Anesthesia Coding Alert

New codes for kidney disease, weight, and joint surgery get specific

Just because the new ICD-9 book won't hit your desk until October doesn't mean you have to be in the dark about code changes until then. Read on for the skinny on how some of the expected new and updated 2006 codes will transform your claims. Code Chronic Kidney Disease by Stage ICD-9 now has a single, catchall code for chronic renal failure (585). One of the most important changes for anesthesia coders might lie in the expanded 585.x series of codes for chronic kidney disease:

585.1 - Chronic kidney disease, stage I

585.2 - Chronic kidney disease, stage II (mild)

585.3 - Chronic kidney disease, stage III (moderate)

585.4 - Chronic kidney disease, stage IV (severe)

585.5 - Chronic kidney disease, stage V

585.6 - End stage renal disease

585.9 - Chronic kidney disease, unspecified. "I'm glad to see an expansion of codes for chronic renal failure," says Emma LeGrand, CPC, CCS, coding supervisor for New Jersey Anesthesia Associates in Florham Park. "The addition of staging levels means a coder will have more definitive codes to choose from when coding for chronic kidney disease or end stage renal disease (failure) - based on the physician's documentation."

"[Code] 585.6 is the biggest code from the group because it will give us a direct code for end stage renal failure," adds Barbara Johnson, CPC, MPC, owner of Real Code Inc. in Moreno Valley, Calif.

The extra codes will be especially useful for patients whose status changes during their course of treatment. Example: LeGrand says it's common to see documentation ranging from renal insufficiency (593.9, Unspecified disorder of kidney and ureter) to chronic and/or end stage renal failure (585), or a code from the 403.x1 series (Hypertensive renal disease; with renal failure) during the same episode of inpatient care.
 
Consider Patient's Weight Oct. 1 News reports and scientific studies about the increasing numbers of overweight Americans - and the associated consequences - seem almost as common as "super size" meals. In fact, a Business Week article in October 2004 claimed that 61 million Americans are now technically obese (meaning their body mass index is 30 or higher) (Business Week online, Oct. 24, 2004; "Weighing Bariatric Surgery's Risks").

Each year, more Americans turn to surgery as a way to treat their weight problem. ICD-9 2006 addresses that issue by including new codes for obesity, normal body mass index (BMI) ranges, and above-normal BMI ranges:
278.02 - Overweight

V85.0 - Body mass index less than 19, adult

V85.1 - Body mass index between 19-24, adult

V85.21-V85.4 - Various ranges for adult body mass index from 25.0-40 and [...]