Oct 2003 Table of Contents

GETTING PAID

ICD-9 Changes and Other Spooky Things



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It’s a new bag of tricks this year, but don’t worry. Our updated tools will keep you coding quickly and accurately.

Fam Pract Manag. 2003 Oct;10(9):19-20.

This content conforms to AAFP CME criteria. See FPM CME Quiz.

It’s October, which not only means it’s time for Halloween, but also for the annual ICD-9 changes and updates. To make sure you don’t get frightened by ghastly claims denials, check out the highlights here. A complete list of the changes is available from the FPM Web site at http://www.aafp.org/fpm/icd9.

V codes

Influenza vaccines given after Oct. 1 will require a new diagnosis code, V04.81, “Need for prophylactic vaccination and inoculation, Influenza.” There is also a new code for RSV immunization (V04.82).

The most extensive V code changes relate to insulin pumps. The new codes allow for more accurate reporting of insulin-pump-related encounters. Among them are fitting (V53.91, “Fitting and adjustment of insulin pump”), instruction (V65.46, “Encounter for insulin pump training”) and check-ups (V45.85, “Insulin pump status”). There is also a new code for insulin pump problems (996.57, “Mechanical complication of other specified prosthetic device, implant and graft; due to insulin pump”).

Three new V codes identify long-term (current) drug use. These include V58.63 (antiplatelet/antithrombotic), V58.64 (nonsteroidal anti-inflammatories) and V58.65 (steroids).

Lastly, two new codes replace the code V65.1, “Person consulting on behalf of another person”: V65.11, “Pediatric pre-birth visit for expectant mother” and V65.19, “Other person consulting on behalf of another person.”

HELP WITH ICD-9 CODING

FPM’s ICD-9 coding references have recently been updated to comply with the ICD-9 codes in effect from Oct. 1, 2003, to Sept. 30, 2004.

The Short List

You’ll find “ICD-9 Codes for Family Practice 2003–2004: The Short List” online at http://www.aafp.org/fpm/icd9). This list was developed by Donald Spencer, MD, MBA, and Allen Daugird, MD, MBA, family physicians and clinical associate professors at the University of North Carolina, Chapel Hill, and Philip S. Whitecar, MD, assistant professor of family medicine at Wright State University, Dayton, Ohio.

The Long List

Drs. Whitecar, Spencer and Daugird have also updated “ICD-9 Codes for Family Practice 2003–2004: The Long List,” an expanded list of about 1,500 codes, available online at http://www.aafp.org/fpm/icd9.

Help us help you

We’ll make both the short and long lists available online again next year, and we’ll print one version in the journal. Which one would be most valuable to you? Send an e-mail to fpmedit@aafp.org to let us know. We’ll count the votes and plan accordingly for next year.

Symptoms, signs, and ill-defined conditions

Since family physicians often see patients with undifferentiated diagnoses, it always helps to familiarize yourself with the changes in ICD-9 codes for symptoms, signs and ill-defined conditions. Among the new codes in this section of ICD-9 are:

  • 780.93 Memory loss,

  • 780.94 Early satiety,

  • 781.94 Facial weakness,

  • 785.52 Septic shock,

  • 788.63 Urgency of urination.

Also in this section, ICD-9 has replaced the single code for abnormal glucose tolerance test (790.2) with the following three new codes:

  • 790.21 Impaired fasting glucose,

  • 790.22 Impaired glucose tolerance test (oral),

  • 790.29 Other abnormal glucose.

Likewise, the single “ill-defined conditions” code 799.8 has been split into two new codes: 799.81, “Decreased libido” and 799.89, “Other ill-defined conditions.”

Respiratory problems

The SARS outbreak earlier this year has resulted in some new diagnosis codes that you may need to be aware of in your practice. For example, new code 079.82 describes “SARS-associated coronavirus,” and new code 480.31 describes “Pneumonia due to SARS-associated coronavirus.” Also, new code V01.82 should now be used to report “Exposure to SARS-associated coronavirus.”

Other new codes for respiratory conditions include 493.81, “Exercise induced bronchospasm,” and 493.82, “Cough variant asthma.”

Injuries

Family physicians who work in emergency or urgent care settings may also want to note some of the ICD-9 changes related to injuries. For example, the previous code for concussion, with brief loss of consciousness, has been replaced with two new codes based on the length of time the patient is unconscious. New code 850.11 describes concussion with loss of consciousness of 30 minutes or less, while new code 850.12 covers loss of consciousness of 31 to 59 minutes.

More changes

ICD-9 has added a fifth-digit classification to the codes for hyperplasia of the prostate (600.0 to 600.9). The fifth digit of “0” will indicate “without urinary obstruction,” while the fifth digit of “1” will specify “with urinary obstruction.”

On the plus side, ICD-9 has collapsed all of the codes for difficulty in walking (719.70 to 719.79) into one new code, 719.7, “Difficulty in walking.” There is also a new code for muscle weakness, 728.87.

As always, these represent only some of the changes in ICD-9. You should review the codes you use most often for other changes. I hope that by doing so, your next remittance advice will have more treats than tricks!

Kent Moore is the AAFP’s manager for health care financing and delivery systems and is a contributing editor to FPM.

Conflicts of interest: none reported.

Send comments to fpmedit@aafp.org.


Copyright © 2003 by the American Academy of Family Physicians.
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