ICD-9 UPDATE FY 2006

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ICD-9 UPDATE FY 2006 Powered By Docstoc
					    ICD-9 UPDATE
       FY 2006

Dale Gaudio, RHIA, CCS-P, CPC, CPC-H
                   September 15, 2005
        Summary of Changes
•   16 New DRGs
•   161 New Diagnostic codes
•   36 New Procedure Codes
•   19 Deleted Procedure Codes
•   28 Revised Diagnosis Codes
•   15 Revised Procedure Codes

                                 2
    Joint Replacement Coding
• Delete DRG 209
• New DRG 544 Major Joint
  Replacement or Reattachment of
  Lower Extremity
• DRG 545 Revision of Hip or Knee
  Replacement
• New codes for Hip and Knee Surgeries

                                     3
     Mechanical Complication
• 996.40 Unspecified
• 996.41 Mechanical Loosening of
  prosthetic joint
• 996.42 Dislocation of Prosthetic
  Joint
• 996.43 Prosthetic Joint Implant
  Failure
                                     4
    Mechanical Complications
• 996.44 Peri-Prosthetic Fracture
  around prosthetic joint
• 996.45 Peri-Prosthetic osteolysis
• 996.46 Articular Bearing Surface
  wear of prosthetic joint
• 996.47 Other mechanical complication
  of implant
• 996.49 Other/Internal Ortho device
                                     5
    Revision of Knee Replacement
•   00.80    All Components
•   00.81    Tibial Component
•   00.82    Femoral Component
•   00.83    Patellar Component
•   00.84    Tibial Insert (liner)
•   84.56   Insertion of (cement) spacer
•   84.57   Removal of (cement) spacer
                                           6
  Revision of Hip Replacement

• 00.70 Both Acetabular and
        Femoral Components
• 00.71 Acetabular Component
• 00.72 Femoral Component
• 00.73 Acetabular Liner and/or
        Femoral Head Only.

                                  7
           Spinal Surgery
• New DRG 546 Spinal Fusions
  Except Cervical with Curvature of
  the Spine or Malignancy
  – 170.2
  – 198.5
  – 733.13
  – Procedure codes of spinal fusion

                                       8
        Chronic Kidney Disease

•   Expansion of code 585
•   Definition include renal insufficiency
•   Do not code 593.9 for CRI
•   http://www.nkdep.nih.gov
•   Disease for Longer than 3 months


                                         9
      Chronic Kidney Disease
• 585.1 Stage I chronic kidney disease
   – Kidney damage with normal or increased
     glomerular
   – filtration rate (GFR), > or equal to
   – 90 ml/min/1.73m2
• 585.2 Stage II chronic kidney disease
   – Kidney damage with mild decrease in
     glomerular filtration rate (GFR), 60-89
     ml/min/1.73m2

                                          10
      Chronic Kidney Disease
• 585.3 Stage III chronic kidney disease
   – glomerular filtration rate (GFR), 30-
     59 ml/min/1.73m2
• 585.4 Stage IV chronic kidney disease
   – Kidney damage with severe decrease
     in glomerular filtration rate (GFR),
     15-29 ml/min/1.73m


                                        11
      Chronic Kidney Disease
• 585.5 Stage V chronic kidney disease
  – Kidney damage with glomerular
    filtration rate (GFR)
  – of less than 15 ml/min/1.73m2
  – Kidney failure with GFR less than 15
    ml/min/1.73m2 not on dialysis
• 585.6 End stage renal disease
  – Stage V chronic kidney disease with
    patient on dialysis
                                           12
      Chronic Kidney Disease
• 585.9 Chronic kidney disease, unspecified
   – Chronic renal insufficiency
   – Chronic renal failure NOS
• 250.4 Diabetes with renal manifestations
   – Use additional code for CKD (585.1-
     585.9)
• 403 Hypertensive renal disease
   – Use additional code for CKD (585.1-
     585.9)
                                         13
             Dehydration
• 276.50 Volume depletion,
  unspecified
• 276.51 Dehydration
• 276.52 Hypovolemia
  – Depletion of volume of plasma




                                    14
             Cardiology

• 426.82 Long Q-T syndrome
• 410.0 to 410.6 and 410.8 are all ST
  elevation MI
• 410.7 Non ST elevation MI
  – Subendocardial infarction



                                        15
           New Stent Codes
• Delete 36.01-36.02 and 36.05
   – PTCA and Stent Placement
• 00.66 New PTCA and then code
• 00.40 Procedure on single vessel
• 00.41-00.43 for 2, 3 and 4 vessels
• 00.45 Insertion of one Vascular Stent
• 00.46-00.48 for 2, 3 and 4 stents

                                          16
             New DRGs
• 547 and 548 Coronary Bypass with Cath
   – With major CV diagnosis
   – Without major CV diagnoses
• 549 and 550 Coronary Bypass W/O Cath
   – With major CV diagnosis
   – Without major CV diagnoses
• Delete 107 and 109

                                      17
Pacemaker and Other Procedures
• DRG 551 Permanent Cardiac
  Pacemaker Implant w/ Major CV
  diagnosis or AICD Lead OR Generator
• DRG 552 Other Permanent cardiac
  pacemaker implant w/o Major CV
  diagnosis
• Change to DRG 103
   – Both 37.65 (VAD) and 37.64

                                        18
   Diabetic Eye Complications
• 362.03 Nonproliferative Diabetic
  Retinopathy NOS
• 362.04 Mild
• 362.05 Moderate
• 362.06 Severe
• 362.07 Diabetic Macular Edema

                                     19
       Diabetic Neuropathy
• 357.20 Unspecified polyneuropathy
  in diabetes
• 357.21 Asymptomatic neuropathy in
  diabetes
• 357.22 Symptomatic neuropathy in
  diabetes
• 357.23 Disabling neuropathy in
  diabetes
                                  20
          Suicidal Ideation

• V62.84 Suicidal Ideation
  – Excludes: suicidal tendencies (300.9)




                                            21
       Urinary Obstruction

• 5th Digit Expansion
• 599.60 Urinary Obstruction,
  Unspecified
• 599.69 Other Urinary Obstruction
• Notation to see BPH when it is due to
  that condition.

                                     22
             New Codes

• 251.6 Secondary Diabetes
• 997.3 Expansion
  – 997.31 Respiratory Complications
  – 997.32 Mechanical Failure of
           Respirator



                                       23
            Sleep Changes
• 291.82 Alcohol-induced sleep disorders
• 292.85 Drug-induced sleep disorders
• 307.41 Transient disorder of initiating
  or maintaining sleep
• 307.42 Persistent disorder of initiating
  or maintaining sleep
• 307.44 Persistent disorder of initiating
  or maintaining wakefulness
                                        24
           Sleep Changes
• 349.40 Organic hypersomnia,
  unspecified
• 349.41 Recurrent hypersomnia
• 349.42 Hypersomnia due to non-mental
  health condition classified elsewhere
• 349.43 Hypersomnia due to mental
  health condition (code that first)
• 349.49 Other organic hypersomnia

                                      25
           Sleep Apnea Codes
•   349.50 Organic sleep apnea, unspecified
•   349.51 Primary central sleep apnea
•   349.52 High-altitude periodic breathing
•   349.53 Obstructive sleep apnea New
    code 349.54 Idiopathic sleep-related
    non-obstructive alveolar
    hypoventilation


                                         26
            Sleep Apnea

• 349.55 Sleep-related hypoventilation
  or hypoxemia in other conditions
• 349.56 Central sleep apnea in other
  conditions
• 349.59 Other organic sleep apnea



                                     27
   Even More Sleep Disorders
• 327.3x Circadian Sleep Rhythm
         disorders
• 327.4x Parasomnia Disorders
• 357.5x Sleep related movement
         disorders



                                  28
          Peritoneal Disorders
•   567.21 Peritonitis (acute) generalized
•   567.22 Peritoneal Abscess
•   567.23 Spontaneous bacterial peritonitis
•   567.29 Other suppurative abscess
•   567.31 Psoas Muscle Abscess
•   567.38 Other retroperitoneal Disorders
•   567.39 Other retroperitoneal disorders
•   567.81 Choleperitonitis
                                          29
        Peritoneal Disorders

• 567.82 Sclerosing mesenteritis
• 567.89 Other specified peritonitis




                                       30
           Anemia/MDS
• 202.9 Other and unspecified
  malignant neoplasms of lymphoid
  and histiocytic tissue
  – Add Myelodysplastic syndrome
  – Add Refractory anemia
• Do not use 238.7 for MDS
• Do not use 284.9 for Refractory
  Anemia
                                    31
              Impotence

• 607.84 Impotence of organic origin
  – Impotence NOS
  – Revise Excludes: nonorganic (302.72)




                                           32
         Changes to V-codes

• V61 Series
  – Includes additional notations for
    clarification of relationships between
    people.
• V62 Series
  – Other additional notations.


                                             33
          History V-codes
• V12.61 Personal History of
  Pneumonia
• V12.69 Personal History of other
  respiratory diseases
• V13.02 Hx of Uninary Tract Infection
• V13.03 Hx of Nephrotic Syndrome
• V15.88 Hx of Fall

                                     34
          Family History
• V17.81 Family history of
         osteoporosis
• V17.89 Family history of other
         musculoskeletal diseases
• V18.9 Family History, Genetic
         Disease carrier
• V49.84 Bed Confinement Status
                                    35
          Chemotherapy
• Expand V58.1
• V58.11 Encounter for
          Antineoplastic chemotherapy
• V58.12 Encounter for
          immunotherapy for
          neoplastic condition
• Still mapped to 410 or 492 for DRG
                                   36
  Contraindication for Vaccines
• V64.01 due to acute illness
• V64.02 due to chronic illness
• V64.03 due to immune compromised
         state
• V64.04 due to allergy to vaccine
• V64.05 due to caregiver refusal
• V64.06 due to patient refusal
• V64.08 patient has had disease already
                                           37
           More V-codes

• V72.42 Pregnancy test, positive
         result
• V72.86 Encounter for blood typing
• V85.0-V85.4
  – Body Mass Index codes
  – Used only for adults

                                      38
            Questions????
       Dale.Gaudio@med.va.gov
      Barbara.Millas@med.va.gov

        Coding Council Website
http://vaww.appc1.va.gov/codequest/index.cfm




                                         39
      Continuing Education
• AHIMA
 – Self report 1 hour CE
• AAPC
 – Validation # DVAEES0607051040




                                   40

				
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