Practice Management Alert

488.1x cheat sheet makes fast work of snagging correct code.

You've recently flipped the calendar to October, which means you should have also updated your ICD-9 coding with the changes for 2011. Don't let rumors of few ICD-9 changes in prep for ICD-10 blindside you to top diagnosis changes that could affect your practice. Without the scoop on expansion to the 488, 784, and 787 categories, denials for invalid codes will derail your claims delaying your payments.

In ICD-9 2011, "Codes continue to become more and more specific necessitating a provider to document clearly and thoroughly to allow for selection of the most specific and accurate code," says Jennifer Swindle, RHIT, CCS-P, CEMC, CFPC, CCP-P, PCS, Director Coding & Compliance Division, PivotHealth, LLC.

Good news: Updating your ICD-9 coding doesn't have to be a chore. Start using your new choices in no time flat following these guidelines.

Look at Manifestation When Assigning "Swine Flu" Dx Starting now, when a patient has H1N1 ("swine flu") you'll want to pay attention to two details. The medical record will have to identify the correct influenza and you will have to capture the appropriate manifestation to select the codes to the degree of specificity now required, Swindle points out

With the change "category 488 (Influenza due to certain identified influenza viruses) would mirror the structure of category 487 (Influenza)," according to the Summary of March 2010 ICD-9-CM Coordination and Maintenance Committee Meeting. The current 488.x sub-category didn't provide the level of detail that category 487 does.

Change: There will be "tremendous expansion of the H1N1 category," Swindle explains. ICD-9 2011 deletes488.0 and 488.1 and adds six new five-digit codes. New codes 488.0x (Influenza due to identified avian influenza virus) and 488.1x (Influenza due to identified novel H1N1 influenza virus) allow you "to uniquely capture pneumonia, other respiratory manifestations, and other manifestations occurring with these types of influenza," states the summary.

As of Oct. 1, you'll assign the correct 488.xx code based on the type of co-morbid manifestation the avian or H1N1 influenza involves:

Don't forget: As with 487.0, when you code 488.01 or 488.11, you'll use an additional code to identify the type of pneumonia (480.0-480.9, 481, 482.0-482.9, 483.0-483.8, 485).

Focus on These Fecal Incontinence Symptoms

You'll now get to be a whole lot more specific when reporting fecal incontinence. The single code 787.6 will give way to four new options that describe fecal incontinence problematic symptoms, such as fecal smearing, fecal urgency, and incomplete defecation.

You're no longer able to report 787.6 (Incontinence of feces), because ICD-9 2011 deleted that code. Instead, you'll use one of the following new codes:

• 787.60 -- Full incontinence of feces
• 787.61 -- Incomplete defecation
• 787.62 -- Fecal smearing
• 787.63 -- Fecal urgency.

Don't miss: Incomplete defecation (787.61) is distinct from constipation and fecal impaction. Rectum and anal sphincter problems (including rectoceles) can cause these problems, but currently, you don't have a way to specify these symptoms.

The 2011 ICD-9 includes a new code, 560.32, for fecal impaction. Previously, this condition was included in 560.39 (Impaction of intestine; other). "The new fecal incontinence code (787.60) is a change that we will have to remember," says Lisa Selman-Holman, JD, BSN, RN, HCSD, COSC, consultant and principal of Selman-- Holman & Associates and CoDR -- Coding Done Right in Denton, Texas. The new code for fecal impaction excludes constipation, she says, which can still be reported using a code from the 564.0X series, "Constipation."

Welcome More Specific Pain Dx in 2011

When the physician diagnoses jaw pain, you can now choose 784.92 (Jaw pain) for the encounter. Previously, consideration included 526.9 (Unspecified diseases of the jaws), "which does not clearly illustrate the complaint," relays Sarah Todt, RN,CPC, CEDC, director of education and compliance for Medical Reimbursement Systems, Inc., in Woburn, Mass.

Benefit: The more specific jaw pain code could help "support some complaints that may be related to dental problems," says Todt.

Add Body Mass Index, BMI, V Codes to Your E/M Arsenal ICD-9 has "expanded the body mass index (BMI) codes to demonstrate higher BMIs with five new codes," notes Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC with CRN Healthcare Solutions in Tinton Falls, NJ.

Stop using V85.4 (Body Mass Index 40 and over, adult) and start using one of the following new V codes in its place:

• V85.41 -- Body Mass Index 40.0 -- 44.9, adult
• V85.42 -- ... 45.0 " 49.9, adult
• V85.43 -- ... 50.0 " 59.9, adult
• V85.44 -- ... 60.0 " 69.9, adult
• V85.45 -- ... 70 and over, adult.

The benefit: "BMI has become an important health tool, and those codes [V85.41-V85.45] will also provide more data," says Susan Vogelberger, CPC, CPC-H, CPC-I, CMBS, CCP-P, CEO of Healthcare Consulting & Coding Education, LLC.

"There are seven vital signs that count for the constitutional bullet in the E/M physical exam coding, and there are those who are of the opinion that BMI should be an eighth option," Vogelberger says. If that eighth bullet gains traction and comes into play for coders, the new V codes could help considerably.

Resource: CMS posted the proposed codes as part of the Inpatient Proposed Payment System, available online at www.cms.gov/AcuteInpatientPPS/IPPS2010/list.asp. To review the codes, download "Proposed Tables 6A-6K." Table 6A includes proposed new codes, 6C shows the proposed deletions, and 6E lists proposed revisions.