Radiology Coding Alert

From pressure ulcers to suspected ob troubles, we've got you covered

Breast disorder diagnosis codes are getting a boost in 2009 with six new codes, and there are even more diagnoses you need to be on alert for.

Part of the radiology coding challenge is the broad range of diagnoses you have to be able to recognize and code accurately. The big changes to headache and oncology diagnoses aren't the only ICD-9 updates that affect you. We've analyzed the preliminary ICD-9 2009 list from CMS and narrowed down the field to these nine additional changes you'll be using next year.

1. Peek at New Pressure Ulcer Options

Your radiologist may assess forming or long-standing pressure ulcers using ultrasound or other modalities. New fifth digits will add stage specificity to your coding, says Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga.:

• 707.20 -- Pressure ulcer, unspecified stage

• 707.21 -- Pressure ulcer, stage I

• 707.22 -- Pressure ulcer, stage II

• 707.23 -- Pressure ulcer, stage III

• 707.24 -- Pressure ulcer, stage IV.

ICD-9 2008 classifies all stages together with a few site-specific codes in the 707.0x range (Decubitus ulcer). But the new codes should help facilities that use coded records to guide quality improvement.

2. Add New Breast Disorder Codes to Your Toolbox

You'll have new codes for breast conditions such as ptosis (611.81, Ptosis of breast), hypoplasia (611.82, Hypoplasia of breast), capsular contracture of breast implant (611.89) and other specified disorders of the breast (611.89).

Also, be on the look out for 612.0 (Deformity of reconstructed breast) and 612.1 (Disproportion of reconstructed breast).

3. Tackle New 5th-Digit Hematuria Options

If you need to indicate that a radiologist performed a test because a patient has blood in the urine, or "hematuria," you'll have new fifth-digit options to describe this condition. Look to codes 599.70 (Hematuria, unspecified), 599.71 (Gross hematuria) and 599.72 (Microscopic hematuria).

Lesson: If your encounter form now lists 599.7 (Hematuria) as an option, you will start getting denials as of Oct. 1 unless you remember to list one or more of the new five-digit codes for this condition, says Guadalupita, N.M.-based independent coding consultant Melanie Witt, RN, CPC-OGS, MA.

4. Get a Grip on New Graft-Vs-Host Disease Codes

If you provide services for patients with graft-versus-host disease, be sure you catch these new immune mechanism disorder codes:

• 279.50 -- Graft-versus-host disease, unspecified

• 279.51 -- Acute graft-versus-host disease

• 279.52 -- Chronic graft-versus-host disease

• 279.53 -- Acute on chronic graft-versus-host disease.

Watch for: Interventional radiologists may increasingly begin using catheters to direct steroids to the patient's affected organs, so you may see more chances to use these codes in the future.

5. List Lipid-Rich Plaque With 414.3

Your interventional physician may use a near infrared spectroscopy device such as InfraReDx to identify plaque composition, and in 2009 you'll be able to identify lipid-rich plaque with new code 414.3 (Coronary atherosclerosis due to lipid-rich plaque), Miller says.

Knowing whether plaque is lipid-rich or non-lipid-rich helps the interventionalist determine the appropriate stent for the patient.

6. ICD-9 Clears Up Seroma Situation

If your interventional radiologist studies and drains seromas and nontraumatic hematomas, don't miss new codes 729.91 (Post-traumatic seroma) and 729.92 (Nontraumatic hematoma of soft tissue), Miller says.

Reason for addition: After receiving requests for coding advice on post-traumatic seromas and nontraumatic hematomas of muscle -- which aren't indexed in ICD-9 2008 -- the AHA's ICD-9 Coding Clinic editorial advisory board suggested that NCHS create new codes for these conditions.

7. Heed New Note for Osteoporosis Patients

ICD-9 2009 may bring these history-of-fracture V codes your way, too:

• V13.51 -- Personal history of pathologic fracture

• V13.52 -- Personal history of stress fracture

• V13.59 -- Personal history of other musculoskeletal disorders

• V15.51 -- Personal history of traumatic fracture

• V15.59 -- Personal history of other injury.

Watch for: ICD-9 may add a note to 733.0x (Osteoporosis) requiring you to report V13.51 for patients with a personal history of pathologic fracture. Patients with this history are more likely to experience additional fractures, and this history affects treatment, according to the ICD-9 Coordination and Maintenance Committee March 2007 meeting agenda (http://www.cdc.gov/nchs/data/icd9/agendamar07.pdf).

These codes may affect bone density study coverage, Miller says.

8. Don't Miss 20 New Diabetes Codes

Secondary diabetes diagnoses are on the rise, says Randall Karpf with East Billing in East Hartford, Conn.

That means you should keep an eye out for new ICD-9 category 249.xx (Secondary diabetes mellitus), Miller says.

Patients can get diabetes from other specific disease processes (such as cystic fibrosis, Cushing's syndrome, malignant neoplasms, and certain genetic disorders). Diabetes may also be a late effect of poisoning.

9. ICD-9 Offers Answer for Suspected Ob Problems

You may see obstetric patients for detailed ultrasounds when an initial screening indicates a possible fetal abnormality. Sometimes the detailed ultrasound shows no abnormality, however, and you might face problems getting reimbursed for this service.

ICD-9 2009 offers new codes that may support the need for an ob ultrasound exam that turns out to be normal, Miller says:

• V89.01 -- Suspected problem with amniotic cavity and membrane not found

• V89.02 -- Suspected placental problem not found

• V89.03 -- Suspected fetal anomaly not found

• V89.04 -- Suspected problem with fetal growth not found

• V89.05 -- Suspected cervical shortening not found

• V89.09 -- Other suspected maternal and fetal condition not found.

Example: If a physician orders an ob ultrasound for suspected fetal growth retardation, but the findings are normal, you will report V89.04, Miller says.