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Primary Care Coding Alert

ICD-9 Creates New BMI Series, Dehydration Codes

Published on Sun Jun 26, 2005

Update your superbills before Oct. 1, or expect denials

You can smoothly transition to the new and revised diagnosis codes if you submit dehydration claims with 276.51 and overweight-adult counseling sessions with two new ICD-9 codes.

CMS released the proposed new codes in the May 4 Federal Register. "These changes are pretty solid," says Jeffrey Linzer Sr., MD, MICP, FAAP, representative to the ICD-9-CM editorial advisory board. Here's what you can expect when the new ICD-9 codes become effective Oct. 1, 2005.

Note: This is part one of a three-part Family Practice Coding Alert series that will prepare you for this fall's new and revised diagnostic codes.

Add a '1' to the End of Your Dehydration Code

Get ready to add a fifth digit to the general dehydration diagnosis. Now,   ICD-9 lumps dehydration, volume depletion and hypovolemia under the same code: 276.5 (Volume depletion). But dehydration and hypovolemia require different treatment approaches.

This fall, 276.5 will require a fifth digit to specify whether a person has:
 

  • 276.50 - Volume depletion, unspecified
      
  • 276.51 - Dehydration
      
  • 276.52 - Hypovolemia.

    Tip: You'll probably only put 276.51 on the superbill. Family physicians (FPs) tend to treat dehydration more often than hypovolemia, says Sherry Wilkerson, RHIT, CCS, CCS-P, coding and compliance manager at Catholic Healthcare Audit Network in Clayton, Mo. "But I would certainly ask the physicians" if they want the encounter sheet to include 276.52 also.

    Overweight Diagnosis Will Be a Welcome Option

    The new codes will allow you to diagnose a patient as overweight without labeling him obese. "Overweight (278.02) will be a nice code for patients whose weight doesn't make them obese, just overweight," says Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City.

    Example: If you want to discuss dietary counseling with a patient who gained 15-20 pounds, you could use new code 278.02 (Overweight) with V65.3 (Dietary surveillance and counseling). If the FP performs the counseling, you should assign an E/M code (such as 99212-99215, Office or other outpatient visit for the evaluation and management of an established patient, which requires two of these three key components ...).

    You'll also use one of 18 new body mass index (BMI) codes (V85.0-V85.4), if known. For instance, suppose the patient's 15- to 20-pound weight gain in the previous example landed him with a 27.5 BMI. You would code 278.02 and specify the patient's BMI with V85.23 (Body mass index 27.0-27.9, adult). For a complete list of the new BMI codes, see the chart later in this issue.

    But you should not report BMI "V" codes for children. Use the V85.x(x) codes for adults only, Linzer says. The American Academy of Pediatrics is still working to get ICD-9 to introduce a pediatric BMI code.

    Excessive Crying Will Apply to Adults

    You will, however, be able to code a symptom for adults that you could previously report only for infants. To describe excessive crying in infants, ICD-9 previously created 780.92 (Excessive crying of infant [baby]). The code was so useful that the American Hospital Association's Editorial Advisory Board and the National Association of Children's Hospitals and Related Institutions (NACHRI) requested a similar code for patients other than infants.

    Result: This October, you'll be able to use 780.95 (Other excessive crying).

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