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:
Hematuria
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.

ICD-9 Changes in 2008

David Stern, MD

Chief Executive Officer at Experity, Previous Chief Executive Offer at Practice Velocity Urgent Care Solutions, Founding Member of the Urgent Care Association of America, Publishing Staff for The Journal of Urgent Care Medicine
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