Radiology Coding Alert

Your radiology coding tools will need to reflect cystostomy and fracture updates, too.

Whether you need a code for pulmonary saddle embolus or coarctation, ICD-9 2012 should offer just what you're looking for.

That's the news from recently posted proposed updates to the code set. If finalized, these codes will become effective Oct. 1, 2011. Here are the main proposals to watch.

Separate Aorta and Pulmonary Saddle Embolus Options

ICD-9 2012 may add new code 415.13 (Saddle embolus of pulmonary artery). "A saddle embolus is where you have a very large blood clot that dislodges and then goes through the blood stream and lands in a big division of an artery," explained National Center for Health Statistics (NCHS) medical officer David Berglund, MD, at the March 2010 ICD-9 Coordination and Maintenance Committee meeting (page 21, www.cdc.gov/nchs/data/icd9/Transcript3_10_2010.pdf).

A pulmonary artery saddle embolus can block blood flow to the lungs, making this a severe, potentially fatal type of embolism, Berglund said. After realizing there's no ICD-9 index entry pointing to an appropriate pulmonary saddle embolus option, NCHS proposed that the diagnosis get its own code.

In contrast: ICD-9 does currently link the term "saddle embolus" to the aorta. If you look under 2011 code 444.0 (Arterial embolism and thrombosis; of abdominal aorta), you'll see "saddle embolus" in the inclusion list.

But ICD-9 2012 will take that connection a step further. Expect 444.0 to expand to provide more precise coding:

• 444.01, Saddle embolus of abdominal aorta
• 444.09, Other arterial embolism and thrombosis of abdominal aorta.

Code 444.09 "would include aortic bifurcation syndrome, aortoiliac obstruction, and Leriche syndrome. These basically are thromboses involving the bifurcation of the aorta rather than an embolus," Berglund said. Those diagnoses currently fall under 444.0.

Don't miss: A current pulmonary embolism isn't the only diagnosis getting attention. ICD-9 plans to add V12.55 (Personal history of pulmonary embolism) to provide a unique code for this part of the patient's history.

Sidestep 2 Potential 747.3x Pitfalls

Continuing the focus on pulmonary diagnoses, you can expect ICD-9 2012 to expand 747.3 (Anomalies of pulmonary artery) to a range of five-digit codes:

• 747.31, Pulmonary artery coarctation and atresia
• 747.32, Pulmonary arteriovenous malformation
• 747.39, Other anomalies of pulmonary artery and pulmonary circulation.

Coarctation and atresia: The first proposed code, 747.31, refers to coarctation and atresia, both of which currently fall under 747.3. Coarctation is another term for narrowing or stenosis. Atresia (also called agenesis) refers to failure of the pulmonary valve to form, so the pulmonary artery's origin doesn't connect to the heart.

AVM: Proposed code 747.32 will allow you to report a code specific to pulmonary arteriovenous malformation (AVM), a communication between pulmonary veins and arteries. You may see these documented as pulmonary arteriovenous aneurysm, Berglund noted at the September 2010 ICD-9 committee meeting (page 43, www.cdc.gov/nchs/data/icd9/Transcript91510Afternoon.pdf). Another possible term is pulmonary arteriovenous fistula.

ICD-9 2011 doesn't index pulmonary AVM, but it does include pulmonary AV aneurysm under 747.3. The addition of the new code will clear confusion about how to report the pulmonary AVM.

Pitfall 1: Berglund noted that pulmonary AVMs are usually congenital, but they can be acquired. Acquired pulmonary AV fistulae are reported using 417.0 (Arteriovenous fistula of pulmonary vessels).

Pitfall 2: Also be sure to pay attention to whether the documentation refers to a pulmonary artery aneurysm or a pulmonary arteriovenous aneurysm. The expectationis that a congenital pulmonary artery aneurysm will belong under 747.39. A congenital pulmonary arteriovenous aneurysm will fall under 747.32. Check your index and the inclusion notes when the codes become official in the fall. That way you'll be sure to choose the appropriate code.

596.8x Adds Cystostomy Specifics

Pulmonary diagnoses aren't the only ones to watch. Also of interest to radiology coders is a proposed expansion of cystostomy complication coding options.

A cystostomy is a surgically-created connection between the urinary bladder and the skin. The connection allows drainage of urine in individuals unable to produce normal urinary flow.

The proposal expands 596.8 (Other specified disorders of bladder) into a new range of five-digit codes:

• 596.81, Infection of cystostomy
• 596.82, Mechanical complication of cystostomy
• 596.83, Other complication of cystostomy
• 596.89, Other specified disorders of bladder.

You can expect to see a "use additional code" note with 596.81 instructing you to report the type of infection, as well, noted NCHS's Amy Blum at the March 2010 meeting (page 34, www.cdc.gov/nchs/data/icd9/Transcript3_10_2010.pdf).

There is also a plan to change notes with 997.5 (Urinary complication) and 996.39 (Mechanical complications of genitourinary device, implant, and graft; other) to make it clear those codes exclude the new infection and complication codes, Blum said.

End Your Pelvic Circle Fracture Code Search

Proposals to update pelvic fracture codes also should create more precise coding under ICD-9 2012.

The new codes will be specific to "without disruption":

• 808.44, Multiple closed pelvic fractures without disruption of pelvic circle
• 808.54, Multiple open pelvic fractures without disruption of pelvic circle.

These codes will offer an alternative to "with disruption" codes 808.43 (Multiple closed pelvic fractures with disruption of pelvic circle) and 808.53 (Multiple open pelvic fractures withdisruption of pelvic circle).

Term tip: In your documentation, physicians may refer to "ring" rather than "circle," said Blum (page 33, www.cdc.gov/nchs/data/icd9/Transcript3_10_2010.pdf).

Learn More From CMS and CDC Sites

As a radiology coder, your reports can have you searching every ICD-9 section, so looking through the complete list of changes is worth your time. For example, you may save yourself a denial by noting that V12.2 (Personal history of endocrine, metabolic, and immunity disorders) will no longer be valid. Instead, ICD-9 plans to add V12.29 with the same descriptor to allow for the addition of V12.21 (Personal history of gestational diabetes).

CMS has posted the proposed codes as part of the FY2012 Hospital Inpatient PPS proposed rule. At publication time,  you can find the proposed changes by going to www.cms.gov/AcuteInpatientPPS/IPPS2012/list.asp and choosing the link for "FY 2012 Proposed Rule and Correction Notice Tables." On the new page, click the link to download tables 6A-6F. Table6A shows new diagnosis codes, table 6C shows invalid codes, and table 6F shows revised codes.

You'll find code proposals, meeting summaries, and transcripts at www.cdc.gov/nchs/icd/icd9cm_maintenance.htm, with additional resources at www.cms.gov/ICD9ProviderDiagnosticCodes/03_meetings.asp.