General Surgery Coding Alert

Answer 1: A. ICD-9 2010 will offer you 12 new chronic venous embolism and thrombosis codes (453.50-453.79).

The individual codes break the category down by specifying upper or lower extremity and the type of vein. For chronic venous embolism and thrombosis of superficial veins of left arm, you'll report 453.71 (Chronic venous embolism and thrombosis of superficial veins of upper extremity). Code 453.8 (Other venous embolism and thrombosis of other specified veins) will be deleted on Oct. 1. Code 453.81 (Acute venous embolism and thrombosis of superficial veins of upper extremity) is for an acute condition, rather than chronic.

Answer 2: False. When a V code is your only option, report it as the primary diagnosis. If you think that you should never report V codes (found near the back of the ICD-9 manual) as primary diagnosis codes, think again.

Although it used to be difficult to collect reimbursement from some insurance companies when you reported only V codes, many are coming around. Some new V codes you may use next year include V53.50 (Fitting and adjustment of intestinal appliance and device), V53.51 (... of gastric lap band), and V53.59 (... of other gastrointestinal appliance and device).

Answer 3: B. ICD-9 2010 will delete 239.8 (Neoplasms of unspecified nature; other specified sites) and will require a fourth digit for codes in this category: 239.81 (Neoplasms of unspecified nature, retina and choroids)  and 239.89 (... other specified sites). Even if you won't have reason to report 239.81, be sure you remember to trade 239.8 for 239.89. You'll use code V10.90 (Personal history of unspecified type of malignant neoplasm) to indicate a personal history of an unspecified malignant neoplasm.

Answer 4: True. 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.

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).

Answer 5: B. The Oct. 1 changes add several "personal history of" codes. If your general surgeon sees a patient with a history of a malignant neuroendocrine tumor, you'll use V10.91 (Personal history of malignant neuroendocrine tumor). This new personal history code will allow you to give a broader picture of the patient and the medical decision making.