CODING Q&A ICD-9 Changes in 2008 ■ DAVID STERN, MD, CPC Q. A. 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? There are numerous separate issues related to this code: Ⅲ First, every year ICD-9 updates go into effect on Octo- ber 1. This year was no exception. This code is now sub- categorized 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 envi- ronmental temperature Ⅲ Second, 780.60 is a specific code that can be used to specify a diagnosis. Ⅲ Third, this code now requires five digits, so most pay- ors will reject the old code for fever (780.6) if you do not add a fifth digit. Ⅲ 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 di- agnose fever (780.60 or even 780.61) along with strep- tococcal pharyngitis (034.0) for the same patient visit. Ⅲ 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) David E. Stern, MD, CPC, is a certified professional coder. He is a part- ner in Physicians Immediate Care, operating 12 urgent care centers in Oklahoma and Illinois. Stern serves on the Board of Directors of the Ur- gent Care Association of America and speaks frequently at urgent care conferences. He is CEO of Practice Velocity (www.practicevelocity.com), providing urgent care software solutions to more than 500 urgent care centers. He welcomes your questions about coding in urgent care. w w w. j u c m . c o m Q. A. Are there other important ICD-9 changes that are commonly used in the urgent care setting? 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: Ⅲ 599.70 Hematuria, unspecified Ⅲ 599.71 Gross hematuria Ⅲ 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: Ⅲ 998.30 Disruption of wound, unspecified Ⅲ 998.33 Disruption of traumatic wound repair Vulvar Pain or Inflammation New codes now exist for vulvar pain or inflammation: Ⅲ 625.70 Vulvodynia, unspecified Ⅲ 625.71 Vulvar vestibulitis Ⅲ 625.79 Other vulvodynia For additional ICD-9 changes highly relevant to urgent care, refer to Coding Q & A at www.jucm.com. ■ 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 ed- ucational purposes only. The reader should not make any appli- cation of this information without consulting with the particu- lar payors in question and/or obtaining appropriate legal advice. JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | N o v e m b e r 2 0 0 8 33