Pathology/Lab Coding Alert

You can stop lumping multiple conditions under one code. ICD-9 2010 lets you provide more specific information to monitor health statistics -- and that's a good thing.

Let our experts show you how the following ICD-9 modifications might change the way you code, or the way physicians code based on the information that your lab provides.

ICD-9 2010 has no new codes for transfusion reactions -- but look for a change in the index that will alter how you use existing codes.

Patrick S. Romano, MD, MPH, proposed transfusion reaction code changes (such as adding 999.87, Other specified transfusion reaction) on behalf of the Agency for Healthcare Research and Quality. The goal was to separate ABO incompatibility reactions from minor antigen reactions. An alternate proposal was to reindex minor antigen reaction terms to 999.89 (Other transfusion reaction), from 999.6 (ABO incompatibility reaction).

The CMS release did not include new code 999.87 -- indicating ICD-9 did not adopt the proposed code. So before you code a transfusion reaction using ICD-9 2010, check the index to be sure you're choosing the appropriate code for minor antigen reactions.

Resource: You can find presentation slides at www.cdc.gov/nchs/about/otheract/icd9/maint/classifications_of_diseases_and1.htm.

Because current poisoning codes limit the usefulness of hospital data to identify the substance responsible for a drug overdose, ICD-9 2010 adds a dozen new five-digit poisoning codes.

Impact: "Because drug screens (80100, 80101, Drug screen, qualitative; ...) are not on Medicare's national coverage list, you're not limited to a fixed list of ICD-9 codes for lab test payment," says William Dettwyler, MT- AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. Physicians may use the new codes or existing condition codes to order the drug screens. Currently, poisoning by antidepressants has a single code: 969.0 (Poisoning by antidepressants). Similarly, current codes group caffeine and amphetamines under an umbrella code: 969.7 (Poisoning by psychostimulants).

To provide greater specificity, you'll find a dozen new poisoning codes among the slew of ICD-9 2010 additions. For instance, the new codes expand subcategory 969.0 for antidepressant poisoning and 969.7 for psychostimulant poisoning, as you can see in the following chart: Although your lab may receive an order for a toxicology screen based on patient condition or abnormal lab results, the lab findings may impact diagnosis code assignment to one of these new codes.