Primary Care Coding Alert

Family practice coding professionals will rely on a number of important new and revised diagnosis codes describing sunburn, asthma and several women's health problems during 2002, says Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa. "There are a number of ICD-9 codes for 2002 that have been developed to better define several conditions that family physicians treat on a regular basis," he says. "Most family physicians will welcome these new codes."

Revisions to the fifth-digit subclassification for the asthma subcategory 493 are among the most important changes for family practices, Fick says. The description for the 0 in this position has been revised to read, "without mention of status asthmaticus or acute exacerbation or unspecified." Previously a fifth digit of "0" in this category  indicated "without mention of status asthmaticus."
 
When a patient presents with extrinsic asthma in 2002, for instance, family practices will assign 493.01 if the patient's condition is status asthmaticus, 493.02 if the condition is acute exacerbation, or 493.00 for an unspecified condition. This code change will make it easier for physicians to report a generic diagnosis when appropriate, Fick notes, but it should not be used as a dump code when more specific diagnostic information is available.

New codes related to women's health conditions are important, he says. Code 256.3 (other ovarian failure) has been augmented with new codes 256.31 (premature menopause) and 256.39 (other ovarian failure). "These 2002 ICD-9 codes provide greater specificity when a woman undergoes premature menopause and allow us to highlight the cause for the condition," he says. Because of these changes, V49.81 (postmenopausal status, age-related, natural) has also been revised to exclude 256.31. V49.81 is intended to be used only as a status code when a patient has no symptoms, while 256.31 describes a patient's condition when she has premature menopause and symptoms such as hot flashes.
 
A second important change in women's health coding affects mammography, says Kent Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians. Code 793.8 (nonspecific abnormal findings on radiological and other examinations of body structure, breast) has been enhanced with three new codes: 793.80 (unspecified abnormal mammogram), 793.81 (mammographic microcalcification) and 793.89 (other abnormal findings on radiological examination of breast).

Moore says there are also several noteworthy changes to gastrointestinal coding, including four new codes. Code 564.0 (constipation) has been deleted and replaced with four new codes: 564.00 (unspecified constipation), 564.01 (slow transit constipation), 564.02 (outlet dysfunction constipation) and 564.09 (other constipation). A new code, 530.12, has also been added for acute esophagitis, he says.
 
Code 464.00 (acute laryngitis, without mention of obstruction) and 464.01 (acute laryngitis, with obstruction) have been added to the 464.0 (acute laryngitis) category. A new subcategory has also been created for supraglottitis (464.5). A fifth digit is required with these codes, requiring family physicians to distinguish between supraglottitis without mention of obstruction (464.50) or supraglottitis with obstruction (464.51).

There are also new codes for stress fractures, Fick says: "Family physicians will find they use these frequently, especially with runners and other patients presenting with sports injuries." They include:
 

733.93 stress fracture of tibia or fibula
 

733.94 stress fracture of the metatarsals
 

733.95 stress fracture of other bone.

The significant new codes are 692.76 (sunburn of second degree) and 692.77 (sunburn of third degree). "We see a lot of sunburn in family practice, and these new options will help us describe the presenting problem better," Fick says.
 
Moore notes several changes to V codes: "There is a new code for personal history of malignant neoplasm, renal pelvis (V10.53), as well as new designations for hemophilia A carriers. V83.01 is specifically for an asymptomatic hemophilia A carrier, and V83.02 is for a symptomatic hemophilia A carrier."
 
He adds that V70.7 has been simplified from examination for normal comparison or control in clinical research to examination of participant in clinical trial.
 
The 2002 ICD-9 code revisions officially went into effect on Oct. 1, 2001. However, CMS gives providers until Jan. 1, 2002, to implement the codes so they have time for transition.
 
Because many local carriers and private payers will not update their computer systems until the beginning of the year, family practices may want to delay implementation of the codes to avoid denials. A complete list of 2002 ICD-9 changes is available at www.hcfa.gov/pubforms/transmit/AB0191.pdf.