A Sneak Peek at Mammoth ICD-9-CM Code Changes

By Sheri Poe Bernard, CPC, CPC-H, CPC-P

Not only are there a record number of ICD-9-CM diagnostic code changes for 2009, but the changes affect virtually every specialty. We have dozens of new codes for diabetes, scores for headaches, codes to report family and personal problems that result from military deployment, codes for leukemias in relapse, and several new fever codes. There are new codes for decubitus ulcers, for Pap test results of vulvar and anal tissue, and codes for benign and malignant carcinoid tumors. There are also new codes for eosinophilic disease, methicillin-resistant Staphylococcus aureus (MRSA), and codes for a variety of pox infections. The breadth of the new codes is too wide to adequately address in Coding Edge, but a full list of new codes and index revisions can be found on page 25-27.

All services beginning Oct. 1 must be coded using the new ICD-9-CM codes. Make sure your office has a handle on the changes now to ensure implementation is systematic and complete. Here’s a checklist of what you need to do.

Determine where the buck stops. Someone in your office should be responsible for ensuring complete and accurate transition to the new codes. It’s important, painstaking work, and if no one has traditionally assumed this role, volunteer to take charge. The scope of implementation crosses several departments, but having a centralized dissemination of information and coordination of codes makes the change easier for everyone.

Define the territory. Put pen to paper and identify every electronic or paper document in your office with embedded codes. Create a checklist and timeline for updating all coded documents.

Educate yourself. Spend a few hours reviewing the changes to the tabular and index sections of ICD-9-CM. Use a highlighter to mark charges that will affect your practice. Keep in mind that some new codes, like the 249 category for secondary diabetes, will likelybe used across every specialty.

Educate the clinicians. Oftentimes, new codes require adjustments in documentation. Don’t expect your physicians to take the same level of interest in code changes you do. Instead, create for each physician a “cheat sheet” of impacts based on the new codes. Identify the new codes affecting them with the documentation by each code. For example, documentation regarding Staphylococcus aureus will now be identified as methlicillin susceptible or methicillin resistant for proper coding.

Educate the coders. The entire staff of coders and billers should discuss in detail the changes and how they will affect day-to-day coding and billing. The changes to “includes” and “excludes” notes and the index should also be discussed, as these can affect code selection. Outside training in the form of audio seminars or workshops are useful for all, or at least for leaders who bring the information back to the team. Education is the key to successful application of new codes.

Talk to the IT team. Bring your information technology folks up-to-date on the changes as early as possible. IT is a key player during code update season.

Order books or software updates. It’s important to have up-to-date resources for your team to perform successfully. Some think they can get away with buying new books every other year, but the revenue lost to miscoded claims is much more than the cost of updated resources. It’s never a mistake to invest in current code books.

Archive a set of old books. Keep a history of year-to-year changes somewhere in your office, as well as a set of old books. Code histories can come in handy as educational tools showing the origins of codes, for correct mapping of codes for practice pattern analysis, and for denials or legal issues that span the years.

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