Medicare Compliance & Reimbursement

Secondary diabetes tops the list of coding improvements.

The next batch of ICD-9 diagnosis codes don't take effect until Oct. 1, but they're already in the pipeline, so take note. The ICD-9 Coordination and Maintenance Committee will hold its next meeting on March 23, and it will consider adding new ICD-9 codes for 10 conditions, including:

• Secondary diabetes. Right now, there is no way to report diabetes resulting from another condition affecting the pancreas, such as pancreatitis or cystic fibrosis, explains Amy Blum, medical classification specialist with the National Center for Health Statistics, which creates the ICD-9 codes. Billers are not allowed to use the current diabetes codes for secondary diabetes, so they're stuck with an unlisted code.

If secondary diabetes receives its own category, it will parallel the codes for primary diabetes. This will be the most significant change to the ICD-9 book "as far as how many codes it will create and how it will affect coders," Blum says.

• Long-term drug use. The ICD-9 book already includes codes for aspirin, anticoagulants and half a dozen other types of drugs. The Committee is considering adding codes for tamoxifen, steroids, and a couple more, says Blum.

• Hypoaldosteronism. Right now, there's a code for hyper-, but no code for hypo-aldosteronism, which is a consequence of chronic renal failure, says Blum.

• Normal-pressure hydrocephalus. This is already included in the index of the ICD-9 book, but doesn't yet have its own code, explains Blum.

• Wound botulism. Right now there's a code for food poisoning, but not for other types of botulism, such as wound botulism and infant botulism. These types of botulism manifest differently than food-borne botulism, notes Blum.

• Neoplasia. The Committee will consider creating new codes for Multiple Endocrine Neoplasia (MEN) Types I, II and III. And the Committee may break out Vulvar Intraepithelial Neoplasia (VIN) into two types. There are already different codes for Type I and II Cervical Intraepithelial Neoplasia (CIN), but only one code for VIN. So the Committee is considering creating separate codes for VIN I and VIN II, says Blum.