ICD-9 Changes: Are You Prepared?

Is your business ready for the more than 300 new ICD-9-CM diagnosis codes that become effective on Oct. 1?

Successful implementation of the new codes requires several steps. First, identify all the places that codes are used: Superbills, look-up software, billing software, EMRs, etc. Get your information technology and coding departments to ensure that changes are captured in all places where codes are used. Then, have your coders create a list of new codes pertinent to immediate care and distribute this widely in your office. Make certain that all clinicians understand what new documentation requirements the codes carry, and that the coding and billing staff understand the rules around the new codes.

Chief among the changes of importance to immediate care are the following codes.

MRSA

Revised            041.11Methicillin susceptible Staphylococcus aureus

New                 041.12Methicillin-resistant Staphylococcus aureus (MRSA)

Under the 2009 changes, the existing ICD-9-CM code for Staphylococcs aureus was altered to report only those forms of Staphylococcus aureus, called MSSA, that are susceptible to traditional antibiotics. A new code identifying infection with MRSA was added. Previously, coders reported 041.11 Staphylococcus aureus with V09.91 Infection with drug-resistent microorganisms with multiple drug resistance to capture the nature of the patient’s MRSA infection. Now, only one code is required.

HIT

New                 289.84Heparin-induced thrombocytopenia (HIT)

Heparin-induced thrombocytopenia (HIT) is an immune-mediated thrombocytopenia affecting at least 50,000 patients each year. About 50 percent of patients with HIT will experience life- or limb-threatening thromboses if untreated. The lack of a unique ICD-9-CM code has hampered efforts to identify and study people with HIT and to educate physicians about this syndrome. Low awareness has contributed to delayed and missed diagnoses leading to poor patient outcomes. HIT had been indexed to 287.4 Secondary thrombocytopenia with E934.2, Adverse affect of anticoagulant. With the creation of 289.84 Heparin-induced thrombocytopenia (HIT), this disorder can now be reported succinctly with a single code.

Carotid sinus syndrome

New                 337.01Carotid sinus syndrome

The typical patient with carotid sinus syndrome is an elderly male, who may develop syncope after turning his head, tugging his collar, or otherwise inadvertently compressing his carotid artery. The pressure is misread by the vagal nerve. Carotid sinus syndrome previously was reported along with other idiopathic peripheral autonomic neuropathies with 337.0. The breakout of a fifth digit allows for this condition to be uniquely reported.

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