What’s Your ICD-9-CM Game Plan?


By Catherine Gray, RHIT, CCS, CPC, CPC-CS

In just a few weeks you’ll start using more than 100 new ICD-9-CM diagnostic codes. Keep in mind that the grace period disappeared a few years ago, so these codes are required after Oct. 1, 2007. Prepare yourself for 2008 with this overview of the new codes.

Certified Interventional Radiology Cardiovascular Coder CIRCC

New Subcategories for Lymphomas

Lymphoma is a type of cancer involving cells of the immune system called lymphocytes. Approximately 35 different types of lymphomas fall into two major categories: Hodgkin’s lymphomas and all other lymphomas (also known as non-Hodgkin’s lymphomas [NHL]). NHLs can be divided into aggressive (fast-growing) or indolent (slow-growing) types and classified as either B-cell or T-cell NHLs. Six new subcategories have been added to the lymphosarcoma section of ICD-9-CM to allow more specificity in coding many of the NHLs. Marginal zone lymphomas (MZLs) are B-cell lymphomas. When marginal zone lymphomas involve the lymph nodes they are called “nodal marginal zone B-cell lymphomas,” whereas when they involve places outside the lymph nodes, they are called “mucosa associated lymphatic tissue lymphomas” (MALT).

A new subcategory has been added in ICD- 9-CM for marginal zone lymphomas, offering these new codes to add specificity to your claims:

200.30 Marginal zone lymphoma, unspecified site, extranodal and solid organ sites

200.31 Marginal zone lymphoma, lymph nodes of head, face and neck

200.32 Marginal zone lymphoma, intrathoracic lymph nodes

200.33 Marginal zone lymphoma, intra-abdominal lymph nodes

200.34 Marginal zone lymphoma, lymph nodes of axilla and upper limb

200.35 Marginal zone lymphoma, lymph nodes of inguinal region and lower limb

200.36 Marginal zone lymphoma, intrapelvic lymph nodes

200.37 Marginal zone lymphoma, spleen

200.38 Marginal zone lymphoma, lymph nodes of multiple sites

Mantle Cell Lymphoma Codes

Mantle cell lymphoma is an aggressive type of B-cell non-Hodgkin’s lymphoma. It is marked by small- to medium-sized cancer cells that may be in the lymph nodes, spleen, bone marrow, blood or gastrointestinal system. A new subcategory for mantle cell lymphomas gives us the following new codes:

200.40 Mantle cell lymphoma, unspecified site, extranodal and solid organ sites

200.41 Mantle cell lymphoma, lymph nodes of the head, face and neck

200.42 Mantle cell lymphoma, intrathoracic lymph nodes

200.43 Mantle cell lymphoma, intra-abdominal lymph nodes

200.44 Mantle cell lymphoma, lymph nodes of axilla and upper limb

200.45 Mantle cell lymphoma, lymph nodes of inguinal region and lower limb

200.46 Mantle cell lymphoma, intrapelvic lymph nodes

200.47 Mantle cell lymphoma, spleen

200.48 Mantle cell lymphoma, lymph nodes of multiple sites

CNS Lymphoma Codes

Primary central nervous system (CNS) lymphoma is a disease in which malignant cancer cells form in the lymph tissue of the brain and/or spinal cord. Because the eye is so close to the brain, primary CNS lymphoma can also start in the eye (called ocular lymphoma). Primary CNS lymphoma may occur in patients who have acquired immunodeficiency syndrome (AIDS) or other disorders of the immune system, or who have had an organ transplant and are immunocompromised.

Following are the new codes for primary CNS lymphomas:

200.50 Primary central nervous system lymphoma, unspecified site, extranodal and solid organ sites

200.51 Primary central nervous system lymphoma, lymph nodes of the head, face and neck

200.52 Primary central nervous system lymphoma, intrathoracic lymph nodes

200.53 Primary central nervous system lymphoma, intra-abdominal lymph nodes

200.54 Primary central nervous system lymphoma, lymph nodes of axilla and upper limb

200.55 Primary central nervous system lymphoma, lymph nodes of inguinal region and lower limb

200.56 Primary central nervous system lymphoma, intrapelvic lymph nodes

200.57 Primary central nervous system lymphoma, spleen

200.58 Primary central nervous system lymphoma, lymph nodes of multiple sites

Large Cell Lymphoma Codes Help Specify Diagnosis

Anaplastic large cell lymphoma is an aggressive type of NHL that is usually a T-cell type of lymphoma. It usually appears in the lymph nodes, skin, bones, soft tissue, lungs or liver. The new codes for anaplastic large cell lymphomas are:

200.60 Anaplastic large cell lymphoma, unspecified site, extranodal and solid organ sites

200.61 Anaplastic large cell lymphoma, lymph nodes of the head, face and neck

200.62 Anaplastic large cell lymphoma, intrathoracic lymph nodes

200.63 Anaplastic large cell lymphoma, intraabdominal lymph nodes

200.64 Anaplastic large cell lymphoma, lymph nodes of axilla and upper limb

200.65 Anaplastic large cell lymphoma, lymph nodes of inguinal region and lower limb

200.66 Anaplastic large cell lymphoma, intrapelvic lymph nodes

200.67 Anaplastic large cell lymphoma, spleen

200.68 Anaplastic large cell lymphoma, lymph nodes of multiple sites

Large cell lymphomas are one of the most common types of lymphomas, comprising approximately 20 to 30 percent of non-Hodgkin’s lymphomas. Following are the new codes for large cell lymphomas:

200.70 Large cell lymphoma, unspecified site, extranodal and solid organ sites

200.71 Large cell lymphoma, lymph nodes of the head, face and neck

200.72 Large cell lymphoma, intrathoracic lymph nodes

200.73 Large cell lymphoma, intra-abdominal lymph nodes

200.74 Large cell lymphoma, lymph nodes of axilla and upper limb

200.75 Large cell lymphoma, lymph nodes of inguinal region and lower limb

200.76 Large cell lymphoma, intrapelvic lymph nodes

200.77 Large cell lymphoma, spleen

200.78 Large cell lymphoma, lymph nodes of multiple sites

Peripheral T-cell lymphoma is also an aggressive non-Hodgkin’s lymphoma that begins in mature T lymphocytes. It is also called mature T-cell lymphoma. Following are the new codes for peripheral T-cell lymphomas:

202.70 Peripheral T-cell lymphoma, unspecified site, extranodal and solid organ sites

202.71 Peripheral T-cell lymphoma, lymph nodes of the head, face and neck

202.72 Peripheral T-cell lymphoma, intrathoracic lymph nodes

202.73 Peripheral T-cell lymphoma, intra-abdominal lymph nodes

202.74 Peripheral T-cell lymphoma, lymph nodes of axilla and upper limb

202.75 Peripheral T-cell lymphoma, lymph nodes of inguinal region and lower limb

202.76 Peripheral T-cell lymphoma, intrapelvic lymph nodes

202.77 Peripheral T-cell lymphoma, spleen

202.78 Peripheral T-cell lymphoma, lymph nodes of multiple sites

Female Reproductive Health Codes Change

Again, as in 2005, there are numerous changes to female reproductive health codes. Carcinoma in situ codes have been expanded. The new codes are:

233.30 Carcinoma, in situ, unspecified female genital organ

233.31 Carcinoma, in situ, vagina 233.32 Carcinoma, in situ, vulva

233.39 Carcinoma, in situ, other female genital organ Subcategory

624.0 (Dystrophy of vulva) has been further expanded for 2008.

Vulvar intraepithelial neoplasia (VIN) I and VIN II, currently grouped together under 624.0, will now have their own codes. This allows for more specificity in coding these conditions, as follows:

624.01 Vulvar intraepithelial neoplasia I [VIN I]

624.02 Vulvar intraepithelial neoplasia II [VIN II]

624.09 Other dystrophy of vulva

Category 664 (Trauma to perineum and vulva during delivery) has been expanded to include three new codes for an anal sphincter tear that is complicating a delivery. ICD-9-CM also adds a code for a healed or old anal sphincter tear. The new codes in this group follow:

664.60 Anal sphincter tear complicating delivery, not associated with third degree perineal laceration, unspecified as to episode of care or not applicable

664.61 Anal sphincter tear complicating delivery, not associated with third degree perineal laceration, delivered, with or without mention of antepartum condition

664.64 Anal sphincter tear complicating delivery, not associated with third degree perineal laceration, postpartum condition or complication

569.43 Anal sphincter tear (healed) (old)

Personal History Codes are Updated

Five additional V codes have been added to further expand the V13 “Personal history” category, the V25 “Encounter for contraceptive management” category and the V26 “Procreative management” category. A new code has also been added to the subcategory V73.8 “Special screening for other specified viral and chlamydial diseases,” for screening for the human papillomavirus (HPV), as follows:

V13.22 Personal history of cervical dysplasia

V25.04 Counseling and instruction in natural family planning to avoid pregnancy

V26.41 Procreative counseling and advice using natural family planning

V26.49 Other procreative management, counseling and advice

V73.81 Special screening examination, human papillomavirus (HPV)

Hearing Loss and Speech Development

Coding for sensorineural hearing loss was updated in 2007. Again for 2008, we will benefit from expanded codes for various types of hearing loss, allowing for more specificity in coding. In addition, we also have a new V code for an encounter for hearing conservation and treatment. Dysphagia coding has also been expanded. New codes include:

315.34 Speech and language developmental delay due to hearing loss

388.45 Acquired auditory processing disorder

389.05 Conductive hearing loss, unilateral

389.06 Conductive hearing loss, bilateral

389.13 Neural hearing loss, unilateral

389.17 Sensory hearing loss, unilateral

389.20 Mixed hearing loss, unspecified

389.21 Mixed hearing loss, unilateral

389.22 Mixed hearing loss, bilateral

V49.85 Dual sensory impairment

V72.12 Encounter for hearing conservation and treatment

787.20 Dysphagia, unspecified

787.21 Dysphagia, oral phase

787.22 Dysphagia, oropharyngeal phase

787.23 Dysphagia, pharyngeal phase

787.24 Dysphagia, pharyngoesophageal phase

787.29 Other dysphagia

Revised diagnosis codes in this category include 389.14 (new descriptor will say “Central hearing loss”), 389.18 (new descriptor will say, “Sensorineural hearing loss, bilateral”), and 389.7 (new descriptor reads, “Deaf, nonspeaking, not elsewhere classified”).

Infectious Diseases

Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum. There are three main kinds of botulism:

  • Foodborn botulism is caused by eating foods that contain the botulism toxin.
  • Wound botulism is caused by toxin produced from a wound infected with Clostridium botulinum.
  • Infant botulism is caused by consuming the spores of the botulinum bacteria, which then grow in the intestines and release toxin.

All forms of botulism can be fatal. The new botulism codes are:

040.41 Infant botulism

040.42 Wound botulism

As for revisions in this category, code 005.1 is now described as “botulism food poisoning,” although it was previously defined as “botulism.” Roseola infantum is a viral illness in young children, most commonly affecting those between the ages of 6 months and 2 years. It is typically marked by several days of high fever, followed by a distinctive rash just as the fever breaks. Two common and closely related viruses can cause roseola: human herpes virus (HHV) Type 6 and HHV Type 7. These two viruses belong to the same family of herpes simplex viruses.

The new codes in this category are:

058.10 Roseola infantum, unspecified

058.11 Roseola infantum due to human herpesvirus 6

058.12 Roseola infantum due to human herpesvirus 7

058.21 Human herpesvirus 6 encephalitis

058.29 Other human herpesvirus encephalitis

058.81 Human herpesvirus 6 infection

058.82 Human herpesvirus 7 infection

058.89 Other human herpesvirus infection

Personal and Family History

A number of new codes have been created for personal history and family history of cardiovascular diseases. There are also new codes for family history of other conditions.

V12.53 Personal history of sudden cardiac arrest

V12.54 Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits

V16.52 Family history of malignant neoplasm, bladder

V17.41 Family history of sudden cardiac death (SCD)

V17.49 Family history of other cardiovascular diseases

V18.11 Family history of multiple endocrine neoplasia [MEN] syndrome

V18.19 Family history of other endocrine metabolic diseases

Not the codes you needed?

Get involved with the process. The meetings of the ICD-9-CM Coordination and Management Committee are open to the public, but you must preregister. Or you can submit recommendations for new codes. Proposals need to be submitted at least two months prior to the meeting. Be sure to include a description of the new code being requested and the rationale as to why the new code is needed. Everything you need to know about the process is available on the CMS website, as are the new codes.

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