DAVID STERN, MD (Practice Velocity)
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 Octo- ber This year was no exception. This code is now sub- categorized as follows:
- 60 Fever, unspecified
- 61 Fever presenting with conditions classified elsewhere
- 62 Postprocedural fever
- 63 Postvaccination fever
- 64 Chills (without fever)
- 65 Hypothermia not associated with low envi- ronmental temperature
- Second, 60 is a specific code that can be used to specify a diagnosis.
- 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
- Fourth, you should not use these fever codes along with a diagnosis of a “confirmed infection” that is causing a 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.
- 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:
The code for hematuria (formerly 599.7) now requires five digits and is subdivided into the following:
- 70 Hematuria, unspecified
- 71 Gross hematuria
- 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:
- 30 Disruption of wound, unspecified
- 33 Disruption of traumatic wound repair
Vulvar Pain or Inflammation
New codes now exist for vulvar pain or inflammation:
- 70 Vulvodynia, unspecified
- 71 Vulvar vestibulitis
- 79 Other vulvodynia
For additional ICD-9 changes highly relevant to urgent care, refer to Coding Q & A at www.jucm.com.