American College of Physicians: Internal Medicine — Doctors for Adults ®

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The new ICD-9 codes that every internist should know

Copyright 2004 by the American College of Physicians.

By Carol McKenzie and Brett Baker

Q: What changes have been made to codes in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) effective Oct. 1, 2004? And does Medicare still allow a three-month grace period before I am required to use them?

A: The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS) released ICD-9-CM code changes that will take effect Oct. 1, 2004.

Medicare no longer gives physicians a three-month grace period to make these changes, so physicians must begin using new codes no later than Oct. 1. A select list of changes relevant to internists appears below in numerical order.

Infectious and parasitic diseases

Code 066.4, "Other arthropod-borne viral diseases—West Nile fever," is rendered invalid by the introduction of four new codes:

  • 066.40: West Nile fever, unspecified
  • 066.41: West Nile fever with encephalitis
  • 066.42: West Nile fever with other neurologic manifestation
  • 066.49: West Nile fever with other complications

Code 070, "Viral hepatitis," is expanded with the introduction of two new codes:

  • 070.70: Unspecified viral hepatitis C without hepatic coma
  • 070.71: Unspecified viral hepatitis C with hepatic coma

Endocrine nutritional metabolic diseases and immune disorders

Code 252.0, "Hyperparathyroidism," is rendered invalid by the introduction of four new codes:

  • 252.00: Hyperparathyroidism, unspecified
  • 252.01: Primary hyperparathyroidism
  • 252.02: Secondary hyperparathyroidism, nonrenal
  • 252.08: Other hyperparathyroidism

Code 273, "Disorders of plasma protein metabolism," is expanded with the introduction of one new four-digit code, 273.4: "Alpha-1-antityrpsin deficiency."

Code 277.8, "Other specified disorders of metabolism" is expanded with the introduction of three new codes:

  • 277.85: Disorders of fatty acid oxidation
  • 277.86: Peroxisomal disorders
  • 277.87: Disorders of mitochondrial metabolism

Diseases of nervous system and sense organs

Code 347, "Cataplexy and narcolepsy," is rendered invalid with the introduction of four new codes:

  • 347.00: Narcolepsy without cataplexy
  • 347.01: Narcolepsy with cataplexy
  • 347.10: Narcolepsy in conditions classified elsewhere, without cataplexy
  • 347.11: Narcolepsy in conditions classified elsewhere, with cataplexy

Code 380.0, "Disorders of external ear—perichondritis of pinna," is expanded with the introduction of a new code, 380.03, "Chondritis of pinna."

Diseases of the circulatory system

Code 453, "Other venous embolism and thrombosis," is expanded with the introduction of three new codes:

  • 453.40: Venous embolism and thrombosis of unspecified deep vessels of lower extremity
  • 453.41: Venous embolism and thrombosis of deep vessels of proximal lower extremity
  • 453.42: Venous embolism and thrombosis of deep vessels of distal lower extremity

Diseases of the respiratory system

Code 477, "Allergic Rhinitis," is expanded with the addition of one code, 477.2, "Allergic rhinitis, due to hair from animals, such as cats or dogs, and dander."

Code 491.2, "Obstructive chronic bronchitis," is expanded with the addition of one new code, 491.22, "Obstructive chronic bronchitis with acute bronchitis."

Diseases of the digestive system

Code 524.6, "Temporomandibular joint disorders" is expanded with the addition of one new code, 524.64, "Temporomandibular sounds on opening and/or closing the jaw."

Code 524.8, "Other specified dentofacial anomalies," is rendered invalid with the addition of three new codes:

  • 524.81: Anterior soft tissue impingement
  • 524.82: Posterior soft tissue impingement
  • 254.89: Other specified dentofacial anomalies

Code 528.7, "Other disturbances of oral epithelium, including tongue," is rendered invalid with the addition of three new codes:

  • 528.71: Minimal keratinized residual ridge mucosa
  • 528.72: Excessive keratinized residual ridge mucosa
  • 528.79: Other disturbances of oral epithelium, including tongue

Code 530.8, "Other specified disorders of the esophagus," is expanded with the addition of two codes:

  • 530.86: Infection of esophagostomy
  • 530.87: Mechanical complication of esophagostomy

Diseases of the genitourinary systems

Code 588.8, "Other specified disorders resulting from impaired renal function," is rendered invalid with the addition of two codes:

  • 588.81: Secondary hyperparathyroidism (of renal origin)
  • 588.89: Other specified disorders resulting from impaired renal function

Code 618.0, "Prolapse of vaginal walls without mention of uterine prolapse," is rendered invalid with the addition of seven codes:

  • 618.00: Unspecified prolapse of vaginal walls
  • 618.01: Cystocele midline
  • 618.02: Cystocele, lateral
  • 618.03: Urethrocele
  • 618.04: Rectocele
  • 618.05: Perinocele
  • 618.09: Other prolapse of vaginal walls without mention of uterine prolapse

Code 618.8, "Other specified genital prolapse," is rendered invalid with the addition of four new codes:

  • 618.81: Incompetence or weakening of pubocervical tissue
  • 618.82: Incompetence or weakening of rectovaginal tissue
  • 618.83: Pelvic muscle wasting
  • 618.89: Other specified genital prolapse

Code 621.3, "Endometrial cystic hyperplasia," is rendered invalid with the addition of four new codes:

  • 621.30: Endometrial hyperplasia, unspecified
  • 621.31: Simple endometrial hyperplasia without atypia
  • 621.32: Complex endometrial hyperplasia with atypia
  • 621.33: Endometrial hyperplasia with atypia

Code 622.1, "Dysplasia of cervix (uteri)," is rendered invalid with the addition of three new codes:

  • 622.10: Dysplasia of cervix, unspecified
  • 622.11: Mild dysplasia of cervix
  • 622.12: Moderate dysplasia of cervix

Code 629, "Other disorders of female genital organs," is expanded with the addition of four new codes:

  • 629.20: Female genital mutilation status, unspecified
  • 629.21: Female genital mutilation type I status
  • 629.22: Female genital mutilation type II status
  • 629.23: Female genital mutilation type III status

Skin and subcutaneous diseases

Code 692.8, "Contact dermatitis and other eczema—due to other specific agents," is expanded with the addition of one new code, 692.84, "Contact dermatitis and other eczema due to animal (cat, dog) dander."

Code 705, "Disorders of sweat glands," is expanded with the addition of two new codes:

  • 705.21: Primary focal hyperhidrosis
  • 705.22: Secondary focal hyperhidrosis

Code 707.0, "Chronic ulcer of skin—decubitus ulcer," is rendered invalid with the addition of nine new codes:

  • 707.00: Decubitus ulcer, unspecified site
  • 707.01: Decubitus ulcer, elbow
  • 707.02: Decubitus ulcer, upper back
  • 707.03: Decubitus ulcer, lower back
  • 707.04: Decubitus ulcer, hip
  • 707.05: Decubitus ulcer, buttock
  • 707.06: Decubitus ulcer, ankle
  • 707.07: Decubitus ulcer, heel
  • 707.09: Decubitus ulcer, other site

Symptoms, signs and ill-defined conditions

Code 780.5, "Sleep disturbances," is expanded with the addition of one code, 780.58, "Sleep related movement disorder."

Code 788.3, "Incontinence of urine," is expanded with the addition of one code, 788.38, "Overflow incontinence."

Code 790.9, "Other non-specific findings on examination of blood," is expanded with the addition of one code, 790.95, "Elevated C-reactive protein (CRP)."

Code 795.0, "Nonspecific abnormal Papanicolaou smear of cervix," is expanded with the addition of four codes:

  • 795.03: Papanicolaou smear of cervix with low grade squamous intraepithelial lesion (LGSIL)
  • 795.04: Papanicolaou smear of cervix with high grade squamous intraepithelial lesion (HGSIL)
  • 795.05: Cervical high risk human papillomavirus (HPV) DNA test positive
  • 795.08: Nonspecific abnormal papanicolaou smear of cervix, unsatisfactory smear

Code 796, "Other non-specific abnormal findings," is expanded with the addition of one four-digit code, 796.6, "Nonspecific abnormal findings on neonatal screening."

Other factors influencing health

Code V01.7, "Contact with or exposure to communicable diseases—other viral diseases," is rendered invalid with the addition of four new codes:

  • V01.71: Contact or exposure to varicella
  • V01.79: Contact or exposure to other viral diseases
  • V01.83: Contact or exposure to escherichia coli (E. coli)
  • V01.84: Contact or exposure to meningococcus

Code V46.1, "Other dependence on machines—respirator," is rendered invalid with the addition of two codes:

  • V45.11: Dependence on respirator, status
  • V46.12: Encounter for respirator dependence during power failure

Code V49.8, "Other specified conditions influencing health status," is expanded with the addition of one new code, V49.83, "Awaiting organ transplant status."

Code V58.4, "Other aftercare following surgery," is expanded with the addition of one new code, V58.44, "Aftercare following organ transplant."

Code V58.6, "Long-term (current) drug use," is expanded with the addition of two new codes:

  • V58.66: Long-term (current) use of aspirin
  • V58.67: Long-term (current) use of insulin

Code V69, "Problems related to lifestyle," is expanded with the addition of a new four-digit code, V69.4, "Lack of adequate sleep."

Code V72.3, "Special investigations and examinations—gynecological examination," is rendered invalid with the addition of two new codes:

  • V72.31: Routine gynecological examination
  • V72.32: Encounter for Papanicolaou cervical smear to confirm findings of recent normal smear following initial abnormal smear

Code V72.4, "Special investigations and examinations—pregnancy examination or test, pregnancy unconfirmed," is rendered invalid with the addition of two new codes:

  • V72.40: Pregnancy examination or test, pregnancy unconfirmed
  • V72.41: Pregnancy examination or test, negative result

Code V84 represents new categories of four and five-digit codes for genetic status:

  • V84.01: Genetic susceptibility to malignant neoplasm of breast
  • V84.02: Genetic susceptibility to malignant neoplasm of ovary
  • V84.03: Genetic susceptibility to malignant neoplasm of prostate
  • V84.04: Genetic susceptibility to malignant neoplasm of endometrium
  • V84.09: Genetic susceptibility to other malignant neoplasm
  • V84.8: Genetic susceptibility to other disease

Q: Are there any changes to ICD-9-CM code titles?

A: Yes. The CMS and the NCHS revised the diagnosis code titles, which means they changed the code descriptor language without changing how it is to be used, in the following categories: 042, 070, 250, 286, 290-299, 300-315, 760, 795 and V07. The following are examples of title changes:

  • The descriptor language for ICD-9-CM 250.00 has been changed from "Diabetes mellitus without mention of complication, type II [non-insulin dependent type] [NDDM type] [adult-onset type] or unspecified type, not stated as uncontrolled" to "Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled."

  • The descriptor language for ICD-9-CM 290.40 has been changed from "Arteriosclerotic dementia, uncomplicated" to "Vascular dementia, uncomplicated."

Update your lists of diagnosis codes common to your practice to reflect the revised titles.

Carol McKenzie is Administrative Coordinator for Regulatory and Insurer Affairs and the Practice Management Center in the College's Washington office. Brett Baker is a third-party specialist in the College's Washington office.

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More information on changes to ICD-9

If you're looking for more information about changes to ICD-9 that will affect internists, you can turn to several resources.

ACP's Practice Management Center will update its "Commonly Used ICD-9" reference sheet by the time the changes take effect on Oct. 1, 2004. ACP members can access the card in Microsoft Word and PDA format online. The laminated version of the card is available through ACP Customer Service by calling 800-523-1546, ext. 2600.

You can access a comprehensive list of the ICD-9-CM changes that take effect on Oct. 1, 2004, through the CMS Web site.

To purchase an updated version of the ICD-9-CM book, call the AMA at 800-621-8335 or go online. The AMA charges $74.95 for members, $84.95 for nonmembers.

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