Radiology Coding Alert

Expect changes to jaw pain and hemoptysis coding options.

When the radiologist doesn't document a definitive diagnosis, you have to hunt down the proper codes for the signs or symptoms that prompted the exam. And ICD-9 2011 wants to add some all-new options to the hunt.

Benefit: These new codes "may justify medical necessity for the diagnostic imaging services from the ordering provider," explains Helen L. Avery, CPC, CHC, CPC-I, manager of revenue cycle services for Los Angeles-based Sinaiko Healthcare Consulting Inc. Take a look at potential new options for jaw pain, hemoptysis, and more, that could go into effect Oct. 1, 2010, if the codes make it into the final version released in the fall. Keep Tabs on 786.3x for Chest Exams The most significant of the proposed signs and symptoms codes may be the expanded listing for hemoptysis, which refers to coughing up blood. The current general code (786.3, Hemoptysis) could become the following, Avery says:

• 786.30 -- Hemoptysis, unspecified
• 786.31 -- Acute idiopathic pulmonary hemorrhage in infants (AIPHI)
• 786.39 -- Other hemoptysis.

The expansion resulted from the Centers for Disease Control's request for a code specific to AIPHI for tracking purposes.Move Jaw Pain Search to 784.92

Another proposed new code you may use when the radiologist doesn't document specific findings is 784.92 (Jaw pain), says Avery. The ICD-9 committee received a request to reindex jaw pain from 526.9 (Unspecified disease of the jaws) "because jaw pain may be a symptom of a myocardial infarction and code 526.9 does not provide any information," according to the Sept.17, 2009, Diagnosis Agenda (www.cdc.gov/nchs/data/icd9/agnedaSep09rv.pdf). Because the symptom is so important, the new specific code was proposed.

Smart Move: Scan All Changes

Radiology exams cover the entire body, so the ICD-9 code you need could be anywhere in the manual. That reality means you'll benefit from reviewing the full range of new codes. For example, depending on documented findings, you may find use for proposed new code 560.32 (Fecal impaction) or V13.6x (Personal history of [corrected] congenital malformations ...), Avery notes. The proposals also "expanded the body mass index (BMI) codes to demonstrate higher BMIs with five new codes," notes Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC, with CRN Healthcare Solutions in Tinton Falls, N.J. ICD-9 2010 includes just one V code to represent a BMI index over 40 (V85.4, Body Mass Index 40 and over, adult), but the new edition of ICD-9 will offer additional categories, ranging from V85.41 (Body Mass Index 40.0-44.9, adult) to V85.45 (Body Mass Index 70 and over, adult). "BMI has become an important health tool, and those codes will also provide more data," says Susan Vogelberger, CPC, CPC-H, CPC-I, CMBS, CCP-P, CEO of Healthcare Consulting & Coding Education LLC in Ohio.

For example, if an interventional radiologist documents that a patient's morbid obesity resulted in spending significantly more time and effort on a procedure than is usual, coding the patient's BMI --- along with other supporting documentation -- may help support appending modifier 22 (Increased procedural services).

Remember: You can access the proposed codes at www.cms.gov/AcuteInpatientPPS/IPPS2010/list.asp. Download "Proposed Tables 6A-6K." Tables 6A, 6C, and 6E list the proposed changes for the diagnosis codes.