Primary Care Coding Alert

ICD-9 beefs up traumatic brain injury code set to make TBI treatments easier to explain.

Coders who want more control over accurately reporting their patients' body mass index (BMI) measurements can breathe easier starting Oct.1, when ICD-9 2011 debuts an expanded BMI V code set.

The new diagnosis code manual will also feature several codes that will help FP practices that treat patients who suffer neurological symptoms after falls.

ICD-9 2011 will contain the following new codes that should help you diagnose your patients with certain neurological injuries:

• 780.33 (Post traumatic seizures)
• 799.51 (Attention or concentration deficit)
• 799.52 (Cognitive communication deficit)
• 799.53 (Visuospatial deficit)
• 799.54 (Psychomotor deficit)
• 799.55 (Frontal lobe and executive function deficit)
• 799.59 (Other signs and symptoms involving cognition).

"Here in Washington state, and I believe in other states as well, there are quite a few new laws related to care for post-TBI (traumatic brain injury) patients," explains Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-I, CCC, COBGC, manager of compliance education for the University of Washington Physicians and Children's University Medical Group Compliance Program.

The state laws and diagnosis code changes coincide with a CDC campaign aimed at prevention and early diagnosis of TBI.

"These laws and education have had a huge impact on family medicine physicians who see patients who have had head injuries from sports or falls, indigent populations, and returning military personnel," says Bucknam, who offers this scenario.

Example: A 17-year-old male new patient presents with spells of "blanking out" over the last several weeks. The patient reports this started a few days after he was hit in the head with a softball. The FP performs a comprehensive history and exam, focusing on possible late effects of the head injury; during moderate-complexity medical decision making (MDM), the FP orders neurologic  testing and requests an evaluation from a local TBI clinic.

Final diagnosis is "mild seizures, status post-TBI."

Beginning Oct. 1, you'll submit the following for this encounter:

• 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity ...) for the E/M
• 780.33 appended to 99204 to represent the seizures 907.0 (Late effects of injuries to the nervous system; late effect of intracranial injury without mention of skull fracture) appended to 99204 to represent the lateeffect status of the injury
• E007.3 (Activities involving other sports and athletics played as a team or group; baseball; softball) appended to 99204 to represent the cause of the patient's injury.

Key More Specific BMI Readings With These 5th Digits

The newest ICD-9 book expands the code set for body mass index (BMI) calculation, adding a fifth digit to greater specify the BMI amount for patients with readings over 40.

Impact: "This will allow for better tracking of heavier individuals. The previous high BMI did not account for the 'superlarge' individuals: over 6 feet tall and over 300 pounds," explains Jill M. Young, CPC, CEDC, CIMC, of Young Medical Consulting, LLC in East Lansing, Mich. and chair of the American Academy of Professional Coders Chapter Association.

Beginning Oct. 1, these codes will replace V85.4 (Body Mass Index 40 and over, adult):

• V85.41 (Body Mass Index 40.0-44.9, adult)
• V85.42 (Body Mass Index 45.0-49.9, adult)
• V85.43 (Body Mass Index 50.0-59.9, adult)
• V85.44 (Body Mass Index 60.0-69.9, adult)
• V85.45 (Body Mass Index 70 and over, adult).

Benefit: "The new BMI codes will help to support the need for weight management treatment that has been sometimes difficult to describe in the past," Bucknam confirms.

Example: A new patient with a BMI of 45 presents to an FP complaining of shortness of breath and related symptoms. The FP determines that all of the symptoms are related to the patient's morbid obesity and proceeds to counsel the patient on options for addressing his weight.

In this case, you would code the encounter with a primary diagnosis of 278.01 (Overweight, obesity, and other hyperalimentation; overweight and obesity; morbid obesity) to represent the cause of the patient's problems and V85.42 to specify the BMI and extent of the morbid obesity. The BMI codes are always secondary diagnoses.

(Note: Look for more stories on how ICD-9 2011 will affect your coding in future editions of Family Practice Coding Alert.)