Are You Ready? Diagnosis Code Changes For 2009 Are Nearly Here!

It is nearing that time of year again, when the diagnosis code changes roll around. For the upcoming year, 2009, there are over 400 significant diagnostic code changes, and these codes must be implemented for dates of service beginning October 1, 2008. There are 373 new diagnosis codes, 70 revised diagnosis codes and 26 invalid diagnosis codes.

Encounter forms must be reviewed and updated, practice management systems must be reviewed and updated, and electronic health record systems must be reviewed — all to ensure that the most current diagnosis code selections are available, and to ensure that the invalid codes cannot be reported. This is critical to all physician practices’ revenue cycles. It also is important to educate the medical office staff and physicians of the upcoming code changes.

PivotHealth, LLC wants to update you on just a sample of the major diagnosis code changes that will be occurring on October 1, 2008, as well as focus on the potential impact that will necessitate more thorough documentation by the physicians for accurate code selection. The final addendum providing complete information on all the code additions, revisions, and deletions can be found on the summary tables at the Centers for Medicare and Medicaid (CMS) by clicking here.

One major change is the addition of a brand new code category: Category 249.XX for Secondary Diabetes. This code category will align itself with the current diabetes code category 250.XX for primary diabetes conditions. An additional code will be appropriate to capture the underlying disease process that caused the secondary diabetes. Physicians will not only need to clearly document and capture that the diabetes is a secondary condition, but also the root cause for the most specific and accurate code capture. To see the new diabetic codes in a side by side comparison to the 250.XX category, please click: Secondary Diabetes-Attachment.doc

An additional NEW code category will be Category 339.XX which will allow for more specific assignment of headache codes. This category will allow a physician to accurately assign the code based on the TYPE of headache (i.e. cluster, tension, etc.) as well as allow for capture of the status of many headaches, such as episodic, chronic or acute. While this certainly much more clearly delineates the headache the patient presents with, it will require significant documentation changes from just the generic headache. Click: Headache-Attachment.doc to view chart outlining headache type and status.

There are also tremendous changes to the Migraine Headache category of 346.XX. While this is not a new code category, the impact of the changes is significant. Just documentation of common migraine will no longer support the accurate and appropriate code selection. The ability to capture the status such as persistent or chronic, or the root cause such as hemiplegic or menstrual, are just some of the subtopics of specificity available. Click: Migraine Headache-Attachment.doc to view over 30 changes to the 346.XX category.

Pressure ulcer codes are also changing and include need for more specificity in code assignments, and certainly more specificity in physician documentation. The six new codes in the 707.20-707.24 code category for pressure ulcers will now allow for the capture of the stage of the ulcer. The less severe but more common Stage I and II ulcers can be captured, as well as the more extensive Stage III and Stage IV ulcers. There is a selection of an unspecified stage, but as with all coding, coding to the highest degree of specificity is best, so if the stage of the ulcer is known it should be documented and coded.

This is certainly not an exhaustive list of all of the upcoming changes, but is a preview clearly demonstrating how the changes will affect accuracy of code selection, as well as place emphasis on the completeness of documentation in the medical record. Staying current on all coding changes is imperative.
 

Have a question? Click here to sumbit a question to Jennifer Swindle, RHIT, CCS-P, CPC, CPC-E/M, CCP-FP, CCP,  Director of Coding and Compliance 
 

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