Reimbursement Strategies

Getting Paid

Use New Diagnosis Codes to Avoid Claim Denials


Fam Pract Manag. 1998 Oct;5(9):15-16.

If it's October, it must be time to update your list of diagnosis codes. Granted, reviewing the latest that the ICD-9 manual has to offer doesn't exactly sound like interesting reading. But you're probably interested in reducing the number of your claims that are rejected or denied, and using the right codes certainly helps. Here are some highlights of the changes that went into effect Oct. 1.

Maternity care

Many of this year's changes relate to maternity care. For example, code 763.8, “Other specified complications of labor and delivery affecting fetus and newborn,” has been replaced with four new codes:

  • 763.81, Abnormality in fetal heart rate or rhythm before the onset of labor;

  • 763.82, Abnormality in fetal heart rate or rhythm during labor;

  • 763.83, Abnormality in fetal heart rate or rhythm, unspecified as to time of onset;

  • 763.89, Other specified complications of labor and delivery affecting fetus and newborn.

Similarly, code V23.8, “Supervision of other high-risk pregnancy,” has been replaced with five new codes:

  • V23.81, Supervision of high-risk pregnancy of elderly primigravida;

  • V23.82, Supervision of high-risk pregnancy of elderly multigravida;

  • V23.83, Supervision of high-risk pregnancy of young primigravida;

  • V23.84, Supervision of high-risk pregnancy of young multigravida;

  • V23.89, Supervision of other high-risk pregnancy.

You'll also find three new codes related to abnormalities in fetal heart rate or rhythm:

  • 659.70, Abnormality in fetal heart rate/rhythm, unspecified as to episode of care or not applicable;

  • 659.71, Abnormality in fetal heart rate/rhythm, delivered, with or without mention of antepartum condition;

  • 659.73, Abnormality in fetal heart rate/rhythm, antepartum condition or complication.

Respiratory care

This year's ICD-9 revisions also include several related to respiratory conditions. For example, code 482.4, “Pneumonia due to Staphylococcus,” has been replaced by these three codes:

  • 482.40, Pneumonia due to Staphylococcus, unspecified;

  • 482.41, Pneumonia due to Staphylococcus aureus;

  • 482.49, Other Staphylococcus pneumonia.

You'll also find revisions and additions related to respiratory failure. For example, “acute” has been added to code 518.81, making it “Acute respiratory failure.” New respiratory codes include 518.83, “Chronic respiratory failure,” and 518.84, “Acute and chronic respiratory failure.”

Finally, there are five new codes for respiratory signs and symptoms:

  • 786.03, Apnea;

  • 786.04, Cheyne-Stokes respiration;

  • 786.05, Shortness of breath;

  • 786.06, Tachypnea;

  • 786.07, Wheezing.

Other illnesses and symptoms

Among other illnesses and symptoms you might frequently code, you should know that 780.7, “Malaise and fatigue,” has been replaced with 780.71, “Chronic fatigue syndrome,” and 780.79, “Other malaise and fatigue.”

“V” codes

The ICD-9 revision has also brought a number of changes in the “V” codes, which provide supplementary classifications of factors influencing health status and patients' contact with health care providers. There are several (other than those involving high-risk pregnancy, mentioned above) that you may find relevant. For example, code V02.5, “Carrier or suspected carrier of other specified bacterial diseases,” has been replaced with three new codes:

  • V02.51, Carrier or suspected carrier of Group B streptococcus;

  • V02.52, Carrier or suspected carrier of other streptococcus;

  • V02.59, Carrier or suspected carrier of other specified bacterial diseases.

Some “V” code changes related to renal conditions may also be of interest to family physicians. Code V16.5, “Family history of malignant neoplasm of urinary organs,” has been replaced with V16.51, “Family history of malignant neoplasm of kidney,” and V16.59, “Family history of malignant neoplasm of other urinary organs.” Similarly, code V18.6, “Family history of kidney diseases,” has been replaced with V18.61, “Family history of polycystic kidney,” and V18.69, “Family history of other kidney diseases.”

Among the other new “V” codes, here are two more that you may find useful: V58.62, “Encounter for aftercare for long-term (current) use of antibiotics,” and V76.44, “Special screening for malignant neoplasm of prostate.”

That's not all, folks

These changes are only a sample of those that went into effect Oct. 1. To make sure your coding is up-to-date, compare the codes you use most often with the complete list of ICD-9 changes, which was published in the July 31 issue of the Federal Register. Doing so should pay off when you submit your claims.

On the next page (see FPM ICD-9 tools) you'll also find an updated version of “ICD-9 Codes for Family Practice,” a list of common codes developed by Allen Daugird, MD, MBA, and Donald Spencer, MD, MBA, both family physicians and associate professors at the University of North Carolina, Chapel Hill.

Of this year's deleted codes; only 780.7, “Malaise and fatigue,” was on the FPM list; it has been replaced with 780.79, “Other malaise and fatigue.” Two new codes — 786.05, “Shortness of breath,” and 786.07, “Wheezing” — have been added to the list, and dyspnea (code 786.09) has been dropped.

In addition, one code from last year's list has been corrected. The proper code for “Special screening for malignant neoplasm, unspecified” (shortened to “Screening, cancer, unspecified” on the FPM list) is V76.9.

Kent Moore is the AAFP's manager for reimbursement issues and a contributing editor to Family Practice Management.


Copyright © 1998 by the American Academy of Family Physicians.
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