Primary Care Coding Alert

You will finally have a code to specify whether a patient's prostate enlargement involves urinary obstruction - thanks to new ICD-9 codes that take effect Oct. 1. Seven major diagnostic additions and revisions will simplify coding and provide solutions for many previously overlooked family practice (FP) diagnoses. 1. 600.0 Requires a Fifth Digit The top ICD-9 2004 code change will alter your prostatic hypertrophy coding. Starting Oct. 1, if you submit 600.0 (Hyperplasia of prostate; hypertrophy [benign] of prostate), payers will deny the code as nonspecific. "Due to the frequency with which FPs treat prostatic hypertrophy, the added specification of the prostatic hypertrophy series (600.x) is definitely one of the top family practice ICD-9 2004 diagnostic changes," 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.
 
"Benign prostatic hypertrophy (BPH) now requires specifying whether urinary obstruction exists," Fick says. For BPH without urinary obstruction, you should report a fifth-digit subclassification of 0 (600.00, Hypertrophy [benign] of prostate; without urinary obstruction) "On the other hand, if the prostate enlargement blocks the urethra, you should use a fifth digit of 1 (600.01, ... with urinary obstruction)," he says. 2. X Out the Last Digit From 719.7x The ICD-9 code revision for difficulty walking (719.7x, Other and unspecified disorders of joint; difficulty in walking) will require eliminating the fifth digit, rather than adding one. "ICD-9 2004 collapses the difficulty walking code from multiple codes to a single code," says Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.
 Eliminating the fifth-digit categories, 719.70-719.79, will allow you to use a diagnosis of difficulty in walking (719.7) without specifying the affected site, such as ankle and foot (719.77), he says. 3. Use 3 New Symptom Codes Other changes include several new signs and symptoms codes for urgency of urination (788.63), facial weakness (781.94) and decreased libido (799.81). "These new codes will prove invaluable for describing encounters that do not result in a definitive diagnosis," says Jaime Darling, CPC, certified coder for Graybill Medical Group in Escondido, Calif. Without a definitive diagnosis, ICD-9 guidelines require reporting the sign and/or symptoms, she says.
 
For instance, when a lab test result is unavailable or negative, you should report the reason that prompted the test. But what if no code describes the patient's symptom?
 
Because no ICD-9 code previously existed for urgent urination, explaining the encounter stumped many coders. ICD-9 2004, however, introduces 788.63 (Urgency of urination), which solves the coding dilemma. Suppose a female patient complains of urgent urination. The in-office test (such as 81002, Urinalysis by dipstick or tablet reagant ...; non-automated, [...]