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

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Make sure your diagnosis codes match ICD-9 changes

From the October ACP Observer, copyright 2006 by the American College of Physicians.

Q: When do ICD-9-CM code changes take place?

A: The CDC's National Center for Health Statistics announces changes to the ICD9-CM every summer and the new codes go into effect on Oct. 1. In the past, the Centers for Medicare and Medicaid Services (CMS) allowed physicians to use both the old and the new diagnosis codes for the first three months of implementation, but that has not been the case for a number of years. Physicians must now discontinue use of deleted codes and begin use of new codes every October.

Q: Will any changes made this year affect internists?

A: The changes this year were relatively modest, but some changes will affect the diagnoses codes used by internists. The following changes take place Oct. 1, 2006. The first two sections are codes that were deleted in favor of more specific five digit ICD-9-CM codes.

Deleted:
288.0 Agranulocytosis

Replaced with:
288.00 - Neutropenia, unspecified
288.01 - Congenital neutropenia
288.02 - Cyclic neutropenia
288.03 - Drug-induced neutropenia
288.04 - Neutropenia due to infection
288.09 - Other neutropenia

Deleted:
995.2 - Unspecified adverse effect of drug, medicinal, and biological substance

Replaced with:
995.20 - Unspecified adverse effect of unspecified drug, medicinal, and biological substance
995.21 Arthus phenomenon
995.22 Unspecified adverse effects of anesthesia
995.23 Unspecified adverse effects of insulin
995.27 Other drug allergy
995.29 Unspecified adverse effect of other drug, medicinal, and biological substance

The following codes have been added that might be of use to internists:

Added
333.94 - Restless Legs Syndrome
338.0 - Central Pain Syndrome
338.11 - Acute Pain due to Trauma
338.19 - Other acute pain
338.21 - Chronic pain due to trauma
338.29 - Other chronic pain
338.4 - Chronic Pain Syndrome
519.11 - Acute bronchospasm
780.96 - Generalized Pain
780.97 - Altered Mental Status
784.91 - Post Nasal Drip
788.64 - Urinary Hesitancy
788.65 - Straining on Urination
V18.51 - Family history, colonic polyps
V18.59 - Family history, other digestive disorders
V58.30 - Encounter for change or removal of nonsurgical wound dressing
V58.32 - Encounter for removal of sutures
V72.11 - Encounter for hearing examination following failed hearing examination
V72.19 - Other examination of ears and hearing

The entire list of deleted, added, and revised codes can be found online.

ACP’s Practice Management Center has updated its “Commonly Used ICD-9” reference sheet with the new changes that went into effect on Oct. 1. ACP members can access the card in Microsoft Word and PDF format online. A laminated version is also available by contacting the PMC.

Q: I have heard that Medicare Part B carriers may be going away? Is that true?

A: CMS is currently working on a project known as Medicare Contracting Reform required by the Medicare Modernization Act (MMA) passed in 2003. Currently, there are separate contracts awarded for Medicare Part A and Part B administrative services in each state in the country. With this new reform, the number of contracts will be reduced to 15. These 15 contracts will be for both Part A and Part B services and will cover multi-state areas. The awarding of the first contract was recently announced covering the states of Arizona, Montana, North Dakota, South Dakota, Utah, and Wyoming. In this case, the contract was awarded to Noridian Administrative Services. Noridian already serves as Part B carrier for the majority of the region, so physicians may see little difference. Different regions may have different results. There will be two additional rounds of contracting for the rest of the country. The new contractors will not be known as Part A fiscal intermediaries or Part B carriers, but will instead be known as Medicare Administrative Contractors (MACs). The new MACs will be in place throughout the country by 2011.

Q: Is there any place where my staff can get free training on billing and coding?

A: Medicare Part B carriers (soon to be known as Medicare Administrative Contractors) are required to offer educational opportunities to physicians. Many of the contractors offer Web-based training, written materials and even day-long seminars on billing and coding. These sessions are often free of charge and offer the opportunity for the staff to further understand the rules without paying a great deal for training.

The Medicare contractors are different in each state and the offerings may vary, but would usually include coding and billing basics in addition to more specific topics like consultations. Physicians and their staff often do not take full advantage of these programs. You can usually find information on these educational offerings on the contractor’s web sites.

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