Radiology Coding Alert

The switch to ICD-9 2010 is only a few short months away; preparing now for three crucial changes in diagnostic imaging will put you ahead of the game.

Remember: ICD-9 2010 codes will be appropriate for services performed on or after Oct. 1, 2009.

Dense breasts may require testing beyond a mammogram to confirm no malignancies, and the request for an appropriate code to describe this resulted in 793.82 (Inconclusive mammogram), according to the ICD-9 Committee's September 2008 meeting agenda (www.cdc.gov/nchs/data/icd9/agendaSep08.pdf).

"The new code may help get insurance companies to pay for additional testing," says Cheryl Scott, CPC, CPC-H, CCS, CCS-P, with HealthTexas in Dallas. "Prior to the 2010 code, the choices were to bill it as screening or to code dense breasts as an 'abnormality'" -- which they aren't, she says.

And precisely because these inconclusive mammogram findings are not "abnormal," ICD-9 2010 will revise the 793.0-793.7 range so that "abnormal" findings aren't a requirement for using these codes:

• 2009: Nonspecific abnormal findings on radiological and other examination of ...

• 2010: Nonspecific (abnormal) findings on radiological and other examination of ...

Codes 793.89 and 793.99 will have the same change, adding parentheses:

• 2010: 793.89 -- Other (abnormal) findings on radiological examination of breast

• 2010: 793.99 -- Other nonspecific (abnormal) findings on radiological and other examination of body structure.

In 2009, choosing the code for a radial torus fracture is a snap: 813.45 (Torus fracture of radius). Torus fractures of the ulna or of both the radius and ulna aren't as easy to code.

2010: New codes will allow you to report these buckle fractures, which may occur when falling on an outstretched arm, for example:

• 813.46 -- Torus fracture of ulna (alone)

• 813.47 -- Torus fracture of radius and ulna.

Watch for: ICD-9 2010 may add the term "buckle fracture" (or "fracture, buckle") to the index to help point you to the torus fracture codes. Humerus torus fracture may be indexed to 812.49 (Other fracture of lower end of the humerus, closed), according to the ICD-9 committee's September 2008 meeting agenda. Lesson: Always check the index and the tabular list before you choose a code.

If you receive referrals from pediatricians or orthopedists, you'll need to know 832.2 (Nursemaid's elbow), which describes subtle subluxation of the elbow joint -- specifically the radio-capitellar joint.

A nursemaid's elbow diagnosis is made by an x-ray showing the radial head out of position. Seeing the subluxation can be difficult because children's bones are not fully formed, so you may see x-rays of the uninjured elbow taken for comparison.

Originally, the proposed code was 832.2x (Subluxation of radial head), with a note specifying that the code is for nursemaid's elbow. But commenters noted that "nursemaid's elbow" was the better descriptor because it is the more commonly used term, according to the ICD-9 Committee's 2008 summary (www.cdc.gov/nchs/classifications_of_diseses_and_f.htm).

Also, the fifth-digit options for the 832.x (Dislocation of elbow) codes don't apply for nursemaid's elbow, according to Jeffrey Linzer Sr., MD, FAAP, FACEP, who represented the American Academy of Pediatrics.

Most likely, you will use 832.2 for pediatric patients between 1 to 3 years of age, and the 2008 summary notes that "the diagnosis would not be made after 5 years of age.

A concern was expressed that the term might be applied to adults, but it was stated that that would be inappropriate."

Current code: ICD-9 2009 directs you to 832.0x (Dislocation of elbow; closed dislocation) for this condition.

Resource: Diagnostic imaging can yield diagnoses listed throughout the ICD-9 manual, so looking through all the changes can help you prepare whether you need to code temporal sclerosis (348.81) or know which of the new fifth-digit options is appropriate for hypoxic-ischemic encephalopathy unspecified (768.70). CMS's proposed Inpatient Prospective Payment System rule lists the expected changes to ICD-9 2010, which go into effect Oct. 1, 2009 (May 22 Federal Register, http://edocket.access.gpo.gov/2009/pdf/E9-10458.pdf).