Primary Care Coding Alert

The new signs and symptoms codes that FPs will find most useful are those describing crying infants. "It's not unusual to see crying infants, and quite often after the history and exam you still don't have a specific diagnosis to explain their symptoms," says A. Clinton MacKinney, MD, MS, the AAFP representative on the AMA CPT Advisory Committee and medical director at HealthPartners Central Minnesota Clinics in St. Cloud, Minn. "These new codes will allow the physician to code these symptoms more accurately, instead of having to use the general signs and symptoms code."

Code 780.9 (Other general symptoms) has been subdivided into three new codes:

Billing for follow-up may get easier with the new and improved aftercare codes. When you report V54.81, use an additional code (i.e., V43.60-V43.69) to identify the joint replacement site, Moore says.

New subcategories for orthopedic aftercare include:

ICD-9 also added a new code for patients with oxygen tanks because they have chronic obstructive pulmonary disease (COPD) or emphysema. Code V46.2 (Other dependence on machines, supplemental oxygen) includes long-term oxygen therapy.

FP coders can now choose from several new codes under the 438 series, which concerns late effects of cerebrovascular disease. Using the new codes requires you to report an additional code to identify the altered sensation or visual disturbance, Moore says.

For example, if you use 438.7, report a code from the 368 (Visual disturbances) series, such as 368.2 (Diplopia), which includes double vision. "These codes are good for general nonspecific complaints for cerebrovascular patients when you can document symptoms without any other diagnosis," 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.

The new codes are:

ICD-9 added a new sub-category, 459.3 (Chronic venous hypertension [idiopathic]), that includes five codes:

Code 454.9 has been revised to include varicose veins not otherwise specified, and a new code has been added:

Menopausal and postmenopausal diagnosis codes have been revised to include the words "symptomatic" and "asymptomatic." "The codes now describe two different clinical situations," MacKinney says. The patient who has hot flashes, fatigue and dry vagina will be diagnosed with one of the codes specifying symptomatic, while the patient who may be worried about osteoperosis or wants a change of medication will be classified as asymptomatic.

Researchers have recently published studies outlining the risks of hormone replacement therapy (HRT), so FPs may have many patients who want to stop the therapy, MacKinney adds.

If your FP performs obstetric services, you should be aware of some key coding changes in this category. You must now include a fifth digit with each of the ectopic pregnancy codes (633.0-633.9). Specifically, a fifth digit of "0" indicates "without intrauterine pregnancy," while "1" denotes "with intrauterine pregnancy."

ICD-9 also added a new sub-category, 765.2, Weeks of gestation, under category 765, Disorders relating to short gestation and low birthweight. The new codes in this subcategory include:

Specificity has also been added to the codes for other respiratory problems after birth (770.8), other infection specific to the perinatal period (771.8), and other specified conditions originating in the perinatal period (779.8).

Although many of these conditions would be treated by another specialist, some FPs will be making these diagnoses. "Any family physician who delivers babies when there is not a pediatrician or neonatologist immediately available may need to evaluate these particular problems," MacKinney says.

The changes are as follows:

Under the categories of personal history of other diseases (V13) and supervision of high-risk pregnancy (V23), new codes related to maternity care include: