Neurosurgery Coding Alert

Prepare Now for 2003 Revisions Although the New Year is still months away, some payers will begin to implement revised ICD-9 guidelines for 2003 as early as Oct. 1, 2002. Proposed revisions to ICD-9, initially announced in the May 9, 2002, Federal Register (Vol. 67, No. 90, pp. 31627-31631), include nearly 150 new diagnosis codes, as well as 19 code deletions. All payers must accommodate the changes on or before Jan. 1, 2003. Many new codes reflect a trend toward greater diagnosis specificity. For example, five codes (459.30, 459.31, 459.32, 459.33 and 459.39) have been added to describe chronic venous hypertension without complications, with ulcer, with inflammation, with ulcer and inflammation, or with other complication, respectively. The largest category of new codes focuses on pediatric and obstetric diagnoses. For example, there are now 10 codes, 633.00-633.91, to describe various abdominal, tubal, ovarian and ectopic pregnancies. New codes of interest to neurosurgery practice include:

040.82 Toxic shock syndrome 357.81 Chronic inflammatory demyelinating polyneuritis 357.82 Critical illness polyneuropathy 357.89 Other inflammatory and toxic neuropathy 359.81 Critical illness myopathy 359.89 Other myopathies 438.6 Alterations of sensations 438.7 Disturbances of vision 438.83 Facial weakness 443.21 Dissection of carotid artery 443.24 vertebral artery 443.29 other artery 998.31 Disruption of internal operation wound 998.32 external operation wound The approximately 150 code additions to ICD-9 for 2003 include 40 new V codes, of which 31 are "aftercare" codes for patient care following surgery (e.g., V58.72, Aftercare following surgery of the nervous system, NEC). Payer response to the new codes is as yet uncertain. Other codes in this category that neurosurgeons may use include: V54.17 Aftercare for healing traumatic fracture of vertebrae V54.27 for healing pathologic fracture of vertebrae V54.89 Other orthopedic aftercare V58.42 Aftercare following surgery for neoplasm V58.43 following surgery for injury and trauma V58.78 following surgery of the musculoskeletal system, NEC Codes 357.8 (Other inflammatory and toxic neuropathy), 359.8 (Other myopathies) and V54.8 (Other orthopedic aftercare), meanwhile, have been eliminated from ICD-9, replaced by the more specific five-digit codes (359.81 and 359.89) listed above. The remaining 16 deletions follow the same pattern but are of minimal significance for neurosurgery practice. Finally, 23 codes will receive revised descriptors for 2003. Of these, 15 involve categories 402.00-402.91 and 404.00-404.93 to describe hypertensive heart disease and hypertensive heart and renal disease, respectively which neurosurgeons may occasionally access as secondary diagnoses. The changes include minor text revisions that will not affect how the codes are applied. Note: For a complete list of additions, deletions and revisions to ICD-9 for 2003, visit the Federal Register at the Government Printing Office Web site: www.access.gpo.gov/su_docs/aces/aces140.html.