Sep 2004 Table of Contents

GETTING PAID

ICD-9 Changes: Update Now or Pay Later



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Failing to update your ICD-9 codes by the Oct. 1 effective date could cost you.

Fam Pract Manag. 2004 Sep;11(8):17-18.

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

Once again, Oct. 1 brings more ICD-9 changes. But this year, it is more important than ever to update your charge sheets and superbills by the effective date because the Centers for Medicare & Medicaid Services is eliminating the 90-day grace period it has historically given for transitioning to the new codes. (See “A lack of grace.”) Here are some of the notable ICD-9 changes relevant to family medicine.

A LACK OF GRACE

This year, the Centers for Medicare & Medicaid Services (CMS) has decided to eliminate the 90-day grace period previously given to physicians and others as a way of helping them transition to the new ICD-9 codes. Citing the fact that the Health Insurance Portability and Accountability Act (HIPAA) “requires usage of the medical code set that is valid at the time that the service is provided,” CMS has announced that for dates of service on or after Oct. 1, 2004, you must use the updated ICD-9 codes. Claims with invalid ICD-9 codes will likely be denied or returned by your Medicare carrier (and possibly even by other payers). For more information on CMS’ decision to eliminate the grace period, see http://www.cms.hhs.gov/manuals/pm_trans/R95CP.pdf

Out with the old

Several existing codes will no longer be valid after Oct. 1. In each case, a four-digit ICD-9 code is being replaced by two or more five-digit codes. For example, instead of using code 707.0 for decubitus ulcers, you will now need to use one of the following codes:

  • 707.00 Decubitus ulcer, unspecified site,

  • 707.01 Decubitus ulcer, elbow,

  • 707.02 Decubitus ulcer, upper back,

  • 707.03 Decubitus ulcer, lower back,

  • 707.04 Decubitus ulcer, hip,

  • 707.05 Decubitus ulcer, buttock,

  • 707.07 Decubitus ulcer, heel,

  • 707.09 Decubitus ulcer, other site.

Similarly, code 252.0 for hyperparathyroidism will be replaced by the following codes:

  • 252.00 Hyperparathyroidism, unspecified,

  • 252.01 Primary hyperparathyroidism,

  • 252.02 Secondary hyperparathyroidism, non-renal,

  • 252.08 Other hyperparathyroidism.

Among the V codes, V01.7, “Other viral diseases,” is being replaced by two new codes: V01.71, “Contact or exposure to varicella,” and V01.79, “Contact or exposure to other viral diseases.” Likewise, V72.3, “Gynecological examination,” is being replaced by V72.31, “Routine gynecological examination,” and V72.32, “Encounter for Papanicolaou cervical smear to confirm findings of recent normal smear following initial abnormal smear.” Finally, V72.4, “Pregnancy examination or test, pregnancy unconfirmed,” is being replaced by V72.40, “Pregnancy examination or test, pregnancy unconfirmed,” and V72.41, “Pregnancy examination or test, negative result.”

In with the new

Some completely new codes will be added this year as well. Here are some examples:

  • 477.2 Allergic rhinitis due to animal (cat or dog) hair and dander,

  • 692.84 Contact dermatitis and other eczema due to animal (cat or dog) dander,

  • 788.38 Overflow incontinence,

  • 796.6 Nonspecific abnormal findings on neonatal screening,

  • V01.83 Contact or exposure to Escherichia coli (E. coli),

  • V01.84 Contact or exposure to meningococcus,

  • V58.66 Long-term (current) use of aspirin,

  • V58.67 Long-term (current) use of insulin,

  • V69.4 Lack of adequate sleep.

There are also new codes for abnormal Pap smears of the cervix. Specifically, ICD-9 will now include the following:

  • 795.03 Papanicolaou smear of cervix with low grade squamous intraepithelial lesion,

  • 795.04 Papanicolaou smear of cervix with high grade squamous intraepithelial lesion,

  • 795.05 Cervical high risk human papillomavirus DNA test positive,

  • 795.08 Nonspecific abnormal Papanicolaou smear of cervix, unsatisfactory smear.

Finally, in a nod to the exploding field of medical genetics, new V codes have been added that describe genetic susceptibility to various malignant neoplasms (V84.01-V84.09) and to other disease (V84.8).

What’s old is new again

Not all of the changes are additions and deletions; some are revisions to existing codes. For example, the fifth-digit descriptors for the diabetes codes 250.0 through 250.9 will now be revised to the following:

  • 0 – type II or unspecified type, not stated as uncontrolled,

  • 1 – type I [juvenile type], not stated as uncontrolled,

  • 2 – type II or unspecified type, uncontrolled,

  • 3 – type I [juvenile type], uncontrolled.

In this revision, the parenthetical references to “non-insulin dependent type” and “insulin dependent type” have been deleted, probably in an attempt to eliminate confusion regarding how to code type-2 patients (currently described as “noninsulin dependent type”) who are prescribed insulin. The parenthetical references to “adult-onset type” have also been deleted in the type-2 descriptors, perhaps to account for children with type-2 diabetes.

Don’t wait

This represents only a sample of the ICD-9 changes that will be effective – and immediately enforceable – on Oct. 1. A complete list of the changes is available from the FPM Web site as described in the box. Now is the time to make these changes; this year, you can’t afford to wait.

ICD-9 CODING TOOLS

FPM’s ICD-9 coding references have recently been updated to comply with the ICD-9 codes that will become effective Oct. 1.

The long list

You’ll find “ICD-9 Codes for Family Medicine: The Long List” on the preceding pages and online at http://www.aafp.org/fpm/icd9. This list of about 1,500 codes commonly used in family medicine was developed by Philip S. Whitecar, MD, assistant professor of family medicine at Wright State University, Dayton, Ohio; and Allen Daugird, MD, MBA, and Donald Spencer, MD, MBA, family physicians and clinical associate professors at the University of North Carolina, Chapel Hill.

The short list

Drs. Daugird, Spencer and Whitecar have also updated “ICD-9 Codes for Family Medicine: The Short List,” a list of about 600 codes that you can find online at http://www.aafp.org/fpm/icd9.

The most common codes

This year, to make these coding tools even more useful, the authors have identified the 100 ICD-9 codes that are especially common in family medicine. They are preceded by arrows in each list.

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 © 2004 by the American Academy of Family Physicians.
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