What you should know about new ICD-9-CM codes
Editor's note: This is the first question-and-answer column on payment issues from ACP-ASIM's Washington Office. The column will answer readers' questions on payment-related topics. Send your questions to Brett Baker via e-mail at firstname.lastname@example.org or via fax at 202-835-0441.
By Brett Baker
Q: Have there been any changes to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes? If so, when must I start using the new codes?
A: HCFA issued ICD-9-CM coding changes in July that went into effect Oct. 1, 1998. There are 65 new codes, 12 invalidated codes and six revised code descriptors. By adding a fifth digit to ICD-9-CM codes, HCFA has made several four-digit codes invalid. The updates also expanded four-digit and five-digit categories to include new codes.
It is important to incorporate these coding changes into your practice, because Medicare will reject any claims with an invalid diagnosis code. Medicare carriers typically give physicians a three-month grace period before enforcing the use of the new codes. To ensure that your claims are processed, you should begin using these new ICD-9-CM codes on all Medicare claims no later than Jan. 1, 1999.
The modest number of changes applicable to internal medicine should make incorporating the new codes relatively easy. Simply noting these changes in your current edition of ICD-9-CM may suffice.
The chart below lists the changes in ICD-9-CM codes by chapter title that ACP-ASIM has identified as most relevant to internists.
Diseases of the respiratory system
Code 482.4, "Pneumonia due to Staphylococcus," is now invalid with the addition of three new five-digit codes:
- 482.40—Pneumonia due to Staphylococcus, unspecified
- 482.41—Pneumonia due to Staphylococcus aureus
- 482.49—Other Staphylococcus pneumonia
Two new five-digit codes were added under the "Other diseases of lung" heading:
- 518.83—Chronic respiratory failure
- 518.84—Acute and chronic respiratory failure
The descriptor for code 518.81, "Respiratory failure," was revised:
- 518.81—Acute respiratory failure
Diseases of the digestive system
Four new five-digit codes were added under the "Disorder of function of stomach" heading:
- 536.40—Unspecified gastrostomy complication
- 536.41—Infection of gastrostomy
- 536.42—Mechanical complication of gastrostomy
- 536.49—Other gastrostomy complication
Code 564.8, "Other specified functional disorder of intestine," is now invalid with the addition of two new five-digit codes:
- 564.81—Neurogenic bowel
- 564.89—Other functional disorder of intestine
Symptoms, signs, and ill-defined conditions
Code 780.7, "Malaise and fatigue," is now invalid with the addition of two five-digit codes:
- 780.71—Chronic fatigue syndrome
- 780.79—Other malaise and fatigue
Five new five-digit codes were added under the "Dyspnea and respiratory abnormalities" heading:
- 786.04—Cheyne-Stokes respiration
- 786.05—Shortness of breath
Injury and poisoning
Code 965.6, "Poisoning by antirheumatics (antiphlogistics)," is now invalid with the addition of two new five-digit codes:
- 965.61—Poisoning by propionic acid derivatives
- 965.69—Poisoning by other antirheumatics
A new five-digit code was added under the "Child maltreatment syndrome" heading:
- 996.56—Mechanical complications due to peritoneal dialysis catheter
A new five-digit code was added under the "Infection and inflammatory reaction due to internal prosthetic device, implant, and graft" heading:
- 996.68—Infection and inflammatory reaction due to peritoneal dialysis catheter
Factors influencing health status and contact with health services
Code V02.5, "Carrier or suspected carrier of other specified bacterial diseases," is now invalid with the addition of three new five-digit codes:
- V02.51—Carrier or suspected carrier of Group B streptococcus
- V02.52—Carrier or suspected carrier of other streptococcus
- V02.59—Carrier or suspected carrier of other specified bacterial diseases
A new five-digit code was added under the "Personal history of malignant neoplasm of genital organs" heading:
- V10.48—Personal history of malignant neoplasm of epididymis
Code V13.6, "Personal history of congenital malformations" is now invalid with the addition of two new five-digit codes:
- V13.61—Personal history of hypospadias
- V13.69—Personal history of congenital malformation
Code V16.5, "Family history of malignant neoplasm of urinary organs," is invalid with the addition of two new five-digit codes:
- V16.51—Family history of malignant neoplasm of kidney
- V16.59—Family history of malignant neoplasm of other urinary organs
Code V18.6, "Family history of kidney diseases," is now invalid with the addition of two new five-digit codes:
- V18.61—Family history of polycystic kidney
- V18.69—Family history of other kidney diseases
A new four-digit code was added under the "Encounter for dialysis and dialysis catheter care" heading:
- V56.2—Fitting and adjustment of peritoneal dialysis catheter
A new five-digit code was added under the "Long-term (current) drug use" heading:
- V58.62—Encounter of aftercare for long-term (current) use of antibiotics
If you would like more help, ACP-ASIM's Center for A Competitive Advantage has developed a list of the ICD-9-CM codes that are most commonly used by internists. This laminated, two-sided sheet is a quick reference tool that can help ensure that you are coding accurately—and to the highest level of specificity. (College members can also get a pocket reference to documentation guidelines for general multisystem examinations, a guide for selecting levels of service and a worksheet to document care plan oversight encounters.) College members can get one copy free by calling ACP-ASIM Customer Service at 800-523-1546, ext. 2600.
If you prefer a comprehensive list, or if you need an updated version of the ICD-9-CM book, you can purchase the AMA's ICD-9-CM 1999 ($53.95 for AMA members, $66.95 for nonmembers) by calling 800-621-8335. It is also available from other vendors.
Brett Baker is a third-party payment specialist at ACP-ASIM's Washington Office.
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