Pathology/Lab Coding Alert

Terrorism hit the annual ICD-9 update, with new codes for anthrax and other potential biological and chemical agents.

Effective Oct. 1, 2002, with a grace period until Jan. 1, 2003, the new codes provide more specific diagnoses, as well as explicit health status (V) and external cause (E) codes for terrorism. Other new ICD9 Codes report lab test results pertaining to infections such as West Nile virus and genetic carrier status for diseases such as cystic fibrosis. You can access a complete list of ICD-9 code changes on the Internet at http://www.cms.hhs.gov/medlearn/icd9code.asp.

Last year's anthrax threat pointed up the inadequacy of the current system for reporting possible terrorist exposure. Although ICD-9 codes existed for confirmed cases of anthrax infection (022.0 cutaneous, 022.1 pulmonary, 022.2 gastrointestinal, 022.3 septicemia, 022.8 other specified manifestations, and 022.9 unspecified), specific codes for exposure status and cause of exposure were nonexistent.

ICD-9 2003 allows reporting three levels of exposure status:

1) Confirmed exposure: The U.S. Centers for Disease Control and Prevention (CDC) last year instructed labs to report general code 795.3 (Nonspecific positive culture findings) for a positive anthrax nasal swab confirming exposure. ICD-9 2003 adds new code 795.31 (Nonspecific positive findings for anthrax) with the definition "positive findings by nasal swab." "Use this code when patients with a positive nasal swab do not exhibit confirmed disease symptoms reportable to 022.x," says Laurie Castillo, MA, CPC, CPC-H, CCS-P, member of the national advisory board of the American Academy of Professional Coders (AAPC) and president of Physician Coding and Compliance Consulting in Manassas, Va.

2) Exposure: General code V01.8 (Contact with or exposure to other communicable diseases) last year reported individuals with contact or exposure to anthrax. Now a subcategory, V01.8, includes two new subclassification codes for 2003: V01.81 (Anthrax), and V01.89 (Other communicable diseases). Report V01.81 when the patient has known exposure to anthrax, but it has not yet been confirmed through a positive nasal swab, Castillo says.

3) Suspected exposure, not found: Report evaluation for suspected anthrax exposure with new code V71.82 (Observation and evaluation for suspected exposure to anthrax) rather than the general code available last year: V71.8 (Observation and evaluation for other specified suspected conditions). For suspected exposure to other organisms, report new code V71.83 (Observation and evaluation for suspected exposure to other biological agent). ICD-9 instruction specifies that the V71 category "is to be used when persons without a diagnosis are suspected of having an abnormal condition, without signs or symptoms, which requires study, but after examination and observation, is found not to exist."

To indicate the cause of exposure to chemical or biological agents, ICD-9 2003 adds new category E979 (Terrorism). For biological weapons exposure, report new code E979.6 (Terrorism involving biological weapons), which lists anthrax, cholera and smallpox. For chemical weapons report E979.7 (Terrorism involving chemical weapons). "Sequence these E codes after the diagnosis or exposure status V code whenever your lab provides tests related to terrorist exposure," Castillo says.

ICD-9 2002 introduced a new category for genetic carrier status (V83.x), with three codes for hemophilia A carriers. Now the 2003 ICD-9 introduces a new code in the category for cystic fibrosis (V83.81, Cystic fibrosis gene carrier) and a new code for other conditions (V83.89, Other genetic carrier status).

The V83 category includes codes describing carrier status only for diseases that can be passed on genetically to the next generation, not codes for all gene-related diseases. "Report these codes to the fifth digit, using V83.89 for genetic carrier status tests not yet specified in ICD-9," says Stacey Hall, RHIT, CPC, CCS-P, director of corporate coding for Medical Management Professionals Inc., a national billing and management firm in Chattanooga, Tenn.

West Nile fever earned its own code in ICD-9 2003 (066.4, West Nile fever) rather than remaining under 066.3 (Other mosquito-borne fever). Use the new code for test results specifying West Nile virus, encephalitis or encephalomyelitis. A new note under 062.8 (Other specified mosquito-borne viral encephalitis) now excludes West Nile virus and directs coders to 066.4.

You'll have to report newborn infections more specifically using four new five-digit codes in ICD-9 2003: 771.81 (Septicemia [sepsis] of newborn), 771.82 (Urinary tract infection of newborn), 771.83 (Bacteremia of newborn) and 771.89 (Other infections specific to the perinatal period). "No longer report these conditions using the four-digit subcategory code 771.8," Hall says.