ICD-9 2012: Now 425.1 Will Fetch you Denials – Immediately!

The ICD-9 2012 codes went into effect on October 1 this year. But are you up to date with the list of ICD-9 codes for 2012? Read on and get more insight.

Coronary atherosclerosis and hypertrophic cardiomyopathy were late additions in ICD-9 2012. Here are some ICD-9 2012 changes you need to heed to. This year's codeset has added 414.4 (it helps single out coronary lesions) after a proposal for a unique code for severely calcified coronary lesions came to the fore. The idea behind the proposal was to be able to distinguish a calcified lesion from other ischemic lesions. Calcified lesions are not the same as lipid rich plaque and chronic total occlusions. Code 414.8 is too general to identify the nature of the lesion.

Now ICD-9 2012 features new coding choices for hypertrophic cardiomyopathy, from October 1, 2011. This is because Hypertrophic cardiomyopathy can have two levels of manifestation - obstructive or nonobstructive. Whether it is obstructive or not, can have a say on the need for different medical or surgical treatments.

Previously, under ICD-9 2011, 425.1 was a valid code (Hypertrophic obstructive cardiomyopathy). If you required to report nonobstructive hypertrophic cardiomyopathy, you used 425.4. Now, the update revises 425.1 so that it's no longer a valid code – you must add a fifth digit for it to be valid: 425.11, 425.18.

These ICD-9 changes give you one code for hypertrophic obstructive (425.11) and one more for other hypertrophic, including nonobstructive (425.18). In order to conform with the changes to the 425.1x range, ICD-9 deletes the terms "hypertrophic" and "nonobstructive" from under 425.4.

For the entire ICD-9 codes list , final revisions and for other ICD-9 code 2012 changes, sign up for a good coding resource like SuperCoder.

ICD-9 2012: Perfect your HTN Coding

ICD-9 2012 codes go into effect on October 1 this year. Like other practices, your cardiology practice too will be impacted by this year's list of ICD-9 codes. And since Hypertension (HTN) is on the rise in the US, it's essential that your HTN coding is top-quality. Or else many of your claims will be in the danger zone.

Here are some rules to polish your HTN coding to perfection:

Utilize the Hypertension Table: This Hypertension Table simplifies your search and can be found under the ICD-9 index entry "Hypertension". It not only shows the basic 401.x (Essential hypertension) codes but also the codes for conditions owing to or associated with HTN. What's more, the table helps clarify when you code choices differ for malignant, benign or unspecified conditions.

Documentation & 401.x 4th Digit

Be it malignant (.0), benign (.1), or unspecified (.9), while reporting codes from 401.x, you must select a fourth digit to complete the code. You shouldn't use either 0 malignant or .1 benign unless medical record documentation supports such a designation.

'Hypertensive' aids 402.x Use

If a patient has both heart disease and HTN, knowing whether the HTN caused the heart condition is key to correct coding. See whether the patient has a condition described under heart disease codes 425.8, 429.0-429.3, 429.8, and 429.9. What's more, you should also check the documentation for a stated or implied causal relationship to HTN.

Think that HTN and chronic kidney disease are connected

ICD-9 codes presume a causal relationship between HTN and chronic kidney disease. If documentation shows a patient ahs HTN and a condition that falls under 585.x or 587, then you should report a code from 403.x even if there is no indication one lead to the other. You should also report the pertinent 585.x code to indicate the CKD stage.

Hypertensive Heart and CKD

A single code from 404.xx indicates the patient has both hypertensive heart disease and hypertensive CKD. You should once again assume a relationship between the HTN and CKD. When the patient suffers from hypertensive heart disease and CKD, you should select a code from 404.xx and not report 402.x (hypertensive heart disease) and 403.x (hypertensive CKD) together.

Head Diagnoses? Think 2 Codes

If the patient is diagnosed with hypertensive cerebrovascular disease, you should first go for the proper code from 430-438.x first and then report the proper hypertension code, 401.x-405.x.

Prepare for ICD-10 Codes Effect

Each year, there are millions of people suffering from kidney ailments. As those numbers are on the rise, the diagnosis code for this code will still rank among your commonly used codes when ICD-10 becomes effective in 2013.

Good tidings: You will almost find a one-to-one code correspondence between ICD-9 2011 and ICD-10 2011for "calculus of kidney and ureter" codes.

The key difference is that ICD-10 offers a code (N20.2) that is proper when the patient has calculi of both the kidney and the ureter. Under ICD-9, you would report the same diagnosis using two codes (592.0 and 592.1).

Instructional news: The 'includes' notes for these codes are almost identical for ICD-9 and ICD-10. Take special care in reviewing the 'excludes' notes, though, as ICD-10 has two different types of excludes notes that have two different meanings.

According to ICD-9 guidelines, an 'excludes' note shows terms that you should code elsewhere. The guidelines state that the term excludes means 'do not code here'. For instance, an ICD-9 excludes note guides you to assign 275.49 for nephrocalcinosis rather than using a code in the 592 range (Calculus of kidney and ureter).

In comparison, ICD-10 has both "Excludes1" and "Excludes2" notes. As per ICD-10 guidelines, Excludes 1 means 'NOT CODED HERE.' As a matter of fact, you should never report the excluded code at the same time as the code above the Excludes 1 note. Excludes 1 means the 'two conditions cannot take place together'.

Instead, an Excludes2 note tells you that the excluded term should be reported using another code. However if the patient has both conditions you may report both codes. In other words, when an Excludes2 note appears under a code it's acceptable to use both the code as well as the excluded code together.

An instance of Excludes1: ICD-10 lists an Excludes1 note directly under N20 (Calculus of kidney and ureter). This means the note applies to the entire N20 range. The excluded terms are "nephrocalcinosis" (E83.5-, Disorders of calcium metabolism) and "that with hydronephrosis" (N13.2, Hydronephrosis with renal and ureteral calculous obstruction).

As these terms are listed as an Excludes1 note, you should never report N20 - with N13.2 or the code for nephrocalcinosis (E83.5).

Excludes2example: Code N21.0 (Calculus in bladder) has an Excludes2 note for staghorn calculus indicating you should report N20.0 in place of N21.0 for that diagnosis. However because this is an Excludes2 note, if the documentation shows both "staghorncalculus" (N20.0) and "calculus in bladder" (N21.0), you may use the codes for each on the same claim.

Remember: When ICD-10 goes into effect, you should apply the codes and official guidelines in effect at that time. Learn more at a one-stop medical coding guide like Supercoder.

I10 covers Essential Hypertension for ICD-10

When it comes to essential hypertension, both ICD-9 2011 and ICD-10 2011 have coding options for it; however you won't find a one-to-one correspondence between them.

For essential hypertension, ICD-9 2011 has three coding choices:

401.0 -- malignant

401.1 -- benign

401.9 -- unspecified

ICD-10 2011 includes only one code, solving the age-old problem of having to choose the unspecified code when documentation fails to indicate benign or malignant. The ICD-10 code is the letter I followed by the number 10.

I10 -- Essential hypertension (primary).

So what's new: When ICD-10 goes into effect, you'll need to keep an eye on documentation for tobacco exposure. ICD-10 covers an instruction to 'use additional code to identify':

Exposure to environmental tobacco smoke (Z77.22)

History of tobacco use (Z87.891)

Occupational exposure to environmental tobacco smoke (Z57.31)

Tobacco dependence (F17.-)

Tobacco use (Z72.0).

What remains the same: Both the ICD-9 and ICD-10 entries state the codes include 'high blood pressure'; however you have separate codes in both sets for when the cardiologist documents an elevated reading without diagnosing hypertension.

ICD-9: 796.2 -- Elevated blood-pressure reading, without diagnosis of hypertension

ICD-10: R03.0 -- Elevated blood-pressure reading, without diagnosis of hypertension.

Keep in mind: When ICD-10 goes into effect on October 1, 2013, you should apply the codes and official guidelines in effect at that time (or more specifically, always use the codes and guidelines with effect from the relevant date of service). Learn more by signing up for a medical coding guide like Supercoder.com

C34 - Requires Location for Malignant Neoplasm Of Main Bronchus

Both ICD-9 2011 and ICD-10 2011 have coding options for a malignant neoplasm of the main brochus. Both indicate that the codes are proper for malignant neoplasms of the carina or hilus of lung.

Difference: ICD-9 2011 includes simply 162.2 (Malignant neoplasm of main bronchus). On the other hand, ICD-10 2011 offers options specific to location:

Unspecified: C34.00 -- Malignant neoplasm of unspecified main bronchus

Right: C34.01 -- Malignant neoplasm of right main bronchus

Left: C34.02 -- Malignant neoplasm of left main bronchus.

ICD-10 2011 also lists an instruction to 'use additional code to identify':

Exposure to environmental tobacco smoke (Z77.22)

Exposure to tobacco smoke in the perinatal period (P96.81)

History of tobacco use (Z87.891)

Occupational exposure to environmental tobacco smoke (Z57.31)

Tobacco dependence (F17.-)

Tobacco use (Z72.0).

Likewise, ICD-10 2011 also lists an instruction to "Use additional code to identify":

Exposure to environmental tobacco smoke (Z77.22)

Exposure to tobacco smoke in the perinatal period (P96.81)

History of tobacco use (Z87.891)

Occupational exposure to environmental tobacco smoke (Z57.31)

Tobacco dependence (F17.-)

Tobacco use (Z72.0).

So when ICD-10 goes into effect on October 1, 2013, you should apply the codes and official guidelines in effect at that time (or more specifically always use the codes and guidelines effective for the relevant date of service ).

Article Source :- http://www.supercoder.com/coding-newsletters/my-icd-10-coding-alert/reader-question-c34-requires-location-for-malignant-neoplasm-of-main-bronchus-108832-article

New Choice to Boost your Diagnosis Coding

ICD-9 Codes 2011 going to effect in October, and here new ‘attention deficit’ to boost your Diagnosis Coding

The 2011 ICD-9 codes going into effect on October 1 have a few welcome additions for younger patients. Here are some examples of new diagnoses you could find yourself reporting on a regular basis.

Attention deficit options provide a better starting point ICD-9 2011 adds the 799.5x family to the ‘I’ll defined and unknown causes of morbidity and mortality’ section. The just-arrived codes include:

799.51 -- Attention or concentration deficit

799.52 -- Cognitive communication deficit

799.53 -- Visuospatial deficit

799.54 -- Psychomotor deficit

799.55 -- Frontal lobe and executive function deficit

799.59 -- Other signs and symptoms involving cognition.

This new series will be useful for symptoms and signs as a diagnosis before the doctor establishes a definitive diagnosis. Physicians treat children with concerns regarding attention or activity. You do not have sufficinet information after the first visit for an official diagnosis; but then you still need something to report.

V codes address retained fragments

ICD-9 2011 also comes up with a series of specific V codes for diferent types of retained fragments. The series (V90.01- V90.9) address objects ranging from metal, plastic or wood to animal quills or spines, glass, teeth, and other specified foreign bodies, including radioactive fragments.

Remember that you won’t report a code for foreign body removal in conjunction with V90.x. These foreign bodies are retained. You will deal with it in terms of the patient’s history and physical, however not an actual procedure to remove the object.

Want to know more about these attention deficit choices and other 2011 ICD-9 code(http://www.supercoder.com/icd9-codes/) changes? Just stay tuned to a medical coding guide like Supercoder.