Primary Care Coding Alert

Your fall superbill should include these new pain diagnoses

Good news: Beginning Oct. 1, you will have 35 new ways to tell a payer why a pregnant woman required more E/M services. ICD-9 2007 will make reporting -obesity complicating pregnancy- possible, as well as 200+ other designations.

-A big list of codes will impact family physicians,- says Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City. A large percentage of these are all the new ob codes. In fact, codes for pregnancy complication and uterine size-date discrepancy comprise about half of the codes that will affect us, he says.

Here are some of the additions you can look forward to.

Explain Extra Ob Visits With 649

ICD-9 2007's new category on pregnancy complications (649.xx) will be invaluable for family medicine. Carriers are increasingly demanding codes that describe specifically why a pregnancy needed more visits (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient -), and more care, says Marcella Bucknam, CPC, CCS-P, CPC-H, CCA, coding manager for the University of Washington's physician group in Seattle.

Many of these codes deal with complications from obesity (649.10-649.14, Obesity complicating pregnancy, childbirth, or the puerperium ...) or bariatric surgery status (649.20-649.24, Bariatric surgery status complicating pregnancy, childbirth, or the puerperium ...). This reflects medical advances, says Suzan Hvizdash, medical auditor for University of Pittsburgh Physicians. Many women who couldn't become pregnant because of obesity can now become pregnant, either thanks to bariatric surgery or thanks to improved fertility treatments.

Important: Codes 649.xx apply to more than just additional encounters for pregnancy complications. You can also use the codes for problems during childbirth and the puerperium. The 35 new codes will allow you to indicate complications due to:

- tobacco use disorder--649.0x
- obesity--649.1x
- bariatric surgery status--649.2x
- coagulation defects--649.3x
- epilepsy--649.4x
- spotting--649.5x
- uterine size-date discrepancy 649.6x.

Justify Prolonged 99231-99233s With Pain Dx

Until the introduction of the new pain section (338.x), you-ve never had a way to describe -significant- pain, Bucknam says. That includes pain that is outside what you-d expect, or requiring extra treatment such as joint injections (20610, Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) or pain service visits (such as 99201-99215, new or established patient office visit), Bucknam says.

Benefit: The ability to code for acute or chronic postoperative pain will be useful for several different purposes, says Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies in Powder Springs, Ga. For example, you can use these codes to justify a pain management visit (99201-99215), admitting a patient postoperatively (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient -), or prolonging the patient's hospital stay (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient -).

Add 4 More-Specific Symptom Codes

The march toward specificity continues with more options that get you out of the taboo -other- or -other specified- zone. Look out for these opportunities to better describe a patient's symptom.

Example: A patient has a postnasal drip, but the family physician doesn't diagnose the patient with allergies. You now end up with a potential payment problematic -other- code (784.9, Other symptoms involving head and neck).

ICD-9 2007, however, will allow you to pinpoint the symptom with specific code 784.91 (Postnasal drip). The -other- code will also morph into a fifth-digit code: 784.99 (Other symptoms involving head and neck).

You-ll be able to avoid another -other- code when a family physician orders an MRI of the brain due to altered mental status. Now you have to use 780.99 (Other general symptoms) to explain this procedure. Starting in October, you-ll be able to use 780.97 (Altered mental status), Miller says.
 
New symptom codes will also exist to describe additional urination abnormalities. Indicate urinary hesitancy (788.64) and straining on urination (788.65) with specific codes, rather than an -other- code (788.69).

For a complete list of new codes that affect family practices, e-mail the editor at jgodreau@medville.com with subject line -FP ICD-9 2007.-