Primary Care Coding Alert

Our quiz shows you how to use new decubitus ulcer, Pap-smear result codes

Starting Oct. 1, if you use the invalid ICD-9 code set, you'll face denials from Medicare and many private payers. To submit error-free claims the first time, take these expert-recommended steps:
 
1. Show your family physician the complete list of new, revised and invalid codes so he can add any useful diagnoses and remove any outdated versions.
 
2. Check your router sheet and practice using the new codes. To get you started, practice coding these top ICD-9 2005 changes:

1. Decubitus Ulcer Diagnoses Now Specify Location

Question 1: An FP treats a difficult decubitus ulcer on a patient's buttock and heel, and a less complicated decubitus ulcer on his elbow. The physician debrides partial-thickness skin on the patient's elbow, and full-thickness skin on the heel and buttock. To show the insurer why the FP performed two types of debridement, which diagnoses should you use?

 a. 707.0, 707.0, 707.0
 b. 707.01, 707.05, 707.07
 c. 707.00, 707.00, 707.00
 d. 707.01, 707.02, 707.06

Answer: B. You should submit 707.01 (Decubitus ulcer, elbow), 707.05 (... buttock) and 707.07 (...heel).
 
Old way: Because previous ICD-9 editions listed only one decubitus ulcer code (707.0), you would have reported 11040 (Debridement; skin, partial thickness) and 11041 (... skin, full thickness) and linked both to 707.0 (Decubitus ulcer).
 
New way: Starting Oct. 1, you could use 707.01, 707.05 and 707.07 to describe the different ulcers. ICD-9 2005 makes coding decubitus ulcers "more complicated," says Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan. Seven site-specific codes (707.01-707.07) and two unspecified/other decubitus ulcer diagnoses (707.00, 707.09) replace the existing code (707.0).
 
Benefit: The new codes will allow you to specify separate bedsore sites to demonstrate medical necessity. "Physicians were having difficulty prior to [ICD-9 2005's] release, because they treated different [ulcer] sites," says Mary I. Falbo, MBA, CPC, president of Millennium Healthcare Consulting in Landsdale, Pa.
 
ICD-9, however, contained only one bedsore code (707.0). Because you had no way to indicate that your FP treated a different site, insurers often denied multiple debridement services. Without your FP's operative report, insurers didn't understand why the physician performed two debridement procedures for one bedsore.
 
Other sites that ICD-9 now defines include: