Adapt to ICD-9 changes most relevant to internal medicine

From the October ACP Internist, copyright © 2009 by the American College of Physicians

By Debra Lansey

New and revised International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) diagnosis codes took effect on Oct. 1 to account for evolving needs in data collection and disease incidence reporting. Physicians’ insurance claims must comply with the changes as of that date because insurers, including Medicare, no longer grant grace periods for the transition as they did in the past.

Q: How much of this update does an internal medicine physician need to know?

A: Fortunately, most of the hundreds of deletions, additions and revisions do not apply to internal medicine. The advice for diagnosis coding remains the same: diagnoses should be coded to the level of greatest specificity (to the fifth digit, whenever possible); all claims must include a diagnosis code if they are processed by the payer; and submitted diagnosis codes should reflect the patient’s condition as accurately as possible.

ICD-9 code selection is also important for physicians who are participating in the Medicare Physician Quality Reporting Initiative (PQRI). The diagnosis code determines which patients should receive quality reporting codes.

Q: Can I wait until January to update our office systems and documents?

A: It’s better for each practice to make the code changes now. Remember that the 2010 ICD-9 changes go into effect on Oct. 1, 2009 and the coding changes need to be ready for use on that day. Obsolete ICD-9 codes could result in denied or rejected claims. You should review the entire set of updates, select the ones that are relevant to your practice, and implement them right away.

Q: What specific code changes should I quickly incorporate into my practice?

A: Here are the changes that ACP expects will most affect internal medicine practices:

Deleted

274.0 Gouty arthropathy

Replaced with

274.00 Gouty arthropathy, unspecified

274.01 Acute gouty arthropathy

274.02 Chronic gouty arthropathy without mention of tophus (tophi)

274.03 Chronic gouty arthropathy with tophus (tophi)

Deleted

453.8 Other venous embolism and thrombosis of other specified veins

Replaced with

453.50 Chronic venous embolism and thrombosis of unspecified deep vessels of lower extremity

453.51 Chronic venous embolism and thrombosis of deep vessels of proximal lower extremity

453.52 Chronic venous embolism and thrombosis of deep vessels of distal lower extremity

453.81 Acute venous embolism and thrombosis of superficial veins of upper extremity

453.82 Acute venous embolism and thrombosis of deep veins of upper extremity

453.83 Acute venous embolism and thrombosis of upper extremity, unspecified

453.84 Acute venous embolism and thrombosis of axillary veins

453.85 Acute venous embolism and thrombosis of subclavian veins

453.86 Acute venous embolism and thrombosis of internal jugular veins

453.87 Acute venous embolism and thrombosis of other thoracic veins

453.89 Acute venous embolism and thrombosis of other specified veins

Deleted

488 Influenza due to identified avian influenza virus

Replaced with

488.0 Influenza due to identified avian influenza virus

488.1 Influenza due to identified novel H1N1 influenza virus

As part of the ICD-9 changes, code 488 has been expanded to a category with two new codes added: 488.0 and 488.1. These codes have been created to provide data on the novel H1N1 influenza virus (swine flu).

Deleted

V10.9 Unspecified personal history of malignant neoplasm

Replaced with

V10.90 Personal history of unspecified malignant neoplasm

V10.91 Personal history of malignant neuroendocrine disorder

New diagnosis codes added for 2010

239.89 Neoplasms of unspecified nature, other specified sites

416.2 Chronic pulmonary embolism

438.13 Late effects of cerebrovascular disease, dyarthria

438.14 Late effects of cerebrovascular disease, fluency disorder

Diagnosis code titles revised for 2010

Helicobacter pylori (H. pylori)

453.40 Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity

453.41 Acute venous embolism and thrombosis of unspecified deep vessels of proximal extremity

Q: Where can I find the complete list of code changes?

A: The changes listed above represent just a small sample. The entire list of ICD-9 changes can be downloaded from the CMS Web site. In addition, ICD-9 coding tools for internists are available on the ACP Web site.

Debra Lansey is Associate for Regulatory and Insurer Affairs for ACP.

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