Home Health ICD-9/ICD-10 Alert

Published on Tue Jan 22, 2008 PDF

Don't get tripped-up by mysterious fifth-digit requirements.

To err is human, and the AMA recently admitted its mistakes by releasing several errors published in its 2009 ICD-9 manual and corrections that you'll want to note to ensure you're on the cutting edge.

Since you've had a few months to peruse the 2009 ICD-9 manual, you may have already noticed these glitches.

No 5th digit needed: Some coders have discovered a "5th digit" requirement next to code 339.3 (Drug induced headache, not elsewhere classified) in the manual. Rest assured, however, that this notation was an error on the publisher's part. The AMA instructs that 339.3 "Is a valid four-digit code." The same is true for 719.7 (Difficulty in walking) -- this remains a four-digit code.

Same goes for chemical exposure. You can also scrap the "5th digit" requirement for new code V87.2 (Contact with and [suspected] exposure to other potentially hazardous chemicals). Only four digits are required for this code.

Wrong 5th digit published: Another puzzler was the inclusion of the fifth digit box preceding category 535, Gastritis and Duodenitis.

The box in the ICD-9 manual notes that fifth digit indicator 0 describes "without mention of obstruction," while a fifth digit of 1 notes, "with obstruction." However, you should change these descriptors to the following:

• 0 -- Without mention of hemorrhage

• 1 -- With mention of hemorrhage

"Since most of the codes in the 535 series require a fifth digit, it's important for us all to make this correction in our ICD-9 manuals now to avoid problems down the road," says Heather Corcoran with CGH Billing.

5th digit required: In other cases, the ICD-9 manual failed to inform readers that a fifth digit was required on certain codes.

For instance, you'll need to add a fifth digit to code 581.8 (Nephrotic syndrome, with other specified pathological lesion in kidney).

The ICD-9 errata sheet also asks you to change several code references in the manual's index. For example, if you look up "headache" (784.0), you'll find "tension" as one of the listed options. In the manual, it refers to a tension headache as code 307.81. You should change this reference to 307.10 instead.

Background: The updates seem to have been made to an index from several years ago -- so many of the newer codes from the last few years aren't in the alphabetic index but do appear in the tabular list. Unfortunately, many ICD-9 manual publishers didn't catch the error until after they had downloaded the errors into their 2009 versions of the manual.

To read the full list of ICD-9 errors, visit the AMA Web site, which you can find at www.ama-assn.org/ama/pub/category/13282.html.