American College of Physicians: Internal Medicine — Doctors for Adults ®

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Update ICD-9 coding materials now to meet October deadline

From the September ACP Internist, copyright © 2008 by the American College of Physicians

By Brian Whitman

Every summer, the CDCís National Center for Health Statistics announces changes to the ICD-9-CM and the new codes go into effect Oct. 1. In the past, CMS allowed physicians to use both the old and new diagnosis codes for the first three months of implementation, but that has not been the case for a number of years. Physicians must now discontinue use of deleted codes and begin using new codes every October. Many private insurers follow the same rules, so it is best to update your ICD-9 coding material this month.

Q: What changes have the biggest impact on internists?

A: There were several hundred changes to the ICD-9 codes for this year. Many of the codes are not commonly used by most general internists.

Still, it is important to remember that physicians are required to use the most specific code or codes possible when assigning diagnoses on a claim form. ICD-9 codes are used to determine appropriate payment for services and make coverage decisions, and they can be an important tracking tool for public health statistics. ICD-9 code assignment is also important for physicians who plan to participate in Medicareís Physician Quality Reporting Initiative (PQRI), because the diagnosis determines which patients would require quality reporting codes.

The following changes will go into effect on Oct. 1. The first sections are codes that were deleted in favor of more specific five-digit ICD-9-CM codes.

Deleted
599.7 Hematuria

Replaced with
599.70 Hematuria, unspecified
599.71 Gross hematuria
599.72 Microscopic hematuria

Deleted
780.6 Fever

Replaced with
780.60 Fever, unspecified
780.61 Fever presenting with conditions classified elsewhere
780.62 Postprocedural fever
780.63 Postvaccination fever
780.64 Chills (without fever)
780.65 Hypothermia not associated with low environmental temperature

As usual, a long list of ICD-9 diagnosis codes has been added. Codes common to internal medicine include:

038.12 Methicillin-resistant Staphylococcus aureus septicemia
078.12 Plantar wart
339.00 Cluster headache syndrome, unspecified
339.01 Episodic cluster headache
339.02 Chronic cluster headache
339.03 Episodic paroxysmal hemicrania
339.04 Chronic paroxysmal hemicrania
339.05 Short lasting unilateral neuralgiform headache with conjunctival injection and tearing
339.10 Tension type headache, unspecified
339.11 Episodic tension type headache
339.12 Chronic tension type headache
339.20 Post-traumatic headache, unspecified
339.21 Acute post-traumatic headache
339.22 Chronic post-traumatic headache
339.41 Hemicrania continua
339.42 New daily persistent headache

The complete list of codes is too long to include in this column. A significant number of codes were added in the area of leukemia (204.xx), carcinoid tumors (209.xx), secondary diabetes mellitus (249.xx), migraine (346.xx), erythema (695.xx), and other areas.

The full list of added, deleted, and revised codes can be found online.

Q: Can I bill Medicare for diabetes self-management training?

A: Yes, but there are restrictions on when diabetes self-management training (DSMT), is a covered service. First, the provider must be accredited to perform DSMT under the standards of a recognized national organization, such as the American Diabetes Association. Of course, this service is restricted to patients with diabetes.

The DSMT must be ordered by a physician and up to 10 hours of initial training the patient receives may be covered by Medicare.

Self-management as defined by Medicare includes instructions in self-monitoring of blood glucose; education about diet and exercise; an insulin treatment plan developed specifically for the patient who is insulin-dependent; and motivation for patients to use the skills for self-management.

Brian Whitman is Associate for Regulatory and Insurer Affairs in ACPís Washington, D.C. office. E-mail your coding questions to acpinternist@acponline.org.

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