 259.50 -- Androgen insensitivity, unspecified - 259.51 -- Androgen insensitivity syndrome - 259.52 -- Partial androgen insensitivity. This set of changes provides further specificity to androgen insensitivity coding, says Christy Shanley, CPC, billing manager for the University of California, Irvine, department of urology. Old way: The ICD-9 proposed changes delete the prior [...]