Radiology Coding Alert
ICD-9 Introduces DVT, Bronchitis Codes
You have until Oct.1 to implement the new diagnosis code changes Coders, take notice: Before midnight on Sept. 30, you'll have to update your encounter forms to reflect new deep venous thrombosis (DVT) diagnosis codes. The Centers for Disease Control and Prevention and CMS have unveiled the new ICD-9 Codes , and because payers do not allow a grace period for the new codes, you should update your superbills by Sept. 30. ICD-9 introduced the new code 491.22 (Obstructive chronic bronchitis with acute bronchitis), which your practice may diagnose following chest x-rays or other diagnostic procedures. New DVT Codes Make Their Debut Also on the ICD-9 horizon are three new venous embolism codes. The following three codes offer more specificity than 453.8 (Other venous embolism and thrombosis; of other specified veins), which coders previously used for deep venous thrombosis: Report Diabetes According to New Descriptors As of Oct. 1, "The fifth digit for the diabetes codes (category 250) will be determined by the type of diabetes the patient has," says Jackie Miller, RHIA, CPC, senior consultant at Coding Strategies Inc., a reimbursement consulting firm in Dallas, Ga. "The two types used to be called 'juvenile onset'and 'adult onset,'then they were called 'insulin dependent'and 'non-insulin dependent.' Now, however, they are referred to as 'type I'and 'type II,'" Miller says. The problem with the existing system is that physicians often assign a type I diabetes diagnosis to any patient who takes insulin, even though many type II patients use insulin also. That's why the new code descriptors'changes should alleviate a lot of confusion for physicians and coders. Here are the revised fifth-digit descriptors for 250.xx as they should appear in the upcoming ICD-9 manual : 0 -- Type II or unspecified type, not stated as uncontrolled In addition to removing "[non-insulin dependent type] [NIDDM type]," CMS also deletes "[adult-onset type]." The "adult" designation led some physicians to inaccurately apply the "0" fifth digit only to adults. 1 -- Type I [juvenile type], not stated as uncontrolled CMS deletes "[insulin dependent type] [IDDM]" from the descriptor. But "juvenile type" remains. 2 -- Type II or unspecified type, uncontrolled Again, CMS removes the non-insulin dependent definition and the "adult-onset type" designation. 3 -- Type I [juvenile type], uncontrolled You'll no longer find "[insulin dependent type] [IDDM]" in this fifth digit either. The radiologist should use this digit for "uncontrolled" diabetes in juveniles. ICD-9 Index Revises Stroke Reference "The diagnoses of stroke and cerebrovascular accident (CVA) are currently reported with code 436 (Acute, but ill-defined, cerebrovascular disease)," Miller says. To review a full listing of the new ICD-9 codes, visit the CMS Web site at http://www.cms.hhs.gov/medlearn/icd9code.asp#coding.
Although the new codes won't dramatically change the way radiologists submit claims, the new DVT and bronchitis codes will affect interventional and diagnostic radiology practices, says Cheryl Schad, BA, CPCM, CPC, owner of Schad Medical Management, a medical reimbursement consulting firm in New Jersey.
"This is a somewhat vague code that is not always included on Medicare coverage policies for CT/MR of the brain."As of Oct. 1, however, you should report 434.91 (Cerebral artery occlusion, unspecified, with cerebral infarction) for stroke and CVA, she adds.
"This is a much more specific code that is more likely to be covered for imaging of the head," Miller says. "Coincidentally, yesterday I was looking over the Empire Medicare hospital coverage policy for MRAof the head and neck, and these exams are not covered for 436 but are covered for 434.91."
Therefore, you might face fewer denials based on ICD-9's new stroke coding reference.
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