Pulmonology Coding Alert

Take 5 Minutes to Nail Down Your Fall ICD-9 Changes

Warning: 519.1 won't be all you need for acute bronchospasm

See if you're up to speed on the new ICD-9 diagnoses effective Oct. 1, 2006, with this three-part quiz.

Ignore Rumors About V Code Listing

Before we focus on the ICD-9 changes for 2007, let's dispel one common V code misconception:

Question: True or false. Certain V codes cannot be used as primary codes.

Answer: False. It's a little-known fact: The talk circulating about some V codes not being primary codes is wrong. V codes can be used in the primary position.

The misconception partially stems from the ICD-9 manual: Some V codes have a red box with the white letters "Sdx" next to them, which indicates the code is a secondary code only. "But the designation applies for inpatient Medicare coding only," says Jeffrey F. Linzer Sr., MD, FAAP, FACEP, associate medical director for compliance and business affairs at EPG--Children's Healthcare of Atlanta at Egleston. For a code specification to be valid, the instruction must appear in the ICD-9 definition, Linzer says.

The designations stem from Medicare's "Unacceptable Principal Diagnosis" edit. Effective Oct. 1, 2006, CMS will add to this list the new V codes for pediatric body mass index (V85.51-V85.54), which will appear in the ICD-9 2007 manual as "Sdx" codes. But you can still use these codes as primary in the outpatient setting.

The designations are a big source of confusion. "Payers may interpret them as rules and sometimes incorporate them into their edits," says Victoria S. Jackson, practice management consultant with JCM Inc. in California.

Be savvy: If an insurer disallows using V85.51-V85.54 as the primary diagnosis with an office visit code (such as 99211 or 99212, Office or other outpatient visit for the evaluation and management of an established patient ...), inform the representative that "the term 'unacceptable primary diagnosis' only applies when used as the primary diagnosis for inpatient Medicare services," Linzer says. "Don't let payers play off your ignorance."

Unique Dx Gets to Root of Bronchospasm Px

Many physicians are miscoding bronchospasm. Are you one of them?
 
Question: Starting Oct. 1, my pulmonologist will report acute bronchospasm as:

a. 519.1--Other diseases of trachea and bronchus, not elsewhere classified

b. 490--Bronchitis, not specified as acute or chronic

c. 519.11--Acute bronchospasm

d. 493.02--Extrinsic asthma; with (acute) exacerbation

Answer: C. ICD-9 2007 will introduce a specific code for acute bronchospasm: 519.11. You should use this code when a patient "presents with bronchospasm but has not been diagnosed with asthma," according to the ICD-9-CM Coordination and Maintenance Committee Meeting on April 1, 2005.

Some physicians are coding acute bronchospasm as bronchitis. But reporting the symptom of bronchospasm may be a more accurate ICD-9 diagnosis at the time of the visit.

Prior to Oct. 1, 2006, you should have been using 519.1. "Many other conditions are indexed to this code including abscess of bronchus, atrophy of trachea, bronchostenosis and calcification of bronchus," state the ICD-9 agenda notes. Having a unique code for bronchospasm will allow better tracking of the condition's chronicity or recurrence, which will aid in better diagnosing the child's underlying problem.

ICD-9 Makes Mucositis Coding More Specific

Question: Fill in the blank. On claims after Oct. 1, 2006, I will code ulcerative mucositis with ____ digits.

Answer: 5. You will be able to specifically identify ulcerative mucositis by using a fifth digit of "1" with the 478.1 series (Other diseases of nasal cavity and sinuses).

Code 478.11 indicates "Nasal mucositis (ulcerative)." The "other specified code" 478.1 will become 478.19 (Other disease of nasal cavity and sinuses). Patients may develop ulcerative mucositis as a side effect of cancer treatment.