285.3 vs. 284.89: Documentation of 'Aplastic' Can Lead to Accurate Coding

Know which condition is more probable to be caused by chemotherapy.

Patients with cancer might develop anemia from numerous cases. Here are some clues to help you identify the source and keep your medical coding compliant.

This article digs into proper anemia medical coding, looking at ICD-9 codes for anemia caused by treatment and at how guidelines are expected to change when ICD-10 use becomes mandatory in 2013.

Reassess Documentation Before You Assign 284.89

When documentation shows that antineoplastic chemotherapy caused a patient's anemia, you need to consider two ICD-9 codes:

285.3 (Antineoplastic chemotherapy induced anemia)

284.89 (Other specified aplastic anemias, due to drugs)

The main dissimilarity between the two is that 284.89 mentions "aplastic" anemia. Aplasia implies that the bone marrow is wiped,as per Coding Clinic for ICD-9-CM (2009, vol. 26, no. 4).

Antineoplastic chemotherapy induced anemia is not generally an aplastic process. The anemia is likely to be short term, however it might range from mild to severe. Thus 285.3 may be applicable to your patient's claims more often than 284.89, however you must let documentation direct your choice. Before you assign 284.89, ensure that the documentation shows the anemia is aplastic and due to drugs.

Expect a Shake-Up When ICD-10 Begins

Paying close attention to diagnosis coding guidelines will become even more vital as you get ready to use ICD-10 in place of ICD-9. To be specific, the ICD-10 2011 guidelines for anemia coding are different from those you know for ICD-9.

Example 1: A patient comes for treatment of just anemia. The physician documents that the patient's neoplasm caused the anemia to develop.

In ICD-9 2012 guidelines, your first-listed code must report the anemia (285.22). The correct malignancy code(s) must follow (ICD-9, Section I.C.2.c.1).

In case you were instead applying ICD-10 2011 guidelines, you would report the malignancy code first and then the anemia code, D63.0 (Anemia in neoplastic disease) (ICD-10, Section I.C.2.c.1).

Example 2: Another patient comes for treatment of just anemia. For this patient, the physician documents that the anemia is because of chemotherapy or immunotherapy.

Using ICD-9 guidelines, your first-listed code must denote anemia (such as 285.3). You smust report the neoplasm as an added code (ICD-9, Section I.C.2.c.2).

On the other hand, the 2011 ICD-10 guidelines ask you to use an adverse effect code as your first-listed code. Your anemia and neoplasm codes must follow that (ICD-10, Section I.C.2.c.2).

Remember: The guidelines given above reflect ICD-10 2011 guidelines. When ICD-10 goes into effect on Oct. 1, 2013, you will apply the official ICD-10 coding guidelines in effect for the pertinent date of service.

Source Code :- http://www.supercoder.com/coding-newsletters/my-oncology-hematology-coding-alert/part-2-diagnosis-coding-2853-vs-28489-documentation-of-aplastic-can-help-steer-your-coding-107679-article

ICD-9 2012: 173.xx Leads List of ICD-9 Updates

With the subsequent round of revisions, ICD-9 might provide a chance to report skin neoplasm types more precisely.

Though the complete list of suggested ICD-9 updates is fairly short, a number of these are applicable to your oncology and hematology claims. Here are the main proposals to watch for when the codes are finalized in the fall.

Get Precise About Basal and Squamous Cell

CMS's recommended changes to ICD-9 2012 comprise of an expansion of 173.x (Other malignant neoplasm of skin). Every code in that series will get novel fifth digit options, which will deliver added details of the skin neoplasm type.

The modifications in the 173.xx skin cancer codes have a pattern where the fifth digit of "0" discusses about an indefinite malignant neoplasm, "1" signifies basal cell cancer (BCC), "2" denotes squamous cell carcinoma (SCC), and "9" defines "other" definite malignant neoplasm. BCC and SCC are the two most general types of skin cancer.

The ICD-9 Coordination and Maintenance Committee extended the code series resulting from a request from the New York State Cancer Registry to help differentiate reportable skin cancers from non-reportable skin cancers, for instance BCC and SCC. The way these general neoplasms behave clinically is dissimilar enough that separating them would be beneficial.

Caution: The expansion implies that the four-digit 173.x codes become invalid in October as each code in the range will want a fifth digit to be complete. Getting ready for the new and revised ICD-9 code modifications needs you to create better documentation habits.

Not only will refining documentation let you code these situations more precisely, but it will also help prepare you for ICD-10's overall increase in documentation requirements

Acquired Hemophilia Gets Its Own Code

You also must plan for ICD-9 2012 to increase existing four-digit code 286.5 (Hemorrhagic disorder due to intrinsic circulating anticoagulants) into a novel range of five-digit codes:

286.52, i.e. Acquired hemophilia

286.53, i.e. Antiphospholipid antibody including hemorrhagic disorder

286.59, i.e. Added hemorrhagic disorder because of intrinsic circulating anticoagulants, antibodies, or inhibitors.

The changes agree to more precise identification and will help monitor "trials on the cause, self-correction, along with pharmaceutical treatment of these disease categories of haemophilia.

Terms you may see associated with 286.52 involve autoimmune hemophilia, autoimmune inhibitors to clotting factors, as well as secondary hemophilia. Code 286.53 might be used most frequently to report the hemorrhagic disorder with an antibody called lupus anticoagulant or systemic lupus erythematosus.

Source URL :- http://www.supercoder.com/coding-newsletters/my-oncology-hematology-coding-alert/icd-9-2012-173xx-leads-list-of-proposed-icd-9-updates-for-october-107223-article

Update Your Anaphylaxis Terminology

In case you require coding anaphylactic or serum reactions under ICD9 2012, ensure that you must check the index. A range of new codes will shift the options you may be used to.

ICD-9 2012 Choices for Thalassemia Coding

The ICD-9 2012 codes went into effect on October 1 this year; here are some ICD-9 tips to ramp up your oncology coding.

This time ICD-9 2012 has added six new codes for thalassemia: 282.40, 282.43, 282.44, 282.45, 282.46, and 282.47.

ICD-9-CM codes: Under the previous ICD-9, there was a one ICD-9-CM code to capture all non-sickle cell related thalassemias. This one ICD-9 code covers the entire range from asymptomatic patients (silent carrier or thalassemia trait) to patients with severe disease (thalassemia major)

A big portion of thalassemia patients are asymptomatic. Those who suffer from the most severe forms need life-long monthly blood transfusions, iron overload monitoring, chelation therapy and they're candidates for hematopoietic stem cell transplant.

Important: You should review the inclusion list for all of the 282.4x codes. For instance, the list with 282.46 clarifies the code is proper if documentation points to 'silent carrier' or thalassemia trait."

In addition, changes to the inclusion notes for 282.49 show a change for how you code microdrepanocytosis. In place of coding the condition to 282.49 (as you did in the previous one), the recent inclusion note revisions guide you to code the condition to 282.41.

For Pancytopenia, you should mark 284.1 as Invalid. Yet another important change is that now 284.1 is no longer a valid code.

Now you'll need to add a fifth digit: 284.11, 284.12, and 284.19.

Under 2011 ICD-9, coders were confused about how to report drug-induced pancytopenia. The Diagnosis Agenda points to 284.89 as the 2011 code. However since pancytopenia related to drugs wouldn't necessarily be related to aplastic anemia, ICD-9 added the more specific 284.1x codes.

You should split 793.1 to get new SPN code

Make it a point to highlight this change in your coding references, too. Under ICD-9 2012 , 793.1 is no longer a valid code. This time it adds required fifth digit choices for 793.1x.

The changes allow for more specific reporting of a solitary pulmonary nodule (SPN). A patient may have more than one SPN present and each may be in a distinct anatomic area. Doctors may find out SPNs using X-ray, CT, or PET, and biopsy can later recognize the nature of the disease or condition the SPN is related to.

ICD-9 Coding Tips for Your Pediatric Practice

The ICD-9 2012 code changes have just gone into effect on October 1, which means you'll soon need to be well-versed with the latest changes. This time there are not much diagnosis code changes as far as your pediatric practice is concerned. But there are still quite a few that could lead you to denied claims if you're not aware about it.

Here are some pediatric coding scenarios to help your ICD-9 coding:

For instance when a 12-year-old patient presents with influenza due to identified novel influenza A virus with pneumonia you should go for new code 488.81. Prior to this, you'd most likely have used 487.0; however that code did not specify the nature of influenza A.

The ICD-9 Committee has revised the influenza codes several years, which might make coding these conditions confusing; however the most important fact to remember when reporting these illnesses is to check the documentation for confirmation of the type of influenza that the patient suffers from. When you're in doubt, you should check any lab reports or ask the physician to clarify.

What's more, you'll find revised diagnosis code descriptors for the H1N1 codes for these codes: 488.11, 488.12, and 488.19.

And what if a patient comes for a tuberculosis skin test and the results come back showing that the patient experienced a reaction to the test but doesn't have active tuberculosis. Well, from October 1, the ICD-9 code listing has deleted code 795.5 and replaced it with a couple of more specific codes, one of which is the right answer to this question, 795.51.

ICD-9 has also come up with code 795.52 to separate out the former 795.5 category.

And what if a six year old patient presents with a rare anaphylactic reaction owing to a vaccination that your pediatrician administered earlier in the day? Well, in 2012, you'll have a wide range of anaphylactic reaction codes, including 999.42 which describes this situation more specifically than other codes.

Now you will not be able to report previous codes 999.4 and 999.5 as these codes have been axed. Many other anaphylaxis codes have been revised too.

And in a situation where a ten year old patient presents with a migraine headache with aura, but without status migrainosus, you should go for 346.01 now post ICD-9 2012 code changes.

ICD-9 2012 Brings more Specific Choices for Your Ob-Gyn Coding

As the nation celebrates 'Labor Day' in a few days from now, SuperCoder brings you a never-before coding offer - a gift card worth $25 to take your coding to a denial-free and maximum-profit zone.

If you're an ob-gyn coder, this year you'll run into more specific ICD-9 codes; this means you need to get on top of these changes that go into effect on October 1. And the Labor Day offer from SuperCoder couldn't have come at a more opportune time as it provides you with the code look-up tools and specialty advice you need for denial-proof coding.

New ICD-9 codes reflect early spontaneous labor with a planned cesarean delivery

You will choose from among these codes - 649.81 and 649.82 – when a patient was thinking about having the cesarean but went into labor early and had to have the cesarean early. This time round, there is also a new diagnosis to demonstrate a chemical or 'false' pregnancy post October; take a look at 631.0. What's more, if a patient has a blighted ovum or mole, you will go for 631.8.

996.39 will make an exit

From October 1 this year, you'll bid code 996.39 goodbye if the patient has an erosion or exposure of mesh material used during pelvic reconstruction surgery. In place of this, you'll have two more specific choices: 629.31, 629.32.

You need to treat new Hemorrhagic Disorder Codes as Secondary Dx

If a patient who's pregnant has antiphospholipid antibodies, you will have two new codes to use as secondary diagnoses. Note that your primary diagnosis would be from the coagulation defects category (649.3x). And if the patient simply had the antibody as a finding, here the secondary code would be the present code 795.79. If the condition happens to be with a hypercoaguable state, the secondary code would be the current code 289.81. But again if the patient has the antibody and has a present hemorrhagic disorder, you can use a new code - 286.53 – to report it.

To add to it all, ICD 9 also adds an 'Other' code to the 286.5x category - 286.59.

More V code choices

When your ob-gyn documents a patient's personal history, you'll have more V code choices: V12.21, V12.29, V23.42 and V23.87.

And the codes these V codes will be replacing are 631 and V12.2.

ICD-9 2012 Update: 173.0-173.9 Get Specific Next Year with New Fifth Digits

Expanded diagnosis code sets will allow coders to classify whether skin cancer is basal, squamous, or unspecified.

On October 1, dermatology coders will be able to more accurately report the location of carcinomas and other neoplasms of the skin.

The Centers for Medicare & Medicaid Service (CMS) has released its proposed changes to ICD-9 2012, and they include an expansion of the 173.x (Other malignant neoplasm of skin) series. Each code in that series will get a list of fifth digits that will specify whether the malignant neoplasm is basal cell, squamous cell, or unspecified.

Example: Now, dermatology coders would report 173.0 (Other malignant neoplasm of skin of lip) for any non-melanoma malignant neoplasm of the lip. But when ICD-9 2012 becomes effective on October 1, 2011, coders can choose from:

173.00 -- Unspecified malignant neoplasm of skin of lip

173.01 -- Basal cell carcinoma of skin of lip

173.02 -- Squamous cell carcinoma of skin of lip

173.09 -- Other specified malignant neoplasm of skin of lip. Additionally, in October, 173.0 will become an invalid diagnosis code.
The changes in the other skin cancer categories follow this pattern, with the fifth digit of "0" referring to an unspecified malignant neoplasm, "1" denoting a basal cell cancer, "2" referring to a squamous cell carcinoma," and "9" describing another specified malignant neoplasm.

The new, revised, and invalid codes have been approved by the by the ICD-9-CM Coordination and Maintenance Committee and were published in the Federal Register on May 5, 2011. After the new codes take effect on Oct. 1, CMS will only add new ICD-9 codes on an emergency basis as it prepares to switch over the diagnosis coding system to ICD-10.

Get Staff Up to Speed on Changes

With only a few months before implementation, the time to act is now, says Pamela Biffle, CPC, CPC-P, CPC-I, CCS-P, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Austin, Texas.

"Coders will have to maker sure their systems are updated with the new codes," she notes. "Training will have to be done for all the staff."

Good idea: "This is a great example of when to have a lunch and learn session for all providers and other clinical staff that may be assigning diagnosis codes," Biffle suggests. Source URL :-

ICD-9 codes 2012: A new Saddle Embolus Code Likely

Here's a refresher on some of the ICD-9 codes that you might have to use starting October 1.

ICD-9 2012 goes into effect on October 1 this year. As such, you need to be all geared up for the changes. Here are some proposed changes you need to be aware of.

Saddle embolus code: This time you may get to use a new saddle embolus code 415.13. For the uninitiated, a saddle embolus is where you have a very large blood clot that dislodges and then goes through the blood stream and lands in a big division of an artery.

NCHS proposes that the diagnosis gets its own code

This code came to the fore after National Center for Health Statistics (NCHS) realized that there is no ICD-9 index entry pointing to a proper pulmonary saddle embolus choice. Presently, ICD-9 does link the term 'saddle embolus' to the aorta. If you look under 2011 code 444.0, you will see 'saddle embolus' in the inclusion list. However this year's ICD-9 code changes will take that connection a step further. You can anticipate 444.0 to expand to provide more spot on coding: 444.01 (Saddle embolus of abdominal aorta) and 444.09 (Other arterial embolism and thrombosis of abdominal aorta).

Source URl :- http://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/icd-9-2012-74731-promises-new-option-for-pulmonary-artery-disorders-107260-article

Apart from this, ICD-9 2012 intends to add V12.55 to provide a unique code for this part of the patient's history. What's more, you can even expect ICD-9 2012 to expand 747.3 to a range of five-digit codes: 747.31, 747.32 and 747.39. 747.31, the first proposed code refers to coarctation and atresia, both of which currently fall under 747.3.

Apart from these, as a radiology coder, you also need to watch out for expansion of cystostomy complication coding options. The proposal expands 596.8 into a new range of five digit codes.

Also anticipate: To add to it all, 997.5 and 996.39 might also undergo changes.

ICD-9 2012: Embolism Coding Changes in the Offing

This time, ICD-9 code set will bring new embolus codes.

Reflecting Centers for Medicare & Medicaid Services' (CMS) continued effort to strive for greater specificity in diagnosis coding in view of the transition to ICD-10, the agency has posted its proposed changes to diagnosis coding that are scheduled to go into effect on October 1 this year.

As in previous years, ICD-9 2012 has brought with it innumerable additions, changes and deletions. This time there will be around 166 new codes along with 88 deletions and 168 revisions. Neoplasm, digestive system, sense organs, etc. have witnessed the most number of code changes in this edition of ICD-9 code changes.

What's in store for cardiology coders?

As a cardiology coder, if you thought you would sit just back and relax, think again as this time it brings a slew of changes as far as your specialty is concerned. In this direction, be prepared for some new embolus codes.

You should gear yourself up for these new embolus codes:

415.13, Saddle embolus of pulmonary artery

444.01, Saddle embolus of abdominal aorta

444.09, Other arterial embolism and thrombosis of abdominal aorta

V12.55, Personal history of pulmonary embolism.

747.3 (Anomalies of pulmonary artery) may be replaced with codes requiring a fifth digit

One code that has been affected by the ICD-9 2012 changes is 747.3 (Anomalies of pulmonary artery). It is likely to be replaced with codes requiring a fifth digit specify coarctation and atresia, arteriovenous malformation, or other anomalies.

Prepare for it now: Since the code changes will go into effect without grace period, you need to prepare for it now.