ICD-9 Changes in 2008
David Stern, MD, CPC
Q. I noticed that I am getting rejections for the code for
fever (780.6). Do I need to add another diagnosis
code to get paid?
A. There are numerous separate issues related to this
code:
First, every year ICD-9 updates go into effect on October
1. This year was no exception. This code is now subcategorized
as follows:
– 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
Second, 780.60 is a specific code that can be used to specify a diagnosis.
Third, this code now requires five digits, so most payors will reject the old code for fever (780.6) if you do not add a fifth digit.
Fourth, you should not use these fever codes along with a
diagnosis of a “confirmed infection” that is causing a fever.
Thus, it would not be appropriate to diagnose fever (780.60
or even 780.61) along with streptococcal pharyngitis (034.0)
for the same patient visit.
Fifth, do not use this code set for the following:
– heat stroke and sunstroke (992.0)
– heat syncope (992.1)
– heat cramps (992.2)
– heat exhaustion (992.3, 992.4 or 992.5)
– or other conditions related to environmental heat
(992.6-992.9)
Q. Are there other important ICD-9 changes that are
commonly used in the urgent care setting?
A. The short answer is “yes.” There are a number of changes
to codes commonly encountered in urgent care. Let’s
break them down and expand on them:
Hematuria
The code for hematuria (formerly 599.7) now requires five digits
and is subdivided into the following:
599.70 Hematuria, unspecified
599.71 Gross hematuria
599.72 Microscopic hematuria
Dehiscence of Traumatic Wound Repair
Previously, no code was available to specify the dehiscence of a
traumatic wound repair, as the codes available (998.31 and
998.32) referred only to dehiscence of an operative wound.
Physicians may now use either:
998.30 Disruption of wound, unspecified
998.33 Disruption of traumatic wound repair
Vulvar Pain or Inflammation
New codes now exist for vulvar pain or inflammation:
625.70 Vulvodynia, unspecified
625.71 Vulvar vestibulitis
625.79 Other vulvodynia
Additions to the Migraine Series
Many additional code definitions have been added to the migraine
series (346.__), which now requires five digits (see an ICD-
9 book for specifics). In addition, many new headache codes have
been added; only a few are included here:
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
339.10 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
339.82 Headache associated with sexual activity
339.83 Primary cough headache
339.84 Primary exertional headache
339.85 Primary stabbing headache
339.89 Other headache syndromes
Erythema Multiforme
The code for erythema multiforme (formerly 695.1) now requires
five digits and is subdivided into the following:
695.10 Erythema multiforme, unspecified
695.11 Erythema multiforme, minor
695.12 Erythema multiforme, major
695.13 Stevens-Johnson syndrome
695.14 Stevens-Johnson syndrome¨Ctoxic epidermal necrolysis
overlap syndrome
695.15 Toxic epidermal necrolysis
695.19 Other erythema multiforme
Staphylococcus aureus
New codes related to Staphylococcus aureus are:
V02.53 Methicillin-susceptible Staphylococcus aureus MSSA
colonization (not infection)
V02.54 Methicillin-resistant Staphylococcus aureus MRSA
colonization
V12.04 Personal history of methicillin-resistant Staphylococcus
aureus
038.12 Methicillin-resistant Staphylococcus aureus septicemia
041.12 Methicillin-resistant Staphylococcus aureus in conditions
classified elsewhere and of unspecified site
482.42 Methicillin-resistant pneumonia due to Staphylococcus
aureus
Overexertion and Strenuous or Repetitive Movements
The code for overexertion and strenuous movements (formerly
E927) has now been subdivided into several more specific codes,
all requiring five digits. These codes may be useful for coding the
causes of injuries (especially in some states for workers compensation
and automobile accidents):
E927.0 Overexertion from sudden strenuous movement
E927.1 Overexertion from prolonged static position
E927.2 Excessive physical exertion from prolonged activity
E927.3 Cumulative trauma from repetitive motion
E927.4 Cumulative trauma from repetitive impact
E927.8 Other overexertion and strenuous and repetitive
movements or loads
E927.9 Unspecified overexertion and strenuous and repetitive
movements or loads
Exposure to Specific Substances
Urgent care physicians now have codes for exposure (or suspected
exposure) to multiple specified substances:
V87.01 Contact with and (suspected) exposure to arsenic
V87.09 Contact with and (suspected) exposure to other hazardous
metals
V87.11 Contact with and (suspected) exposure to aromatic
amines
V87.12 Contact with and (suspected) exposure to benzene
V87.19 Contact with and (suspected) exposure to other hazardous
aromatic compounds
V87.2 Contact with and (suspected) exposure to other potentially
hazardous chemicals
V87.3 Contact with and (suspected ) exposure to other potentially
hazardous substances
V87.31 Contact with and (suspected) exposure to mold
V87.39 Contact with and (suspected) exposure to other potentially
hazardous substances
History of Musculoskeletal Disorders
For patients with a personal history of musculoskeletal disorders
(formerly V13.5), physicians can now be more specific as
to the injury that the patient suffered in the past.
V13.51 Personal history of pathologic fracture
V13.52 Personal history of stress fracture
V13.59 Personal history of other musculoskeletal disorders
V15.21 Personal history of undergoing in utero procedure
during pregnancy
V15.22 Personal history of undergoing in utero procedure
while a fetus
V15.29 Personal history of surgery to other organs
V15.51 Personal history of traumatic fracture
V15.59 Personal history of other injury
Note: CPT codes, descriptions, and other data only are copyright 2007 American Medical Association. All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the American Medical Association (AMA).
Disclaimer: JUCM and the author provide this information for educational purposes only. The reader should not make any application of this information without consulting with the particular payors in question and/or obtaining appropriate legal advice.
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David Stern is a partner in Physicians Immediate Care,
with nine urgent care centers in Illinois and Oklahoma,
and chief executive officer of Practice Velocity
(www.practicevelocity.com), a provider of charting, coding
and billing software for urgent care. He may be contacted
at
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