Podiatry Coding & Billing Alert

This month you're faced with more than 350 ICD-9 changes. If you don't incorporate those changes into your coding, your practice could face denials and lost revenue. There are 311 new, 22 invalid, and 45 revised ICD-9 codes that took effect on Oct. 1, 2009, for fiscal year 2010. Three of the top changes you'll need to look out for are embolism and thrombosis additions, new neoplasm codes, and V and E code changes.

Every dollar -- and every productivity hour -- counts these days, so we've scoured the diagnosis code changes for you. Here's what you need to know in podiatry to ensure you code properly now that Oct. 1 has come and gone.

If your podiatrist deals with vascular problems, you have several new and revised embolism and thrombosis codes that will allow you to offer more specific information to your payers. ICD-9 2010 offers you 12 new chronic venous embolism and thrombosis codes

(453.50-453.79, Chronic venous embolism and thrombosis ...). The individual codes break the category down by specifying upper or lower extremity and the type of vein. In podiatry, you'll want to pay attention to the following new codes:

• 453.50 -- Chronic venous embolism and thrombosis of unspecified deep vessels of lower extremity

• 453.51 -- ... of deep vessels of proximal lower extremity

• 453.52 -- ... of deep vessels of distal lower extremity

• 453.6 -- Venous embolism and thrombosis of superficial vessels of lower extremity.

You'll also have five new acute venous embolism and thrombosis codes, which are broken down by vein in the same way as the chronic codes. ICD-9 2010 revises 453.40- 453.42 (Acute venous embolism and thrombosis ...) to provide greater specificity for lower extremity procedures as follows:

• 453.40 -- Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity, deep vein thrombosis NOS

• 453.41 -- Acute venous embolism and thrombosis of deep vessels of proximal lower extremity, such as femoral, thigh, upper leg NOS

• 453.42 -- Acute venous embolism and thrombosis of deep vessels of distal lower extremity, such as calf or lower leg NOS

• 453.84 -- Acute venous embolism and thrombosis of axillary veins

• 453.87 -- Acute venous embolism and thrombosis of other thoracic veins.

"These changes will be beneficial," says La Donna Brown, CPC, coding specialist at Sanford Clinic Vascular Associates in Sioux Falls, S.D. "Any time we have the opportunity to use a more specific diagnosis code it is a great day not only for us as coders but for our physicians, and especially the insurance companies."

"I truly believe that coders are 'painting a picture' for the insurance companies on what health issues the patient is having, and the more exact we can be, the better for everyone involved with that patient's care," Brown adds.

One additional revision was for 453.2 (Other venous embolism and thrombosis of inferior vena cava), which now is more specific also. This code currently describes only venous embolism and thrombosis of the vena cava.

Deletion: You'll no longer find 453.8 (Other venous embolism and thrombosis of other specified veins).

ICD-2010 will bring you multiple carcinoma and neoplasm diagnosis changes.

You should add seven new Merkel cell carcinoma diagnosis codes to your arsenal on Oct. 1 (209.31-209.36 and 209.75). You'll also have several new codes for secondary neuroendocrine tumors: 209.70-209.74 (Secondary neuroendocrine tumor ...) and 209.79 (Secondary neuroendocrine tumor of other sites).

This year's changes also include the deletion of 239.8 (Neoplasms of unspecified nature, other specified sites) to make room for 239.81 (Neoplasms of unspecified nature, retina and choroid). Now you'll use 239.89 (... other specified sites) for unspecified neoplasms.

Physicians are always interested in cancer/neoplasms, "although these changes aren't really going to send anyone through the roof," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians and Children's University Medical Group Compliance Program.

The 2010 edits don't pass by E codes or V codes. If your surgeon documents a surgical mishap -- hopefully an infrequent occurrence -- you'll have two new codes to turn to. ICD-9 2010 includes new codes E876.6 (Performance of operation [procedure] on patient not scheduled for surgery) and E876.7 (Performance of correct operation [procedure] on wrong side/body part).

Warning: These two new codes describe situations that are considered "never" events. In other words, the codes represent surgical mistakes that should never happen. Adding E876.6 or E876.7 to a claim ensures "that you will not get paid and may also add malpractice exposure," says Bucknam. "Use of these codes should be a decision that is made with your surgeon with a full understanding of the implications."

Remember: You should use E codes to describe external causes of injuries or accidents. You should never bill E codes as your primary code, and you should always list the E codes last. It may be necessary to assign more than one E code to fully explain each cause.

V code changes: The Oct. 1 changes also add several "personal history of" codes. If your podiatrist sees cancer patients, there are two new ICD-9 codes that may be of interest to you: V10.90 (Personal history of unspecified type of malignant neoplasm) and V10.91 (Personal history of malignant neuroendocrine tumor). These new personal history codes are a welcome addition because they will allow you to give a broader picture of the patient and the medical decision making, experts say.

More information: You can review the entire list of ICD-9 2010 changes online at www.cdc.gov/nchs/icd.htm.