Procedure (CPT) and diagnosis (ICD-9-CM) codes that don't match spell denied claims. On Oct. 1, surgeons will have more than 100 new diagnosis codes to add to their coding arsenals, helping you assign more accurate codes to hopefully stave off denials. Here's a look at a few of the new codes you're likely to encounter.
Lymphoma. Physicians may treat lymphoma patients by performing such outpatient procedures as lymph node excisions, splenectomies or biopsies. These surgeons will need to become familiar with the new codes and expand their documentation practices accordingly so that your business office can abstract codes to the highest level of specificity.
ICD-9-CM will add an entire new subsection under the 200 series (lymphosarcoma and reticulosarcoma). Your documentation must now differentiate among various forms and sites, including marginal zone lymphoma, which will now be classified using the 200.30 to 200.38 series.
ICD-9-CM will further specify this series according to the location of the lymphoma. In the past, if you documented marginal zone lymphoma, your coder would be able to assign the appropriate code using the 200.x series. However, you'll now have to clearly note the location. For example, if you document marginal zone lymphoma of the intrathoracic lymph nodes, your coder will know to assign new code 200.32. If you document marginal zone lymphoma of the spleen, 200.37 will be more appropriate. However, if you don't note the lymphoma site, your coder won't be able to assign a code, and your claim will be delayed.
Lymphoma codes will also debut in the ranges of 200.40 to 200.48 (mantle cell lymphoma), 200.50 to 200.58 (primary central nervous system lymphoma), 200.60 to 200.68 (anaplastic large cell lymphoma) and 200.70 to 200.78 (large cell lymphoma). In addition, ICD-9-CM will let physicians code peripheral T-cell lymphoma using new codes 202.70 to 202.78.
Documenting the lymphoma location is just as important as noting the lymphoma type. If you simply document that you addressed peripheral T-cell lymphoma of the abdominal/pelvic region, your coder won't know whether to assign 202.73 (which refers to the intra-abdominal lymph nodes), 202.76 (which refers to the intrapelvic lymph nodes) or 202.77 (which applies to the spleen). Without this information, the coder can't assign a fifth digit, and without a fifth digit, the insurer will deny your claim due to a truncated diagnosis code.
Hearing loss. Otolaryngologic surgeons may be pleased to find that ICD-9-CM will offer increased specificity to the hearing loss diagnoses. Effective Oct. 1, you'll have to be sure to carefully document when you address mixed hearing loss. The new edition of ICD-9-CM deletes the previous, nonspecific code 389.2 (mixed conductive and sensorineural hearing loss) and introduces three more specific hearing loss codes in its place. Now you must record whether the patient suffers from mixed hearing loss (described by new code 389.20), unilateral mixed hearing loss (389.21) or bilateral mixed hearing loss (389.22).
In addition, new codes will debut for acquired auditory processing disorders (388.45), unilateral conductive hearing loss (389.05), bilateral conductive hearing loss (389.06), unilateral neural hearing loss (389.13) and unilateral sensory hearing loss (389.17). You can't be ambiguous in your operative reports or progress notes.
Ophthalmology. Ophthalmologists will face denials if they submit code 364.8 (other disorders of iris and ciliary body) for dates of service on or after Oct. 1, but only because ICD-9-CM has expanded it into a five-digit code. New code 364.89 takes its place using the same descriptor. This shouldn't significantly affect ophthalmologists' documentation practices.
Ophthalmologists may benefit from a more specific code for floppy iris syndrome, which will now be described with 364.81. If you use acronyms or eponyms for this diagnosis (such as "IFIS"), let your coders know that you are referring to floppy iris syndrome so they can assign the correct code.
Circulatory system. The ICD-9-CM manual will introduce several codes that describe circulatory system conditions that previously were lumped into other descriptors. For example, if you treat chronic total occlusion of the coronary artery, your coder previously assigned an unspecified code for this condition. However, you should now be sure and let your billing staff know that you addressed this specific condition, so they can assign the new code 414.2 (chronic total occlusion of coronary artery).
In addition, surgeons will benefit from new codes 415.12 (septic pulmonary embolism), 423.3 (cardiac tamponade), 440.4 (chronic total occlusion of artery of the extremities) and 449 (septic arterial embolism). Again, if you plan to use eponyms such as "pericardial tamponade," let your coder know that these are synonymous with the terms described by the new codes so they don't continue to use unspecified codes for these conditions.
Ob-Gyn, urology. ICD-9-CM has deleted code 233.3 (carcinoma in situ, other and unspecified female genital organs) to make way for the following five-digit codes:
- 233.30 (carcinoma in situ, unspecified female genital organ)
- 233.31 (carcinoma in situ, vagina)
- 233.32 (carcinoma in situ, vulva)
- 233.39 (carcinoma in situ, other female genital organ)
Because this new code series relies on accurate documentation of the cancer site, you'll have to avoid using terms such as "vaginovulvar" unless absolutely necessary. Otherwise, your coder won't know whether to assign the cancer diagnosis for the vagina (233.31) or the vulva (233.32).
New "V" codes. The new edition of ICD-9-CM will also include 21 new "V" codes describing supplementary factors influencing health status. If your facility must use a different type of anesthesia because a patient has a history of cardiac arrest, you should document that reason in the patient's record. This way, the coder can describe the reason for using the different anesthetic with new code V12.53 (personal history of sudden cardiac arrest). Other important new V codes include V12.54 (personal history of transient ischemic attack [TIA] and cerebral infarction without residual deficits), V13.22 (personal history of cervical dysplasia) and V49.85 (dual sensory impairment).
No grace period
Medicare no longer allows a grace period for using deleted ICD-9-CM codes. Be sure to update your software and surgical forms by Oct. 1 to ensure that you're submitting accurate diagnosis codes.