Primary Care Coding Alert

ICD-9 2007 introduces new pediatric BMI codes

You can dodge truncated-V58.3 denials as long as you change -dressing change/suture removal- to a two-line entry. When you revamp your superbill this autumn, ICD-9 will make this and 20 other V code changes necessary.

Gain 3 Specific Post-Op Care Codes

If you yearn for aftercare specificity, ICD-9 2007 answers your call with three new V58.3x codes. Now the designation -attention to surgical dressing and sutures- is a catchall for dressing changes and suture removal. When the new codes become effective on Oct. 1, you-ll be able to specify three aftercare types.

Catch: You-ll have to add a flag to your system that V58.3 is no longer valid this fall. The encounter code will require a fourth digit to indicate an encounter for

- nonsurgical wound dressing change or removal--V58.30

- surgical wound dressing change or removal--V58.31

- suture removal--V58.32.
 
-Hopefully, having a specific suture removal code will help practices get paid for this procedure (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient -),- says Victoria S. Jackson, practice management consultant with JCM Inc. in California.

Payers may still require you to report the injury code (such as 883.0, Open wound of finger[s]; without mention of complication) as a secondary diagnosis to tie the original billing to the postoperative care, she says.

Try this: If the family physician didn't perform the original laceration repair, report the suture removal with an E/M code and, starting Oct. 1, V58.32. In Jackson's office, the physician always checks the wound before the nurse performs the removal. -So we use 99212 or 99213 depending on whether the laceration required Steri-Strips to keep closed.-

Warning: Do not separately code the suture removal if the FP placed the sutures, says Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan. -In this case, the laceration repair includes the postoperative care of removing the sutures,- he says.

Support Over/Under-Eating Sessions for Children

In other news, the codes for body mass index head into the pediatric realm. ICD-9 2007 will introduce four new codes for pediatric BMI. -This smart addition will help explain physician counseling (99201-99215) for obesity, as well as for failure to thrive,- Jackson says. The new series will include:

- V85.51--Body Mass Index, pediatric, less than 5th percentile for age

- V85.52--Body Mass Index, pediatric, 5th percentile to less than 85th percentile for age

- V85.53--Body Mass Index, pediatric, 85th percentile to less than 95th percentile for age

- V85.54--Body Mass Index, pediatric, greater than or equal to 95th percentile for age.

Try New Retesting Indicator Tool

Send more information related to Pay for Performance with a new hearing examination V code, says Richard H. Tuck, MD, FAAP, a nationally recognized coding speaker with PrimeCare of Southeastern Ohio. When a patient presents to your office for a hearing screening after failing an initial test, and no problem is found, you now have no way of distinguishing the encounter from a first-time screening.

New method: ICD-9 2007 will open the door to explaining why a subsequent screening was necessary. You-ll be able to indicate that -The patient failed the first screening- with V72.11 (Encounter for hearing examination following failed hearing screening).