Special Coverage: AHIMA’s 74th Conference in San Francisco
DRG Coding Advisor: ICD-9 code update requires more investigation by coders
The key is: Be specific, document
Coders will be required to learn a variety of new ICD-9-CM codes for fiscal year 2003, as well as change the way they were using some existing codes. These changes are part of the recent trend of the government and the HIM industry moving toward more specific and better documented coding of diagnoses and services.
"A lot of the ICD-9 changes are related to increased specificity and needing documentation to support more specific codes," says Sue Prophet-Bowman, RHIA, CCS, director of coding policy and compliance at the American Health Information Management Association (AHIMA) in Chicago. Prophet-Bowman spoke about ICD-9 coding changes, effective Oct. 1, 2002, at AHIMA’s 74th National Convention and Exhibit, held Sept. 21-26 in San Francisco.
Changes expand diagnostic concepts
For example, there are changes in coding for systolic and diastolic heart failure, Prophet-Bowman says. "We have new codes to identify the distinction."
There are 12 new codes for systolic heart failure. Previously, coders would have used ICD-9 428.0, she adds.
"Pretty much all of the code changes expanded some diagnostic concepts," Prophet-Bowman says. "What was coded nonspecifically in the past, now is broken down into more specific codes."
Furthermore, physicians will need to document these differences. The medical record will have to state what type of heart failure a patient has experienced, whether it’s chronic or not chronic, she says.
AHIMA favors greater attention to detail in coding because, from a data-quality perspective, it will enable coders to code more accurately, and hopefully this will result in appropriate reimbursement, Prophet-Bowman says.
Another area in which ICD-9 codes have changed involves codes in the 700 category, including codes that apply to premature infants.
"In the past, we had codes for prematurity based on birth weight, a combination of birth weight and/or the number of weeks of gestation," Prophet-Bowman notes. "Now they’ve split that out so you can be more specific with two codes with both aspects: One will show the baby’s birth weight, and the second code will show the different ranges and what the completed weeks of gestation were."
Also, there are additional perinatal conditions added to the coding, including primary apnea for a newborn, respiratory failure, bacteremia, urinary tract infections, septicemia, and others.
"Before, those were all lumped into a general infection code, and now it’s broken down into individual conditions so you can tell what kind of infection a baby has," Prophet-Bowman says.
New code for anthrax
Not surprisingly, coders also will see new codes for diagnoses that previously were almost never anticipated or seen, such as for anthrax.
"They have a code for just having a positive test for anthrax, without symptoms, and a code for contact or exposure to anthrax," Prophet-Bowman says. "There’s also a code for observation for suspected exposure to anthrax, such as when someone seeks diagnostic testing because they are concerned they might have been exposed to anthrax, and then it turns out they have not been exposed."
There already exists a code for anthrax as a diagnosis, but the new codes, which are not located near the existing code, are all V codes.
New V codes cover post-acute setting
Coders also should be aware of the whole series of new V codes to describe various services, such as aftercare. These V codes are used when an acute condition is no longer present, but the patient continues to receive aftercare, such as physical therapy, in a post-acute setting like a nursing home or home health.
"I think this reflects the growing population receiving care in the post-hospital setting," Prophet-Bowman says. "We have a lot of members who work in the post-acute setting, and they have been advocating to have better data in those settings."
It’s not enough to have good data on the acute side, because when patients are moved from the acute setting to the post-acute setting, the coders no longer can use the more specific acute codes, she adds.
"The data loss was significant, so a lot of people were coding the acute condition anyway, even though the coding rules said you shouldn’t code it after the acute phase was over," Prophet-Bowman says. "So we were advocating improved data on the post-acute phase so people would adhere to coding rules and not feel like they had to capture the acute condition code, because the post-acute code didn’t tell them anything."
Here are some of the changes made to ICD-9 codes, effective this year:
1. V code changes:
- V71.82: Observation (without need for further medical care) for anthrax.
- V71.83: Observation (without need for further medical care) for biological agent NEC.
- V01.81: A new code for contact with anthrax.
- V58: New codes include V58.43 for aftercare following surgery NEC for injury or trauma; V58.42 for neoplasm; V58.73 for circulatory system; V58.75 for digestive system; V58.76 for genital organs; V58.76 for genitourinary system; V58.78 for musculoskeletal system; V58.72 for nervous system; V58.75 for oral cavity; V58.74 for respiratory system; V58.71 for sense organs; V58.77 for skin; V58.77 for subcutaneous tissue; V58.75 for teeth; and V58.76 for urinary system.
2. Heart failure coding changes:
- 428.40: a new code for combined systolic and diastolic heart failure.
- 428.41: a new code for combined systolic and diastolic acute heart failure.
- 428.43: a new code for combined systolic and diastolic acute on chronic heart failure.
- 428.42: a new code for combined systolic and diastolic chronic heart failure.
- 428.30: a new code for diastolic heart failure.
- 428.31: a new code for acute diastolic heart failure.
- 428.33: a new code for acute on chronic diastolic heart failure.
- 428.32: a new code for chronic diastolic heart failure.
- 428.20: a new code for systolic heart failure.
- 428.21: a new code for acute systolic heart failure.
- 428.23: a new code for acute on chronic systolic heart failure.
- 428.22: a new code for chronic systolic heart failure.
3. Infant coding changes:
- 765.22: Gestation of liveborn infant with 24 completed weeks.
- 765.23: Gestation of liveborn infant with 25-26 completed weeks.
- 765.24: Gestation of liveborn infant with 27-28 completed weeks.
- 765.25: Gestation of liveborn infant with 29-30 completed weeks.
- 765.26: Gestation of liveborn infant with 31-32 completed weeks.
- 765.27: Gestation of liveborn infant with 33-34 completed weeks.
- 765.28: Gestation of liveborn infant with 35-36 completed weeks.
- 765.29: Gestation of liveborn infant with 37 or more completed weeks.
- 765.21: Gestation of liveborn infant with less than 24 completed weeks.
- 765.20: Gestation of liveborn infant with unspecified completed weeks.
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