Radiology Coding Alert

From head to toe, the new diagnosis codes hold something for everyone.

Whether your patients present with cardiologic, orthopedic, or gynecologic complaints, the next round of ICD-9 codes could hold important changes for you. Here's the rundown on the new codes most relevant to radiologists -- including a new option for retained magnetic metal fragments.

Remember: ICD-9 2011 will go into effect Oct. 1, 2010. The official version will be released in the fall, so the codes below are not yet final.

1. Look Forward to More Specific Ectasia Codes

The proposed changes to ICD-9 2011 add four codes specific to aortic ectasia. These codes are among the most significant changes for radiology coders because you may see that term in your radiologist's findings, says Helen L. Avery, CPC, CHC, CPC-I, manager of revenue cycle services for Los Angeles-based Sinaiko Healthcare Consulting Inc. "Ectasia" means dilation or enlargement, and aortic ectasia typically refers to enlargement that is milder than an aneurysm. But ICD-9 2010 does not distinguish ectasia from aneurysm, indexing aortic ectasia to 441.9 (Aortic aneurysm of unspecified site without mention of rupture) and 441.5 (Aortic aneurysm of unspecified site, ruptured).

The proposed 2011 codes are specific to aortic ectasia and differ based on anatomic site:

• 447.70 -- Aortic ectasia, unspecified site
• 447.71 -- Thoracic aortic ectasia
• 447.72 -- Abdominal aortic ectasia
• 447.73 -- Thoracoabdominal aortic ectasia.

2. Watch for 'Claudication' in Stenosis Report

Another one of the important changes is the proposed addition of 724.03 (Spinal stenosis, lumbar region, with neurogenic claudication), says Avery. The code refers to lumbar spinal stenosis, which is a narrowing of the spinal canal, according to the Sept. 16-17, 2009, ICD-9-CM Coordination and Maintenance Committee meeting proposal available at www.cdc.gov/nchs/icd/icd9cm_maintenance.htm. Neurogenic claudication "is a commonly used term for a syndrome associated with significant lumbar spinal stenosis leading to compression of the cauda equina (lumbar nerves)," the proposal states.

ICD-9 2010 includes 724.02 (Spinal stenosis, other than cervical; lumbar region). Andelle Teng, MD, a spine and orthopedic surgeon in Washington, requested a code addition to differentiate patients with and without neurogenic claudication because "with" is a possible surgical condition. The 2011 proposal revises 724.02 to "Spinal stenosis, lumbar region, without neurogenic claudication," in contrast to the 724.03 proposal for patients with claudication.

3. Match New Uterine Codes to Clinical Class

If you code gynecological imaging, don't miss the proposed new codes for uterine abnormalities. So-called müllerian duct abnormalities can cause infertility, but surgical correction is sometimes possible. Radiological imaging, usually MRI, confirms the diagnosis, so the radiologist should document the specific type of abnormality in his findings, Avery says. The ICD-9 2011 proposal expands the 752.3 (Other anomalies of uterus) range:

• 752.31 -- Agenesis of uterus
• 752.32 -- Hypoplasia of uterus
• 752.33 -- Unicornuate uterus
• 752.34 -- Bicornuate uterus
• 752.35 -- Septate uterus
• 752.36 -- Arcuate uterus
• 752.39 -- Other anomalies of uterus.

Bonus tool: Avery reveals how the ICD-9 2011 proposal matches to the müllerian duct abnormality classifications:

Watch for: You'll also find proposed expansion of 752.4x (Anomalies of cervix, vagina, and external female genitalia):

• 752.43 -- Cervical agenesis
• 752.44 -- Cervical duplication
• 752.45 -- Vaginal agenesis
• 752.46 -- Transverse vaginal septum
• 752.47 -- Longitudinal vaginal septum.

4. Review New Retained Fragment Proposals

Over one-third of the proposed codes are "V" codes, which describe "supplementary classification of factors influencing health status and contact with health services," according to the ICD-9 manual. A number of the codes describe retained fragments, which the radiologist may note in his findings, Avery says.

For instance: For retained metal fragments, you would choose among the following:

V90.10 -- Retained metal fragments, unspecified

V90.11 -- Retained magnetic metal fragments

V90.12 -- Retained nonmagnetic metal fragments.

The Department of Defense requested codes to help identify retained objects resulting from explosion injuries, but the codes could prove useful in other cases, as well. For example, an embedded magnetic object (V90.11) is a contraindication to an MRI exam.

Resource: CMS posted the proposed codes as part of the Inpatient Proposed Payment System, available online at www.cms.gov/AcuteInpatientPPS/IPPS2010/list.asp. To review the codes, download "Proposed Tables 6A-6K." Table 6A includes proposed new codes, 6C shows the proposed deletions, and 6E lists proposed revisions.