As on every Oct. 1, there are additions and deletions to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code set. Practices need to review their frequently used diagnosis codes and then prepare to update their documents and systems to accommodate the code changes.
Q: Are there many modifications that apply to internists?
A: Yes, even more than last year. In addition to the code changes listed here, there are also numerous updates to category headings and the exclusions notes that appear in the subcategories. Although this article focuses on the codes that will have the greatest impact on the specialty, many others are not included here. You will want to be sure to check your ICD-9 codebook for the sections that you use most frequently.
Q: I thought that ICD-9 was being replaced. When will that happen?
A: That will be the ICD-10 coding system, the next revision of the ICD set. It is scheduled to go into effect on Oct. 1, 2013. On that date, all physician practices and other health care providers will be expected to have their systems and documents ready to use the new code set. The ICD-10 diagnosis codes will be required for use on all Health Insurance Portability and Accountability Act of 1996 (HIPAA) transactions, including outpatient claims with dates of service and inpatient claims with dates of discharge on or after Oct. 1, 2013.
ACP is preparing a series of educational pieces for its members, which will be announced and made available in the near future. Until Oct. 1, 2013, continue to use the ICD-9 codes.
Q: What are the most relevant ICD-9 code changes that I need to incorporate into my practice beginning this October?
A: Lists of the specific, relevant changes are shown below. The first list shows the deleted codes that will be invalid on and after Oct. 1, 2010 and are being replaced with new, more specific codes found in the second list. Also note that there are a number of “V-codes” (sometimes called status codes) for recording a patient's personal medical history and for delineating a patient's body mass index (BMI).
An illustrative description of a specific, relevant code change is the expansion of diagnosis code options to indicate influenza. Last year, code 488 (influenza) was expanded to a category with two new codes added: 488.0 and 488.1. These codes were created to provide data on the novel H1N1 influenza virus (also known as swine flu) and avian influenza (also known as bird flu), respectively. Each single, four-digit code has been replaced with three five-digit codes for this year.
Deleted diagnosis codes for 2010
275.0 Disorders of iron metabolism [replaced]
488.0 Influenza due to identified avian influenza virus [replaced]
488.1 Influenza due to identified novel H1N1 influenza virus [replaced]
787.6 Incontinence of feces [replaced]
V25.1 Encounter for insertion of intrauterine contraceptive device [replaced]
V85.4 Body mass index 40 and over, adult [replaced]
New diagnosis codes added for 2010
275.01 Hereditary hemochromatosis
275.02 Hemochromatosis due to repeated red blood cell transfusions
275.03 Other hemochromatosis
275.09 Other disorders of iron metabolism
276.69 Other fluid overload
278.03 Obesity hypoventilation syndrome
488.01 Influenza due to identified avian influenza virus with pneumonia
488.02 Influenza due to identified avian influenza virus with other respiratory manifestations
488.09 Influenza due to identified avian influenza virus with other manifestations
488.11 Influenza due to identified novel H1N1 influenza virus with pneumonia
488.12 Influenza due to identified novel H1N1 influenza virus with other respiratory manifestations
488.19 Influenza due to identified novel H1N1 influenza virus with other manifestations
780.33 Post-traumatic seizures
784.92 Jaw pain
787.60 Full incontinence of feces
787.61 Incomplete defecation
787.62 Fecal smearing
787.63 Fecal urgency
970.81 Poisoning by cocaine
970.89 Poisoning by other central nervous system stimulants
V11.4 Personal history of combat and operational stress reaction
V13.62 Personal history of other (corrected) congenital malformations of genitourinary system
V13.63 Personal history of (corrected) congenital malformations of nervous system
V13.64 Personal history of (corrected) congenital malformations of eye, ear, face and neck
V13.65 Personal history of (corrected) congenital malformations of heart and circulatory system
V13.66 Personal history of (corrected) congenital malformations of respiratory system
V13.67 Personal history of (corrected) congenital malformations of digestive system
V13.68 Personal history of (corrected) congenital malformations of integument, limbs, and musculoskeletal systems
V15.53 Personal history of retained foreign body fully removed
V25.11 Encounter for insertion of intrauterine contraceptive device
V25.12 Encounter for removal of intrauterine contraceptive device
V25.13 Encounter for removal and reinsertion of intrauterine contraceptive device
V49.86 Do not resuscitate status
V49.87 Physical restraints status
V62.85 Homicidal ideation
V85.41 Body mass index 40.0-44.9, adult
V85.42 Body mass index 45.0-49.9, adult
V85.43 Body mass index 50.0-59.9, adult
V85.44 Body mass index 60.0-69.9, adult
V85.45 Body mass index 70 and over, adult
Q: Where can I find the complete list of changes?
A: The changes listed here represent just a small sample. The entire list of ICD-9 changes can be downloaded from the Centers for Disease Control and Prevention website here and here. In addition, ICD-9 coding tools for internists are available on the ACP website.