Anesthesia Coding Alert

Pay special attention to V codes Don't let your ICD-9 coding fall by the wayside: Incorporate these new ICD-9 changes before the new year and avoid unnecessary denials.
 
Two new diagnosis codes will improve anesthesiologists' diagnosis coding specificity, especially for pain management cases: 728.87 (Muscle weakness) and 781.94 (Facial weakness). Muscle weakness is a common symptom justifying muscle biopsy, and facial weakness might be diagnosed after an injury or fracture, says Barbara Johnson, CPC, MPC, coder with Loma Linda University Anesthesiology Medical Group in Loma Linda, Calif. Having specific codes for these diagnoses will let you report the services more accurately instead of resorting to codes such as 351.9 (Facial nerve disorder, unspecified) or 738.19 (Other specified deformity), which are now your best options.
 
Several new V codes are also a welcome addition for anesthesia and pain management coders:

V15.87 - History of extracorporeal membrane oxygenation (ECMO) gives coders another option for explaining situations for premature infants.

V54.01 - Encounter for removal of internal fixation device. Johnson says this will be a good code to use for removal of plates or devices rather than V54.0 (Aftercare involving removal of fracture plate or other internal fixation device).

V58.63, V58.64 and V58.65 specify the type of long-term medication a patient now takes (antiplatelet/ antithrombotic, nonsteroidal anti-inflammatories or steroids). These medications can affect patients in many ways and are important diagnoses to know about when the patient will undergo anesthesia.

V64.41-V64.43 specify whether a laparoscopic, thoracoscopic or arthroscopic surgical procedure was converted to an open procedure. Johnson says these are good replacements for the previously reported V64.4 (Laparoscopic surgical procedure converted to open procedure), which only focused on laparoscopic procedures. But even the welcome additions can be confusing. Be careful reporting myoneural disorders. ICD-9 2004 deletes 358.0 (Myasthenia gravis) and replaces it with 358.00 (Myasthenia gravis without [acute] exacerbation) and 358.01 (Myasthenia gravis with [acute] exacerbation) to further explain a patient's acute or nonacute status. ICD-9 2004 also adds fifth digits to the codes for hyperplasia of the prostate (previously 600.0-600.9). Fifth digits give physicians the option of being more specific, such as whether a patient's symptoms present with or without urinary obstruction, and whether it involves nodular prostate, benign localized hyperplasia or hyperplasia of prostate.
 
You should also note the more than 30 invalid diagnosis codes when you're getting acquainted with the new ICD-9 book. A few of these deletions include:
277.8 - Other specified disorders of metabolism

719.70-719.79 - sites affected by Difficulty in walking

V53.9 - Fitting and adjustment of other device, other and unspecified device

V65.1 - Person consulting on behalf of another person.
Your use of the new or revised ICD-9 codes depends on the cases your practice usually sees. [...]