Primary Care Coding Alert

2011 edition brings more specificity for ADD and retained fragments.

The 2011 ICD-9 codes going into effect Oct. 1 have a few welcome additions for your younger patients. Read on for examples of new diagnoses you could find yourself reporting on a regular basis.

Attention Deficit Options Give a Better Starting Point ICD-9 2011 adds the 799.5x family to the "Ill Defined and Unknown Causes of Morbidity and Mortality" section. New codes include:

• 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.

"This new series will be useful for symptoms and signs as a diagnosis before the physician establishes a definitive diagnosis," says Richard L. Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio in Zanesville. "Physicians see children with concerns regarding attention or activity. You don't have enough information after the first visit for an official diagnosis, but you still need something to report."

Example: Your physician sees a child who has an attention problem but doesn't yet meet diagnostic criteria for attention deficit disorder. Previously, you couldn't report coding choices 314.00 (Attention deficit disorder; without mention of hyperactivity) or 314.01 (... with hyperactivity) until the physician established a definitive diagnosis. Beginning Oct. 1, you could submit 799.51 until tests confirm a diagnosis.

V Codes Address Retained Fragments

ICD-9 2011 also introduces a series of specific V codes for different types of retained fragments. The series (V90.01- V90.9) address objects ranging from metal, plastic, or wood to animal quills or spines, glass, teeth, and other specified foreign bodies, including radioactive fragments.

Remember: You won't report a code for foreign body removal in conjunction with V90.x. "These foreign bodies are 'retained,'" Tuck explains. "You'll deal with it in terms of the patient's history and physical, but not an actual procedure to remove the object."

Example: A mother brings her son to your office because he has a very small piece of plastic under the skin. The family physician does not remove the piece because it doesn't pose a danger. You could include V90.2 (Plastic retained fragments) on your claim.