Medicare Compliance & Reimbursement

Billers need to start mastering the new ICD-9 codes now.

With new ICD-9 codes on the horizon, the prognosis for providers may include more reimbursement--if they learn how to use the new codes in six key areas.

1. Pain coding. Until the introduction of the new pain section (338.x), coders have never had a way to describe "significant" pain, says Marcella Bucknam, coding manager for the University of Washington's physician group in Seattle. That includes pain that is outside what coders would expect, or requiring extra treatment such as joint injections or pain service visits, explains Bucknam.

The ability to code for acute or chronic postoperative pain will be useful for several different purposes, says Jackie Miller, senior consultant with Coding Strategies in Powder Springs, GA. For example, coders can use these codes to justify a pain management consultation, admitting a patient postoperatively or prolonging the patient's hospital stay.

2. Torsion coding. If a surgeon performs an appendectomy along with another procedure, the coder often can't justify billing separately for the appendectomy. But now they'll be able to use the new torsion of the appendix codes (608.23-608.24) to describe the reason for the extra appendectomy, says Bucknam.

3. Altered mental status. Physicians often perform an MRI of the brain due to altered mental status, and currently coders have to use 780.99 (Other general symptoms) to explain this procedure. Starting in October, billers will be able to use 780.97 (Altered mental status), and carriers may cover the procedure more often, says Miller.

4. Complications of pregnancy. The new section on pregnancy complications (649.x) will be invaluable for family medicine, obstetrics and maternal and fetal medicine physicians. Carriers are increasingly demanding codes that describe specifically why a pregnancy needed more visits and more care, says Bucknam.

5. Bariatric surgery status. This new code (V45.86) will help to point out an important factor in many patients' health, says Bucknam.

6. Takotsubo syndrome. Cardiologists and radiologists are documenting this condition more and more frequently, but they haven't had a good way to report it, until the introduction of new code 429.83, says Miller.