ICD-9-CM: 997.4 Makes Way for Four New Codes for Bariatric Procedures

Proposed ICD-9-CM code set for 2012 has changes for gastric band or bariatric procedures, pelvic circle fracture codes, skin cancer dx and more.

If the proposed ICD-9 CM codes become final, starting October 1 this year you will have four new codes to report complications of gastric band or bariatric procedures. This time you will get 539.xx and other new, invalid and revised codes that will have an impact on your general surgery practices.

Bariatric surgery or gastric band procedure: Presently, complications related to these are indexed to 997.4 as there is no secondary code to use. But all that is set to change on October 1, 2011 if the proposed codes - 539.01, 539.09, 539.81 and 539.89 - become final. When these codes go into effect, you can start reporting bariatric/gastric band complications with one of these four codes.

Note: ICD-9 adds an 'excludes' note to 997.4, and directs coders to these just-in codes.

These four codes come with a lot of advantages: The existing code 997.4 does not distinguish digestive system complications from bariatric or gastric band surgeries from complications owing to any other procedures or conditions. These new codes provide better data collection for bariatric and gastric band procedures.

Skin excision & ICD-9 2012: Apart from these changes, ICD-9 2012 proposed changes will expand 10 present codes to 40 new codes that you will have to use when your surgeon carries out a skin excision. Skin site distinguishes the 10 existing codes (173.0-173.9) that will become invalid.

Although the same site distinctions remain in the just-in codes, ICD-9 2012 adds a fifth digit to each four digit code to differentiate cancer type.

Here are four fifth digits to distinguish each site-specific four digit code based on neoplasm details:

0 -- Unspecified malignant neoplasm of

1 -- Basal cell carcinoma of

2 -- Squamous cell carcinoma of

9 -- Other specified malignant neoplasm of

Pelvic circle fracture code search: Under ICD-9 2012 , there will be more precise coding choices as far as pelvic fracture codes are concerned. The just-in codes will be specific to 'without disruption: 808.44 and 808.54. These codes will offer choices to 'with disruption' codes 808.43 and 808.53.

For more details on the proposed ICD-9 code changes for 2012, sign up for a good coding resource like SuperCoder that provides you with fast online searches for this code set.

ICD-9-CM codes: More Specificity for Neoplasm and Glaucoma Stages

Apart from new codes for acute respiratory failure and other complications after surgery, this time ICD-9-CM also brings five new V codes.

The ICD-9 Coordination and Maintenance Committee will implement a partial breeze of the ICD-9-CM and ICD-10 codes before transitioning to ICD-10. On October 1 this year, the last regular, annual updates to both ICD-10 and ICD-9-CM code sets will be made. As such, you need to brush up on the latest code choices now.

Now you will have more choices for lip neoplasm and glaucoma

This year, you need to pay special attention to expanded lip neoplasm and glaucoma choices in addition to new codes for acute respiratory failure and other complications after surgery. In other words, when ICD-9-CM codes go into effect, you will be able to locate some neoplasms and glaucoma stages more specifically:

Neoplasm codes 173.0-173.9 will take the exit path and be replaced by just-in fifth-digit choices 173.00-173.99 while glaucoma codes will expand to the fifth-digit level in order to differentiate the different stages. The just-in codes will be 365.70-365.74.

Fifth digit expansions to codes: This will help coders and physicians start thinking in terms of more detailed diagnoses.

Apart from this, you also need to get familiar with diagnosis changes for surgical procedures since anesthesiologists can find themselves covering all surgical areas. Just-in ICD 9 procedure codes (surgical) choices include:

539.01-538.89

629.31

726.13

518.81, 518.83, 518.84, 518.51

New codes: ICD-9 2012 ( Source "http://www.supercoder.com/icd9-codes/") will provide you with five V codes to help your physician better indicate conditions a patient might have as part of her personal or family medical history. The new options will include V12.21, V12.29, V12.55, V13.81 and V13.89.


Revised codes: As far as the revised codes are concerned, there are many migraine diagnoses listed. The descriptors are the same, but then the punctuation changes to some extent. Revised descriptors add a comma after the ‘so stated’ phrase in the fifth-digit ‘1’ subclassification descriptor for each type of migraine noted

Eye Infection, Strep Diagnoses Post ICD-10

When ICD-10 goes into effect, you will have to gear up for changes across the board as far as diagnosis coding is concerned. Many a time, you will have more choices that may need changing the way you document services and a coder reports it. Take a look at the following examples of how ICD-10 will alter your coding choices after October 1, 2013.

Get on top of upcoming eye infection coding changes

Conjunctivitis is an eye infection that can affect patients of all ages. And most likely your practice is familiar with the signs and symptoms of this condition. However, like all other conditions, conjunctivitis will come under new codes after ICD-10 goes into effect.

Presently, there are several coding options for conjunctivitis, depending on the type of condition that the doctor treats. Under ICD-10, you will not only have to denote the specific type of conjunctivitis by using the most proper diagnosis code, but you'll also have to point out which eye was affected.

Documentation: Already, your doctors should be including the affected eye in their documentation. As a coder, all you need to do to capture this already present information is to format your superbill to capture the additional anatomical information.

Medical coder tips: On your superbill, after ‘conjunctivitis, list the available choices to prompt the doctor to enter this information. A condensed system could include:

H10.3x, Unspecified acute conjunctivitis (x=0 for unspecified eye, 1 for right eye, 2 for left eye, and 3 for bilateral)

H10.40x (x=1 for right eye, 2 for left eye, 3 for bilateral, and 9 for unspecified eye)

Key: Remember that the "x" digits in the H10.3x and H10.40x examples above do not translate exactly from one conjunctivitis condition to the other. For H10.3x, a "0" for the final digit refers to an unspecified eye, whereas for H10.40x, a "9" for the final digit refers to an unspecified eye. As such, physician training will be imperative for this condition, and the coder should screen all conjunctivitis diagnoses right away post ICD-10 implementation prior to sending out claims to the insurer.

Strep throat coding changes should be minimal

Probably, primary care practices see patients with symptoms of strep throat every day, and this common illness is marked by pain and redness in the throat, potential fever, and sometimes flushed cheeks (scarlet fever).

While using the ICD-9-CM code set, you use 034.0 (Streptococcal sore throat) if the patient suffers from streptococcal sore throat. The ICD-9 manual also points you to this code if the patient suffers from streptococcal tonsillitis.

ICD-10 changes: With effect from October 1, 2013, you will not have a simple catch-all code for streptococcal throat infections. In its place, ICD-10 codes (Source "http://www.supercoder.com/icd-10/")will differentiate between the following two types of conditions:

J02.0 (Streptococcal pharyngitis)

J03.00 (Acute streptococcal tonsillitis, unspecified)

J03.01 (Acute recurrent streptococcal tonsillitis)

Documentation: You shouldn't report the strep] throat diagnosis code unless your practice gets confirmation from a lab test (either rapid strep or throat culture) indicating that the patient tested positive for a streptococcal throat infection. If you do not have a positive lab test confirming strep throat, you should just report the diagnosis codes for the symptoms (sore throat, fever, scarlet fever, etc.)

As such, your documentation must include a copy of the laboratory report confirming that the patient had strep throat prior to selecting your diagnosis code.

Key: Your doctor will require to clearly note which type of throat condition the patient has. Contrary to previous years, when one code covered both streptococcal pharyngitis and streptococcal tonsillitis, that will not be the case post ICD-10. As such, it'll be important for your documentation to include a notation of whether the patient's streptococcal infection affected the pharynx or the tonsils.

What's more, if the patient suffers from streptococcal tonsillitis, you'll have to further delineate whether he's experiencing an acute or recurrent condition. If you use J03.01 (recurrent), your documentation will have to confirm that the patient has suffered from the condition in the past.

Medical coder tips: See to it that you print both new strep throat codes on your superbills before ICD-10 goes into effect. You should also let your practitioners know that they'll need to differentiate between streptococcal pharyngitis versus streptococcal tonsillitis.