Primary Care Coding Alert

Changes also make blood-in-urine, pressure-ulcer coding more specific You can head off fall compliance woes by getting a heads-up now on new codes for secondary diabetes, hematuria and pressure ulcers. ICD-9 has released its preliminary list of new diagnosis codes for late 2008 and 2009, and coders should get familiar with them now, because once October rolls around, the law requires that you use these new codes. Remember: Since the passage of HIPAA, new ICD-9 codes have no grace period. You-ve got to be ready to go with the new codes on Oct. 1, says Joan Gilhooly, CPC, CHCC, president of Medical Business Resources in Chicago. "This federal law applies to all payers, so in essence, your time to prepare for these codes is now," Gilhooly says. CMS has approved the following codes for use, but slight changes are possible before the list is finalized over the summer. For all the latest news on ICD-9 2009, check out future issues of Family Practice Coding Alert. Use 249.xx When Condition Causes Diabetes The newest ICD-9 version will have an entire code set for secondary diabetes. While genetics or environmental factors are typically the cause of "primary" diabetes, secondary diabetes exists when an underlying patient condition is causing the diabetes, Gilhooly says. Impact: "Until these new codes, there was no good way of showing that a patient's diabetes was due to some other problem,"says Jeffery F. Linzer Sr., MD, FAAP, FACEP, associate medical director for compliance and business affairs at Children's Healthcare of Atlanta at Egleston. Secondary diabetes can often occur in chronic illnesses such as cystic fibrosis, chronic pancreatitis, Cushing's syndrome, malignant neoplasm, certain genetic disorders, pancreatic injury, or late effect of poisoning, Linzer says. For example, a patient's chronic pancreatitis can severely affect his insulin production, thereby causing diabetes. You would consider the diabetes in this case secondary diabetes, Gilhooly says. The new code set starts with 249.00 (Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified) and ends with 249.91 (Secondary diabetes mellitus with unspecified complication, uncontrolled). In between, you-ll find a host of codes that describe the patient's diabetes and the underlying factor causing the condition. Here is a sampling of the new codes: - 249.01 -- Secondary diabetes mellitus without mention of complication, uncontrolled - 249.10 -- Secondary diabetes mellitus with ketoacidosis, not stated as uncontrolled, or unspecified - 249.11 -- - uncontrolled - 249.40 -- Secondary diabetes mellitus with renal manifestations, not stated as uncontrolled, or unspecified - 249.41 -- - uncontrolled - 249.50 -- Secondary diabetes mellitus with ophthalmic manifestations, not stated as uncontrolled, or unspecified - 249.51 -- - uncontrolled - 249.70 -- Secondary diabetes mellitus with peripheral circulatory disorders, [...]