They're baaaaack! Your two-year reprieve from ICD-9 diagnosis-code changes will soon end. Having overcome the Y2K concerns that caused them to forgo last year's ICD-9 revision, officials of the Health Care Financing Administration have issued new and revised ICD-9 diagnosis codes that will take effect Oct. 1, 2000. Here are some of the changes that may be relevant to family practice.
The biggest area of change is in the V codes. These are the codes used to describe factors influencing health status and occasions when a circumstance other than a disease or injury is the reason for contact with the patient.
For example, V76.8, “Special screening for malignant neoplasms, other neoplasm,” will be deleted. In its place you will find the following new codes:
V76.46 Special screening for malignant neoplasms, ovary;
V76.47 Special screening for malignant neoplasms, vagina;
V76.50 Special screening for malignant neoplasms, unspecified intestine;
V76.51 Special screening for malignant neoplasms, colon;
V76.52 Special screening for malignant neoplasms, small intestine;
V76.81 Special screening for malignant neoplasms, nervous system;
V76.89 Special screening for other malignant neoplasm.
Other V code changes include the following:
Deleting V49.8, “Other specified problems influencing health status,” and adding V49.81, “Postmenopausal status (age-related) (natural),” and V49.89, “Other specified conditions influencing health status”;
Deleting V67.0, “Follow-up examination following surgery,” and adding V67.00, “Follow-up examination, following unspecified surgery,” V67.01, “Following surgery, follow-up vaginal pap smear,” and V67.09, “Follow-up examination, following other surgery”;
Deleting V71.8, “Observation for other specified suspected conditions,” and adding V71.81, “Observation for suspected abuse and neglect,” and V71.89, “Observation for other specified suspected conditions”;
Deleting V82.8, “Special screening for other specified conditions,” and adding V82.81, “Special screening for osteoporosis,” and V82.89, “Special screening for other specified conditions.”
Maternity and infant care
If you provide maternity care, you should be aware that some of the codes you may have been using will no longer be valid on Oct. 1. These include 645.00, “Prolonged pregnancy, unspecified as to episode of care or not applicable,” 645.01, “Prolonged pregnancy, delivered, with or without mention of antepartum condition,” and 645.03, “Prolonged pregnancy, antepartum condition or complication.” In lieu of these codes, the following new diagnosis codes will be available:
645.10 Post term pregnancy, unspecified as to episode of care or not applicable;
645.11 Post term pregnancy, delivered, with or without mention of antepartum condition;
645.13 Post term pregnancy, antepartum condition or complication;
645.20 Prolonged pregnancy, unspecified as to episode of care or not applicable;
645.21 Prolonged pregnancy, delivered, with or without mention of antepartum condition;
645.23 Prolonged pregnancy, antepartum condition or complication.
There will also be new codes to classify low birth weight babies. These will include the following:
V21.30 Unspecified low birth weight status;
V21.31 Low birth weight status, less than 500 grams;
V21.32 Low birth weight status, 500–999 grams;
V21.33 Low birth weight status, 1000–1499 grams;
V21.34 Low birth weight status, 1500–1999 grams;
V21.35 Low birth weight status, 2000–2500 grams.
Allergy and asthma
A new code, 477.1, will be added for “Allergic rhinitis, due to food.” Also, code V15.0, “Allergy, other than to medicinal agents,” will be deleted in favor of more specific codes, including the following:
V15.01 Allergy to peanuts;
V15.02 Allergy to milk products;
V15.03 Allergy to eggs;
V15.04 Allergy to seafood;
V15.05 Allergy to other foods;
V15.06 Allergy to insects;
V15.07 Allergy to latex;
V15.08 Allergy to radiographic dye;
V15.09 Other allergy, other than to medicinal agents.
Four new codes related to asthma will be available. These include the following:
493.02 Extrinsic asthma, with acute exacerbation;
493.12 Intrinsic asthma, with acute exacerbation;
493.22 Chronic obstructive asthma, with acute exacerbation;
493.92 Unspecified asthma, with acute exacerbation.
Signs and symptoms
The code for “Other symptoms involving nervous and musculoskeletal systems,” 781.9, will be deleted in favor of two new codes: 781.91, “Loss of height,” and 781.92, “Abnormal posture.”
Likewise, 783.22, “Abnormal loss of weight,” will be revised to read “Underweight,” and a new code, 783.21, “Loss of weight,” will be added.
Finally, 783.4, “Lack of expected normal physiological development,” will be deleted and replaced by the following new codes:
783.40 Unspecified lack of normal physiological development;
783.41 Failure to thrive;
783.42 Delayed milestones;
783.43 Short stature.
Note that there will also be a new code for “Adult failure to thrive,” 783.7.
Diagnosis code 294.1, “Dementia in conditions classified elsewhere,” is being replaced with two new codes: 294.10, “Dementia in conditions classified elsewhere without behavioral disturbance,” and 294.11, “Dementia in conditions classified elsewhere with behavioral disturbance.”
New FPM coding tools
To help simplify ICD-9 coding, Family Practice Management is now offering two quick-reference lists:
The FPM short list. "ICD-9 Codes for Family Practice: The FPM Short List" is a list of common codes developed by Allen Daugird, MD, MBA, and Donald Spencer, MD, MBA, both family physicians and clinical associate professors at the University of North Carolina, Chapel Hill. Drs. Daugird and Spencer updated it for this issue with the help of Philip S. Whitecar, MD, assistant professor of family medicine at Wright State University, Dayton, Ohio.
This list of about 600 codes has been a popular FPM resource over the past few years. At two pages, it's hard to beat for convenience. Some readers have commented, however, that the number of “NOS” (not otherwise specified) codes on the list makes it hard to use, because their insurers insist on more specific codes wherever possible.
The FPM long list. With that in mind, and in light of reports that HCFA plans to crack down on physicians who don't specify a fourth or fifth digit starting this fall, we're also offering a longer list. This list of about 1,500 codes common in family practice, developed by Drs. Whitecar, Daugird and Spencer, replaces many of the “unspecified” and “NOS” (not otherwise specified) codes with more specific alternatives. It also includes more codes useful for hospital care. This list is available online at https://www.aafp.org/fpm/icd9, and it will be published in our October issue.
Likewise, diagnosis code 600, “Hyperplasia of prostate,” will no longer be available. In its place, you will need to use one of the following codes:
600.0 Hypertrophy (benign) of prostate;
600.1 Nodular prostate;
600.2 Benign localized hyperplasia of prostate;
600.3 Cyst of prostate;
600.9 Unspecified hyperplasia of prostate.
Lastly, code 564.1 has been revised from “Irritable colon” to “Irritable bowel syndrome,” and code V26.3 has been revised from “Genetic counseling” to “Genetic counseling and testing.”
Check out the whole list
As always, this kind of article can only highlight some of the changes that will affect family physicians. One hundred new ICD-9 codes will take effect Oct. 1. In addition, 20 have been deleted, and three have been revised. I would encourage you to review the diagnosis codes you use most often when you get your new ICD-9 book, or compare them with the complete list of ICD-9 changes, which was published in the May 5 issue of the Federal Register (page 26382). Not only is this good coding advice, it can also mean the difference between claims being paid or denied.