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The new ICD-9 codes that every internist should know

From the September ACP Observer, copyright 2003 by the American College of Physicians.

By Carol McKenzie

Q: What changes have been made to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for 2004, and when do I need to start using them?

A: The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics released ICD-9-CM code changes that will take affect Oct. 1, 2003. Medicare and many other payers give physicians a three-month "grace period" to begin implementing new codes no later than Jan. 1, 2004.

The changes most relevant to internists are noted below and appear in numerical order.

Endocrine, nutritional and metabolic diseases, and immunity disorders
Code 255.1, "Disorders of adrenal glands—hyperaldosteronism (primary and secondary), Bartter's syndrome, Conn's syndrome," is rendered invalid by the introduction of five new five-digit codes:

  • 255.10—Primary aldosteronism
  • 255.11—Glucocorticoid-remediable aldosteronism
  • 255.12—Conn's syndrome
  • 255.13—Bartter's syndrome
  • 255.14—Other secondary aldosteronism

Code 277.8, "Other specified disorders of metabolism—Hand-Schuller-Christian disease, histiocytosis (acute and chronic), histiocytosis X (chronic)," is rendered invalid by the introduction of five new five-digit codes:

  • 277.81—Primary carnitine deficiency
  • 277.82—Carnitine deficiency due to inborn errors of metabolism
  • 277.83—Iatrogenic carnitine deficiency
  • 277.84—Other secondary carnitine deficiency
  • 277.89—Other specified disorders of metabolism

Diseases of the blood and blood-forming organs
Code 282.4, "Thalassemias," is rendered invalid by the introduction of three new five-digit codes:

  • 282.41—Sickle-cell thalassemia without crisis
  • 282.42—Sickle-cell thalassemia with crisis
  • 282.49—Other thalassemia

Code 282.6, "Sickle-cell anemia," is expanded with the introduction of two new five-digit codes:

  • 282.64—Sickle-cell/Hb-C disease with crisis
  • 262.68—Other sickle-cell disease without crisis

Code 289.5, "Other diseases of spleen," is expanded with the introduction of one five-digit code:

  • 289.52—Splenic sequestration

Code 289.8, "Other specified diseases of blood and blood-forming organs," is rendered invalid by the introduction of three new five-digit codes:

  • 289.81—Primary hypercoaguable state
  • 289.82—Secondary hypercoaguable state
  • 289.89—Other specified diseases of blood and blood-forming organs

Diseases of the nervous system and sensory organs
Code 331.1, "Pick's disease," is rendered invalid with the introduction of two new five-digit codes:

  • 331.11—Pick's disease
  • 331.19—Other frontotemporal dementia

Code 331.8, "Other cerebral degeneration," is expanded with the introduction of a new five-digit code:

  • 331.82—Dementia with Lewy bodies

Code 348.3, "Encephalopathy, unspecified," is rendered invalid with the introduction of three new five-digit codes:

  • 348.30—Encephalopathy, unspecified
  • 348.31—Metabolic encephalopathy
  • 348.39—Other encephalopathy

Code 358.0, "Myasthenia gravis," is rendered invalid with the introduction of two new five-digit codes:

  • 358.00—Myasthenia gravis without (acute) exacerbation
  • 358.01—Myasthenia gravis with (acute) exacerbation

Diseases of the circulatory system
Code 414.0, "Coronary atherosclerosis," is expanded with the introduction of a new five-digit code:

  • 414.07—Coronary atherosclerosis of bypass graft (artery)(vein) of transplanted heart

Code 458.2, "Iatrogenic hypotension," is rendered invalid by the introduction of two new five-digit codes:

  • 458.21—Hypotension of hemodialysis
  • 458.29—Other iatrogenic hypotension

Diseases of the respiratory system
Code 493, "Asthma," is expanded to include two new five-digit codes:

  • 493.81—Exercise induced bronchospasm
  • 493.82—Cough variant asthma

Code 517, "Lung involvement in conditions classified elsewhere," is expanded to include a new four-digit code:

  • 517.3—Acute chest syndrome

Diseases of the digestive system
Code 530.2, "Ulcer of esophagus," is rendered invalid by the introduction of two new five-digit codes:

  • 530.20—Ulcer of esophagus without bleeding
  • 530.21—Ulcer of esophagus with bleeding

Code 530.8, "Other specified disorders of esophagus," is expanded with the introduction of a new five-digit code:

  • 530.85—Barrett's esophagus

Diseases of the genitourinary system
Four codes (600.0, 600.1, 600.2 and 600.9), "Hyperplasia of prostate," are invalidated by the introduction of eight new five-digit codes:

  • 600.00—Hypertrophy (benign) of prostate without urinary obstruction
  • 600.01—Hypertrophy (benign) of prostate with urinary obstruction
  • 600.10—Nodular prostate without urinary obstruction
  • 600.11—Nodular prostate with urinary obstruction
  • 600.20—Benign localized hyperplasia of prostate without urinary obstruction
  • 600.21—Benign localized hyperplasia of prostate with urinary obstruction
  • 600.90—Hyperplasia of prostate, unspecified without urinary obstruction
  • 600.91—Hyperplasia of prostate, unspecified with urinary obstruction

Code 607.8, "Other specified disorders of penis," has been expanded with the introduction of code:

  • 607.85—Peyronie's disease

Musculoskeletal system and connective tissue
Code 719.7, previously described as "Other and unspecified disorders of ankle and foot," is now listed as "Difficulty in walking." There are two new five-digit codes:

  • 728.87—Muscle weakness
  • 728.88—Rhabdomyolysis

Symptoms, signs and ill-defined conditions
Code 780.9, "Other general symptoms," is expanded with the introduction of two new five-digit codes:

  • 780.93—Memory loss
  • 780.94—Early satiety

Code 781.9, "Other symptoms involving nervous and musculoskeletal systems," is expanded with the introduction of a new five-digit code:

  • 781.94—Facial weakness

Code 790.2, "Abnormal glucose tolerance test," is invalidated with the introduction of three new five-digit codes:

  • 790.21—Impaired fasting glucose
  • 790.22—Impaired glucose tolerance test (oral)
  • 790.29—Other abnormal glucose

Code 799.8, "Other ill-defined conditions," is invalidated with the introduction of a new five-digit code:

  • 799.81—Decreased libido
  • 799.89—Other ill-defined conditions (DEF: general ill health and poor nutrition)

While this article covers most of the pertinent codes for internists, additional revisions have been posted online. Changes to ICD-9-CM codes for injury/poisoning and V codes for supplementary classification of factors influencing health status are online.

If you need a comprehensive list or an updated version of ICD-9-CM, you can purchase it through the AMA ($74.95 for members, $84.95 for nonmembers). To order, call 800-621-8335 or go online.

Revised guidelines may be accessed on the AMA's Web site. ICD-9-CM is also available through other vendors.

Carol McKenzie is Administrative Coordinator for Regulatory and Insurer Affairs and the Practice Management Center in the College's Washington office.

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