Pulmonology Coding Alert

The 2010 ICD-9 procedure code updates throw a few more changes your way, making diagnoses of thrombosis and speech changes, for instance, ever more specific.

Here's your briefing:

Next time your pulmonologist performs a bronchial valve insertion or replacement, you should be aware of a new and a revised code in this procedure set to distinguish multiple valve replacements during one session:

New code: 33.73 -- Endoscopic insertion or replacement of bronchial valve(s), multiple lobes

Revised code: 33.71 -- Endoscopic insertion or replacement of bronchial valve(s), single lobe.

Take note: Currently, there is no CPT code to accommodate the insertion or replacement of single or multiple bronchial valves. One would have to use the bronchial-tracheal procedures 31899 code (Unlisted procedure, trachea, bronchi) along with a detailed description of the procedure in order to bill for it, says Alan L. Plummer, MD, professor of medicine, division of pulmonary, allergy, and critical care at Emory University School of Medicine in Atlanta.

With the update, the 33.73 code can help hospitals support medical necessity for the procedure when the pulmonologist inserts valves. Similarly, 33.71 can help support medical necessity if the pulmonologist was removing or revising valves, Plummer says.

You also have picked up several new codes for reporting speech disturbances.

Before: In 2009, the code 784.49 (Voice disturbance; other) included change in voice, dysphonia, hoarseness, hypernasality, and hyponasality, says Jill M. Young, CPC, CEDC, CIMC, of Young Medical Consulting in East Lansing, Mich.

Now: In 2010, several of those diagnoses will have their own specific codes. For instance, dysphonia (784.42) describes a change in the voice quality that is not "normal," notes Philip Marcus, MD, MPH, FACP, FCCP, chief of pulmonary medicine at the St. Francis Hospital Heart Center in Roslyn, N.Y.

Difference: While dysphonia is often used interchangeably with hoarseness (784.42 in 2010), hoarseness specifically describes a deepening of the voice, says Marcus.

While the nuances may add value for other specialties, ultimately, you could use either code (784.42 or 784.59) to indicate that inhaled corticosteroids (V87.44), for instance, caused a change in voice quality, depending on the physician's specified documentation, Marcus says.

3. Know the New Venous Thromboembolic Codes

If you have many patients who suffer from thrombosis, the 2010 updates give you many new diagnosis codes to work with.

The long list of new venous thromboembolic codes (453.50-453.89) helps indicate where the venous thrombosis is localized and specifies whether it is chronic or acute. A sample of these new codes includes:

• 453.51 -- Chronic venous embolism and thrombosis of deep vessels of proximal lower extremity

• 453.71 -- Chronic venous embolism and thrombosis of superficial veins of upper extremity

• 453.84 -- Acute venous embolism and thrombosis of axillary veins

• 453.87 -- Acute venous embolism and thrombosis of other thoracic veins.

Lastly, some pulmonologists will be interested in the new hypoxic-ischemic encephalopathy codes, which will be especially useful for intensivists who work in neurology ICUs. These codes are:

• 768.70 -- Hypoxic-ischemic encephalopathy, unspecified

• 768.71 -- Mild hypoxic-ischemic encephalopathy

• 768.72 -- Moderate hypoxic-ischemic encephalopathy

• 768.73 -- Severe hypoxic-ischemic encephalopathy.