ICD-9 Changes: Are You Prepared?

Malignant pleural effusion

New                 511.81Malignant pleural effusion

Malignant pleural effusion is the result of impaired pleural lymphatic drainage and a direct invasion by a malignancy. Previously, malignant pleural effusion defaulted to secondary malignant neoplasm of the pleura, although malignant pleural effusion can be a symptom from other conditions, including thoracic lymphoma. The new code provides a precise method for reporting malignant pleural effusion. It should be sequenced secondary to the appropriate neoplasm code.

Hematuria

New                 599.71Gross hematuria

New                 599.72Microscopic hematuria

The differentiation between gross and microscopic hematuria will allow for reporting of the degree of blood found, and provide medical necessity information regarding further testing. Before the fifth-digit classification was created, both types of hematuria would have been reported with 599.7 Hematuria.

Vulvodynia

New                 625.70Vulvodynia, unspecified

New                 625.71Vulvar vestibulitis

New                 625.79Other vulvodynia

Vulvodynia is a syndrome of unexplained pain that is frequently accompanied by physical and psychological disability, limitation of daily activities, and sexual dysfunction. Vulvar vestibulitis is a subtype of vulvodynia characterized by distinct tenderness, and erythema. The cause of vulvar vestibulitis and other vulvodynia is unknown, but it is not associated with STDs or malignancies. A National Institutes of Health study reports that 13 million women suffer from vulvodynia and suggests a need for continuing research. Vulvodynia had been indexed to 625.9, Unspecified symptoms associated with female genital organs. A reindex to 625.8, Other specified symptoms associated with female genital organs, became effective October 1, 2007.

Seroma

New                 729.91Post-traumatic seroma

New                 729.92Nontraumatic hematoma of soft tissue

Patients who suffer from a large traumatic hematoma may subsequently develop a seroma in the soft tissue of the affected area. ICD-9-CM currently indexes a seroma complicating a procedure but not one which develops post-traumatically. There was also no code for a nontraumatic hematoma of muscle. With these new codes, each can be reported.

Fever

New                 780.60Fever, unspecified

New                 780.61Fever presenting with conditions classified elsewhere

New                 780.62Postprocedural fever

New                 780.63Postvaccination fever

New                 780.64Chills (without fever)

New                 780.65Hypothermia not associated with low environmental temperature

Fevers are common with illness, but considered a significant complication when associated with many chronic conditions, such as leukemia and sickle cell disease. The current generic fever code did not convey well that a fever may require specific evaluation. The new codes identify fevers of specific origins, as well as chills and hypothermia. FUO would be reported with 780.60.

Wound disruption

New                 998.30Disruption of wound, unspecified

Revised            998.31Disruption of internal operation (surgical) wound

Revised            998.32 Disruption of external operation (surgical) wound

New                 998.33 Disruption of traumatic wound repair

Disrupted wounds must be monitored to ensure that they do not progress and require surgery. Finally, the most extensive cases of dehiscence require surgery in order to prevent evisceration. Previous descriptions for 998.31 and 998.32 separate internal were unclear.

Dialysis

New                 V45.12 Noncompliance with renal dialysis

Dialysis patients who are noncompliant are at risk of fluid overload in addition to the other complications of chronic kidney disease. Code V15.81 Noncompliance with medical treatment, did not provide sufficient detail regarding noncompliance.

Headaches and more

More than 50 new codes for headaches and migraines are part of this year’s changes, too many to enumerate here. A PDF containing a complete listing of the ICD-9-CM changes for 2009 can be found at here.

Sheri Poe Bernard, CPC, CPC-H, CPC-P, is vice president of member relations at the American Academy of Professional Coders (AAPC), the nation’s largest education and credentialing association for medical coders. AAPC provides certified credentials to medical coders in physician offices, hospitals and outpatient centers. The three certifications AAPC offers are CPC, CPC-H and CPC-P and represent the gold standard certification for medical coding.

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