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.

Guarantee Accurate Modifier Reporting for EKG with Annual Visit and Submit Clean Claims

New Medicare stand takes you away from modifier 25.

In case your family physician regularly orders an EKG as component of patients' annual visits, you should certainly double check your modifier reporting prior to filing claims. Medicare now needs a modifier on claims reporting EKGs as component of a patient's annual wellness visit (AWV) for dates of service. Read on to know how to submit clean claims in such scenarios.

Scenario: You submit a claim to Medicare using G0438 (Annual wellness visit; includes a personalized prevention plan of service [PPS], initial visit) as well as EKG code 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report). Medicare pays for G0438, but rejects the EKG on the basis that your claim either includes an invalid modifier or doesn't have a modifier.

In case Medicare won't accept modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on these given claims, what are the acceptable options? Read on for guidance from real-world coders on how to submit clean claims for EKG during an AWV.

Move to Modifier 59

As Medicare no longer accepts modifier 25 for these given situations, your best option is modifier 59 (Distinct procedural services).

When you will run the scenario through your code checker for CCI edits after receiving denials, it will indicate that -59 is the only acceptable modifier for code 93000.

Difference: One way to help come to a decision whether to append modifier 25 or modifier 59 to your claim is to take a more detailed look at the service your physician offers. You should only append modifier 25 to an E/M service code. When the physician carries out an EKG together with an annual wellness visit, it is the EKG, not the E/M code that is potentially being bundled. As you are trying to independently report an EKG rather than an E/M code, you can't report modifier 25; you have to use modifier 59 as a substitute if you wish to submit clean claims.

Confirm Diagnosis and Referrals

Even though you should always code based on the physician's documentation, payers have policies stating which diagnoses bear medical necessity for procedures. The two diagnoses they use most frequently for EKG as component of an AWV are 272.4 (Other and unspecified hyperlipidemia) and 401.9 (Unspecified essential hypertension).

Payers from time to time need a referring physician's name and NPI (National Provider Identifier) prior to approving charges for an EKG. If you want to submit clean claims, then you should always check guidelines for the payer in question to authenticate whether the patient requires a referring physician prior to having the EKG.

Click here to submit clean claims and read the whole

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Lookout for Expanded Neoplasm, Personal History Codes That Govern 2012 ICD-9 Updates

Plus: Migraine revisions concentrate on punctuation addition, not descriptor change.

New and revised ICD-9 codes for 2012 went into effect October 1, which means it's time to brush up on the latest code options. You should pay special attention to expand your lip neoplasm as well as glaucoma choices, and more new ICD-9 codes for acute respiratory failure and further complications following surgery.

Expand Digits for Certain Neoplasm, Glaucoma Diagnoses

With ICD-9-CM 2012 going into effect, you are now able to determine some neoplasms and glaucoma stages more precisely:

Neoplasm codes i.e. 173.0-173.9 (Other malignant neoplasm of skin) are now deleted and replaced by new fifth-digit options 173.00-173.99.

Glaucoma codes now expand to the fifth-digit level so as to distinguish the different stages (unspecified, mild, moderate, severe, or indeterminate stage). The new codes are 365.70-365.74.

Reasoning: You'll have much more precise diagnosis options when ICD-10 goes into effect in October 2013. Adding fifthdigit expansions to ICD-9 codes like these now will help coders and physicians start considering in terms of more detailed diagnoses.

Watch for Gastric Band and Other Surgical Additions

As anesthesiologists can find themselves involved in cases encompassing all surgical areas, get acquainted with diagnosis changes for surgical procedures. New ICD-9-CM surgical procedure choices you'll want to check out include:

Infection or complications because of gastric band or bariatric procedures (539.01-538.89)

Erosion of implanted vaginal mesh as well as other prosthetic material near an organ or tissue (629.31)

Partial tear of rotator cuff (726.13)

Acute or chronic respiration failure, in normal conditions or following trauma and surgery (518.81, 518.83, 518.84, 518.51).

An anesthesiologist will report a wide range of diagnosis codes. Whatever someone can have done surgically and require anesthesia for, that's what anesthesiologists are required to know.

Get Familiar With New Personal, Family History Options

Five new V codes will aid your physician better specify conditions which could be a part of patient's personal or family medical history. Your new choices are:

V12.21 –- i.e. Personal history of gestational diabetes

V12.29 -- i.e. Personal history of further endocrine, metabolic, and immunity disorders

V12.55 -- i.e. Personal history of pulmonary embolism

V13.81 -- i.e. Personal history of anaphylaxis

V13.89 -- i.e. Personal history of other stated diseases.

Migraine Revisions Don't Mean Real Change

When you read through the list of revised ICD-9 codes , you'll see many migraine diagnoses listed (for instance 346.01, Migraine with aura, with intractable migraine, so stated, excluding mention of status migrainosus, and 346.11, Migraine without aura, with intractable migraine, so stated, without mention of status migrainosus). The descriptors themselves don't change, but the punctuation changes to some extent. Updated descriptors further add a comma following the "so stated" phrase in the fifth-digit "1" subclassification descriptor for every single type of migraine which is noted.

Source URL :- http://www.supercoder.com/coding-newsletters/my-anesthesia-coding-alert/2012-code-changes-watch-for-expanded-neoplasm-personal-history-codes-that-dominate-2012-icd-9-updates-107385-107385-107385-article

Start Small When Preparing for ICD-10 Conversion

Familiarize yourself with the top 30 diagnoses which you think your practice sees and you'll get an edge towards compliance.

If you've studied the ICD-10 book, you know that it would be virtually impossible to remember all of the codes that it has. But preparing for ICD-10 won't need you to even learn the codes by heart.

Switching from ICD-9 to ICD-10 will not require practitioners to or memorize new code sets--in fact, most practitioners perhaps don't know many ICD-9 codes by heart, so they won't be expected to memorize ICD-10 codes either.

What do physicians need to do for the conversion? To prepare for ICD 9 to ICD-10 conversion, doctors will need to look at the codes they use most regularly in their offices and make novel job aids or superbills for those procedures.


Strategy: Use your list of the top diagnoses that your practice sees to find the corresponding ICD-10 codes, and you've got your cheat sheet. Then, make sure that your coders are well-trained, that your claims are necessarily form 5010 compliant, and also that your claim submission system supplier is ready for ICD-10. Besides, in case you have an electronic medical record or you are planning to get one, ensure that it can handle ICD-10. If you're planning to bring in an EMR, you want to convert to ICD-10 first, not bring one in under ICD-9 and then convert.

Physicians should tighten up documentation: As is the case under ICD-9, coders will be unable to bring together ICD-10 codes from a physician's documentation if it isn't detailed and comprehensive, so physicians should take this as an opportunity to enhance their documentation skills. Coders cannot code what's not present in the medical record. Because there are more opportunities for coders to choose from a list, they're going to be coming back to physicians early on to say 'Wait, I need more definition to help me pick A or B.'

Non-Medicare Payers, Too, Are Prepping for ICD-9 to ICD-10 Conversion

CMS has no plans of postponing the implementation of ICD-10 beyond Oct. 1, 2013. However, not all entities are prepared for the ICD-9 to ICD-10 conversion

Starting July 2011, 11 state Medicaid programs are at high risk for not meeting the ICD-10 implementation date, though 21 states are at moderate risk, 15 are at low risk, and four states have not told CMS as to where do stand in the process.

Interestingly, many non-required entities like workers compensation programs and property and casualty insurers are also working towards ICD-9 to ICD-10 conversion. Besides, keep in mind that CMS is very close to determining how to process claims that span the ICD-10 implementation date.

Source URL :- http://www.supercoder.com/coding-newsletters/my-ophthalmology-coding-alert/icd-10-readiness-start-small-when-prepping-for-icd-10-conversion-cms-says-107689-article

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.

Tips to Ensure a Successful CABG Coding

Here are some tips to ensure a pain-free CABG (coronary artery bypass graft) coding:

You should make it a point to examine the code choices. During CABG procedures, there are three CPT codes for anesthesia: 00562, 00566, and 00567.

The associated base units differ as per the procedure.

You should watch for pump documentation. The first question you need to answer when coding anesthesia during CABG is whether the anesthesiologist used a pump oxygenator during the procedure.

An 'off pump' case takes place when the surgeon operates on the patient's still-beating heart. The physician is required to document 'off pump' before you can report the codes with higher base unit values. It can be worth approximately $85 more for an average Medicare case; however see to it that your anesthesiologist has earned it before you code it.

And just as in any other type of procedure, the key to reimbursement is documentation.

You shouldn't always add qualifying circumstances

Some payers let coders report "qualifying circumstances" codes that explain aspects of the patient's situation that complicated the anesthesiologist's work. Three of these codes - 99100, 99116, and 99135 – might apply to cardiovascular cases.

You shouldn't include these codes with all CABG procedures. Often, Hypothermia is included in the anesthesia code and shouldn't be reported separately in those cases.

You should look for notes that add units

Documentation can sometimes justify extra base units; as such you should read your anesthesiologist's notes and the operative report carefully.

For instance, if the surgeon sews a graft during an off-pump procedure, the anesthesiologist is due one additional unit owing to the increased risk. Also, you can shift from 18 base units with 00567 to 20 base units with 00562 if the CABG procedure includes another heart procedure like valve placement or if the patient is having a re-do CABG more than one month after an original CABG surgery.

To get the full picture, you need to look at the operative note along with the anesthesia record to get the complete picture. If something is mentioned in the surgical note that counts as documentation, you can use in your anesthesia coding.

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.