General Surgery Coding Alert

In just a few months, you'll be faced with more than 350 ICD-9 changes. If you don't incorporate those changes into your coding that day, your practice could face denials and lost revenue. There are 311 new, 22 invalid, and 45 revised ICD-9 codes that take effect on Oct. 1, 2009, for fiscal year 2010.

Every dollar -- and every productivity hour -- counts these days, so we've scoured the diagnosis code changes for you. Here's what you need to know in general surgery to ensure you code properly after Oct. 1.

If your general surgeon performs vascular surgery procedures, you'll have several new and revised embolism and thrombosis codes that will allow you to offer more specific information to your payers.

ICD-9 2010 will offer you 12 new chronic venous embolism and thrombosis codes (453.50-453.79, Chronic venous embolism and thrombosis ...). The individual codes break the category down by specifying upper or lower extremity and the type of vein.

You'll also have eight new acute venous embolism and thrombosis codes for upper extremity procedures (453.81-453.89, Venous embolism and thrombosis ...), which are broken down by vein in the same way as the chronic codes. ICD-9 2010 revises 453.40-453.42 (Acute venous embolism and thrombosis ...) to provide greater specificity for lower extremity procedures.

"These changes will be beneficial," says La Donna Brown, CPC, coding specialist at Sanford Clinic Vascular Associates in Sioux Falls, S.D. "Any time we have the opportunity to use a more specific diagnosis code it is a great day not only for us as coders but for our physicians, and especially the insurance companies." "I truly believe that coders are 'painting a picture' for the insurance companies on what health issues the patient is having, and the more exact we can be, the better for everyone involved with that patient's care," Brown adds.

Deletion: You'll no longer find 453.8 (Other venous embolism and thrombosis of other specified veins) after Oct. 1.

"I actually had a couple surgical reports I coded out yesterday that I could have used the chronic venous codes [for] and I ended up using 453.8," Brown says. "As you know we coders do not like using the 'other specified' or 'unspecified' ICD-9 codes."

ICD-2010 will bring you multiple carcinoma and neoplasm diagnosis changes. You should add seven new merkel cell carcinoma diagnosis codes to your arsenal on Oct. 1 (209.31-209.36 and 209.75). You'll also have  several new codes for secondary neuroendocrine tumors: 209.70-209.74 (Secondary neuroendocrine tumor ...) and 209.79 (Secondary neuroendocrine tumor of other sites).

This year's changes also include the deletion of 239.8 (Neoplasms of unspecified nature; other specified sites) to make room for 239.81 (Neoplasms of unspecified nature, retina and choroids). Now you'll use 239.89 (... other specified sites) for unspecified neoplasms. "General surgeons are always interested in cancer/neoplasms, although these changes aren't really going to send anyone through the roof," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians and Children's University Medical Group Compliance Program.

If your general surgeon works with trauma patients, you'll want to add two more new codes to your coding repertoire: V15.52 (Personal history of traumatic brain injury) and V80.01 (Special screening for traumatic brain injury).

Gastro additions: For surgeons who perform gastrointestinal procedures, you'll have several additional codes starting Oct. 1:

• 569.71 -- Pouchitis

• 569.79 -- Other complications of intestinal pouch

• 756.72 -- Omphalocele

• 756.73 -- Gastroschisis

• 787.04 -- Bilious emesis

• V53.50 -- Fitting and adjustment of intestinal appliance and device

• V53.51 -- ... of gastric lap band

• V53.59 -- ... of other gastrointestinal appliance and device.

The 2010 edits don't pass by E codes or V codes. If your surgeon documents a surgical mishap -- hopefully an infrequent occurrence -- you'll have two new codes to turn to. ICD-9 2010 includes new codes E876.6 (Performance of operation [procedure] on patient not scheduled for surgery) and E876.7 (Performance of correct operation [procedure] on wrong side/body part).

Warning: These two new codes describe situations that are considered "never" events. In other words, the codes represent surgical mistakes that should never happen. Adding E876.6 or E876.7 to a claim ensures "that you will not get paid and may also add malpractice exposure," says Bucknam. "Use of these codes should be a decision that is made with your surgeon with a full understanding of the implications."

Remember: You should use E codes to describe external causes of injuries or accidents. You should never bill E codes as your primary code, and you should always list the E codes last. It may be necessary to assign more than one E code to fully explain each cause.

V code changes: The Oct. 1 changes also add several "personal history of" codes. If your general surgeon sees cancer patients there are two new ICD- 9 codes that may be of interest to you: V10.90 (Personal history of unspecified type of malignant neoplasm) and V10.91 (Personal history of malignant neuroendocrine tumor). These new personal history codes are a welcome addition because they will allow you to give a broader picture of the patient and the medical decision making, experts say.

More information: You can review the entire list of ICD-9 2010 changes online at http://edocket.access.gpo.gov/2009/pdf/E9-10458.pdf.

Bonus: For a handy list of all the 2010 ICD-9 code changes for general surgery, e-mail the editor, Leesa Israel, at leesai@elijournals.com with the subject line "General Surgery Dx Changes."