Part B Insider (Multispecialty) Coding Alert

Published on Sat Apr 18, 2009 PDF

Some of the new codes may help you with ICD-10.

If youve got high hopes that youll have a lot of new ICD-9 codes to use starting this fall, CMS delivers, with 141 new diagnosis codes debuting on Oct. 1.

CMS will publish the full listing of ICD-9 codes in the May 22 Federal Register but released the list early, offering a few surprises.

Most of the new codes will offer additional specificity to existing diseases, which can help you code more accurately. Any time we get diagnosis codes that provide additional specificity, I think that is great, says Marvel J, Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO of MJH Consulting in Denver.

Youll find new codes in most categories, ranging from oncology (such as the 209.31-209.36 series, Merkel cell carcinoma) to orthopedics (813.46-813.47, Torus fracture).

However, orthopedic coders had hoped for a wider range of codes, says Leslie A. Follebout, CPC, COSC, PCS, coding manager at Peninsula Orthopaedic Associates in Salisbury, Md.

Youll also find an expansion of the 799.2 (Nervousness) section, with new codes for irritability (799.22), impulsiveness (799.23), and demoralization and apathy (799.25), among others.

The new 5th digit ICD-9 codes can be used to report emotional and/or behavioral symptoms, Hammer says. If these symptoms are associated as a late effect to a traumatic brain injury (TBI), the new ICD-9 code(s) could be paired with the appropriate late effect code, 905.0 (Late effect of fracture of skull and face bones) or 907.0 (Late effect of intracranial injury ...).

Coding late effects generally requires two codes, Hammer says.The condition or nature of the late effect is sequenced first; the late effect code is sequenced second. But if the emotional/behavioral signs and symptoms are inherent in an established diagnosis, you should not code them separately.

Additionally, these new codes parallel the ICD-10-CM codes found in the R45.X Symptoms and Signs Involving Emotional State section, allowing for easier mapping when providers convert to ICD-10 in 2013, Hammer says.

Turn the page to get a few highlights of the new ICD-9 codes that will be effective in October.