ICD-9-CM: Shifts in Respiratory Conditions

Don't report 488.12 except if the physician verifies H1N1 influenza. Learn what code should fit your claim.

In case you're intimidated by the thought of going through each and every diagnostic coding change that went into effect on Oct. 1, 2011, you should not worry any more. Grab the insider's information with this rundown on some of the new respiratory system diagnosis codes that have an effect on you.

Quick reference: You should always check equally the diagnoses index as well as the tabular list in order to select the correct codes to include on your encounter form.

Keep Up With Fresh Novel Influenza Code Amendments

With this condition repeatedly developing new forms, ICD-9-CM has made changes to new influenza codes for three years in a row. Changes to the novel influenza codes were suggested by the CDC National Center for Immunization and Respiratory Diseases (NCIR).

A novel subcategory 488.8 (Influenza due to novel influenza A) as well as related codes have been made to report Novel influenza A. They are:

488.81 -- Influenza owing to identified novel influenza A virus including pneumonia

488.82 -- Influenza owing to identified novel influenza A virus including other respiratory manifestations

488.89 -- Influenza owing to identified novel influenza A virus including other manifestations.

Definition: Novel influenza cover all human infections including influenza A viruses that are either new or unlike presently circulating human influenza viruses. These involve viruses subtyped as nonhuman in starting point, and those that cannot be subtyped by means of standard laboratory methods.

Providers frequently refer to the 2009 pandemic influenza as 2009 H1N1 influenza rather than novel H1N1 influenza, as a result ICD-9-CM has revised the following listed codes, with preceding references to "novel" in their descriptors to modify to "2009." The codes involve:

488.11 – i.e Influenza owing to identified 2009 H1N1 influenza virus including pneumonia

488.12 -- i.e Influenza owing to identified 2009 H1N1 influenza virus including other respiratory manifestations

488.19 -- i.e Influenza owing to identified 2009 H1N1 influenza virus including other manifestations.

Turn To 512.2 While Reporting Postoperative Air Leaks

ICD-9-CM has implemented revisions and novel codes made to Category 512 to distinguish air leaks from pneumothorax. This category is at the present labeled pneumothorax and air leaks.

New code: You are now allowed to report postoperative air leaks by means of 512.2 (Postoperative air leak). You before reported this particular situation using code 512.1 (Iatrogenic pneumothorax), which was confusing as a patient might go through a postoperative air leak with no significant air in the pleural space leading to pneumothorax. ICD-9-CM forbids reporting 512.1 or 512.2 except the physician documentation specially denotes postoperative or because of a procedure.

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-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

Coding Life Becomes Easier With This Denial Busting Tool

Is the CPT-ICD 9 code linkage pushing you towards denials? Well, ICD Cross-Ref tool lets you know whether you are safe.

To get this Cross-Ref tool and stay away from denials, sign up for Supercoder as the site has come up with this denial busting tool with effect from November 2. This CrossRef allows a coder to look up a surgical CPT procedure code and see which diagnosis codes Medicare and private payers allow.

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Not just this, there are more reasons now to become members of Supercoder as it puts more spot on coding with Lay Terms for every CPT code (http://www.supercoder.com/cpt-codes) for major specialties. And to add to it all, SuperCoder Codesets & Tools and Advantage members should look for this feature in addition to visually helpful anatomical illustrations under Code Details.

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