October 1, 2007 ICD-9-CM Changes  Webcast  September 27, 2007 Sandy Giangreco, CPC, CPC-H Coding & Reimbursement Educator/...
What is the impact for  FY 2008? <ul><li>144 New Diagnosis Codes </li></ul><ul><li>17 Deleted Diagnosis Codes </li></ul><u...
Rationale of Coding Changes <ul><li>Greater specificity </li></ul><ul><ul><li>Some due to technology </li></ul></ul><ul><l...
New Subcategory 040.4 Other specified botulism <ul><li>Non-foodborne intoxication due to toxins of Clostridium botulinum [...
From a Clinical Perspective  <ul><li>S/S of infant botulism </li></ul><ul><li>include: </li></ul><ul><li>Constipation </li...
New Codes for Viral Illnesses <ul><li>New Section and Category: OTHER HUMAN HERPES VIRUSES 058  </li></ul><ul><li>New 058 ...
Roseola Infantum <ul><li>New code 058.10 Roseola infantum, Exanthema subitum [sixth disease],  unspecified </li></ul><ul><...
New Herpes Encephalitis Codes <ul><li>New subcategory 058.2 Other human herpes virus encephalitis  </li></ul><ul><ul><li>E...
More Herpes Codes <ul><li>New subcategory 058.8 Other human herpes virus infections  </li></ul><ul><li>New code 058.81 Hum...
Respiratory System Virus <ul><li>New code 079.83 Parvovirus B19   </li></ul><ul><ul><ul><li>AKA: Human parvovirus  </li></...
Clinical Aspects of Viral Illnesses <ul><li>DNA Analysis is being used to identify more diseases and further differentiati...
Clinical Information about Human Herpes Virus  <ul><li>Signs and Symptoms include: Rash or roseola, and chronic fatigue sy...
Lymphoma Code Changes  <ul><li>Lymphomas have been named by their discoverer, or by some difference in their activity, rel...
Clinical Aspects of REAL  <ul><li>First classified by cell type – the cell which, if it is normal, most closely looks like...
Mature B-Cell Tumors (NHL)  <ul><li>Chronic lymphocytic leukemia/small lymphocytic lymphoma </li></ul><ul><li>B-cell proly...
Mature T-Cell and Natural Killer Cell Tumors (NHL)  <ul><li>T cell prolymphocytic leukemia </li></ul><ul><li>T cell large ...
Hodgkin’s Lymphoma <ul><li>Nodular lymphocyte-predominant Hodgkin lymphoma </li></ul><ul><li>Classical Hodgkin lymphoma </...
Immunodeficiency-Associated Lymphoproliferative Disorders  <ul><li>Associated with a primary immune disorder </li></ul><ul...
Histiocytic and Dendritic Cell Neoplasms (CNS)  <ul><li>Histiocytic sarcoma </li></ul><ul><li>Langerhans cell histiocytosi...
Classification by Immunologic Subtype and Aggressiveness  <ul><li>B Cell </li></ul><ul><ul><li>Small lymphocytic </li></ul...
Revision to Code 200  <ul><li>Revise 200 Lymphosarcoma and reticulosarcoma  and other specified malignant tumors of lympha...
Our New Subdivisions for Lymphomas <ul><li>200.3X Marginal zone </li></ul><ul><li>200.4X Mantle zone </li></ul><ul><li>200...
Further Breakdown of These Codes <ul><li>200.3X Marginal Zone Lymphoma – typically indolent and accounts for approx. 10% o...
More Information  <ul><li>200.6X Anaplastic Large Cell Lymphoma – also aggressive and accounts for 2% of all lymphomas.  <...
Peripheral T-Cell Lymphoma  <ul><li>New code 202.7X Peripheral T-cell lymphoma  </li></ul><ul><li>.X0 Unspecified site </l...
Carcinoma In-Situ (CIS)  <ul><li>Deleted 233.3  – other and unspecified- greater specificity desired with HPV connection w...
Endocrine Specific Codes  <ul><li>Deleted 255.4 Corticoadrenal insufficiency which included both glucocorticoid (cortisone...
Clinical Perspective of Endocrine Changes  <ul><li>The adrenal cortex produces 50 hormones including 98% of the corticoste...
Clinical Aspects of Hormones <ul><li>Effects of corticosteroids </li></ul><ul><ul><li>Stimulates production of glucose fro...
2 types of Adrenal Insufficiency <ul><li>Primary Adrenal Insufficiency </li></ul><ul><ul><li>Reduction of both aldosterone...
Acute Adrenal Insufficiency  <ul><li>Can result in shock and possible rapid death </li></ul><ul><li>May result from rapid ...
Actual Codes <ul><li>New code 255.41 Glucocorticoid deficiency   </li></ul><ul><ul><li>Addisonian crisis  </li></ul></ul><...
A Few Good MEN  <ul><li>New code 258.01 Multiple endocrine neoplasia [MEN] type I   </li></ul><ul><ul><li>Wermer’s syndrom...
MEN May be in Women  <ul><li>Long known groupings of endocrine tumors with genetic cause </li></ul><ul><li>MEN I – parathy...
MEN May be in Women cont.  <ul><li>MEN II – Medullary carcinoma of thyroid [bad acting thyroid cancer, worse than papillar...
New Anemia Codes  <ul><li>New code 284.81 Red cell aplasia (acquired) (adult) (with thymoma)   </li></ul><ul><ul><li>Red c...
One solo Code  <ul><li>New code 288.66 Bandemia   </li></ul><ul><ul><li>Bandemia without diagnosis of specific infection  ...
Developmental Delays <ul><li>New code 315.34 Speech and language developmental delay due to hearing loss   </li></ul><ul><...
Hydrocephalus Code  <ul><li>New code 331.5 Idiopathic normal pressure hydrocephalus (INPH)   </li></ul><ul><ul><li>Normal ...
Myotonic Conditions  <ul><li>New code 359.21 Myotonic muscular dystrophy   </li></ul><ul><ul><ul><li>Dystrophia myotonica ...
Clinical Perspective  <ul><li>Excessive tone or spasms to muscles, impairs movements </li></ul><ul><li>Myotonic muscular d...
Floppy Iris Syndrome <ul><li>Variant of small pupil syndrome </li></ul><ul><li>A complication of TV ads – telling men to a...
Eye Codes  <ul><li>New code 364.81 Floppy iris syndrome   </li></ul><ul><ul><li>Intraoperative floppy iris syndrome (IFIS)...
Hearing Codes  <ul><li>New code 388.45 Acquired auditory processing disorder  </li></ul><ul><ul><li>Auditory processing di...
More Hearing Codes  <ul><li>New code 389.20 Mixed hearing loss, unspecified  </li></ul><ul><li>New code 389.21 Mixed heari...
Cardiac Codes  <ul><li>New Code 414.2 Chronic total occlusion of coronary artery   </li></ul><ul><ul><li>Complete occlusio...
Septic Embolism  <ul><li>Septic embolism is a venous blood clot that can be present because of stasis from prolonged occlu...
Septic Embolism Codes  <ul><li>New code 415.12 Septic pulmonary embolism   </li></ul><ul><ul><li>Septic embolism NOS  </li...
Septic Embolism  <ul><li>415.12 is septic pulmonary embolism – from peripheral venous circulatory system, usually related ...
More Heart Codes  <ul><li>New code 423.3 Cardiac tamponade  </li></ul><ul><ul><li>Code first the underlying cause  </li></...
Influenza  <ul><li>New code 488 Influenza due to identified avian influenza virus   </li></ul><ul><li>Note: Influenza caus...
Dental Codes  <ul><li>New code 525.71 Osseointegration failure of dental implant   </li></ul><ul><ul><ul><li>Hemorrhagic c...
More Dental Codes <ul><li>New code 525.73 Post-osseointegration mechanical failure of dental implant   </li></ul><ul><ul><...
Anal Sphincter Tear <ul><li>New code 569.43 Anal sphincter tear (healed) (old)   </li></ul><ul><ul><li>Tear of anus, nontr...
VIN and CIN are NOT the same  <ul><li>New code 624.01 Vulvar intraepithelial neoplasia I [VIN I]   </li></ul><ul><ul><li>M...
Anal Sphincter Tear w/ Pregnancy  <ul><li>New code 664.6X  Anal sphincter tear complicating delivery, not associated with ...
Aseptic Necrosis of Bone  <ul><li>New code 733.45 Aseptic Necrosis of Bone, Jaw   </li></ul><ul><ul><li>Use additional E c...
Hard to Swallow Codes  <ul><li>New code 787.20 Dysphagia, unspecified   </li></ul><ul><ul><li>Difficulty in swallowing NOS...
Greater Definition of Dysphagias <ul><li>787.21 Oral Phase </li></ul><ul><ul><li>Impaired structure/physiology of palate, ...
Implications of Dysphagia Phases  <ul><li>Some implications of dysphagia </li></ul><ul><ul><li>Aspiration (pneumonia, bron...
Expansion of Ascites  <ul><li>Code 789.5 Ascites has been deleted </li></ul><ul><li>New code 789.51 Malignant ascites   </...
Clinical Aspect  <ul><li>Malignant Ascites </li></ul><ul><ul><li>Adenocarcinoma deposits on the peritoneum which cause lea...
V Codes  <ul><li>New code V12.53 Sudden cardiac arrest   </li></ul><ul><ul><li>Sudden cardiac death successfully resuscita...
OB V Code  <ul><li>New code V13.22 Personal history of cervical dysplasia   </li></ul><ul><ul><li>Personal history of cond...
More Family Hx V Codes!  <ul><li>Revise Family history of condition classifiable to  188– 189   </li></ul><ul><li>New code...
Endrocrine V Codes  <ul><li>New code V18.11 Multiple endocrine neoplasia [MEN] syndrome  </li></ul><ul><li>New code V18.19...
Contraception and Procreative Mgmt <ul><li>New code V25.04 Counseling and instruction in natural family planning to avoid ...
More V Codes!  <ul><li>New code V49.85 Dual sensory impairment   </li></ul><ul><ul><li>Blindness with deafness  </li></ul>...
Disability Evals/Exams  <ul><li>New code V68.01 Disability examination   </li></ul><ul><ul><li>Use additional code(s) to i...
Misc V Codes  <ul><li>New code V72.12 Encounter for hearing conservation and treatment   </li></ul><ul><li>New code V73.81...
Genetic Susceptibility V Codes  <ul><li>New code V84.81 Genetic susceptibility to multiple endocrine neoplasia [MEN]  </li...
New E Codes!!!!!  <ul><li>New code E928.6 Environmental exposure to harmful algae and toxins  </li></ul><ul><li>Includes: ...
E code for Bisphosphonates <ul><li>E933 Primarily systemic agents  </li></ul><ul><li>New code E933.6 Oral bisphosphonates ...
Case Scenarios
Case Scenario # 1  <ul><li>A 58 year old female patient is seen for biopsy of masses found in both the chest and her groin...
Case Scenario # 2  <ul><li>Patient is admitted to the Emergency Room after having spent the day at the beach. Family membe...
Case Scenario # 3 <ul><li>45 year old patient presents to the clinic for a work-up of left lower quadrant abdominal pain. ...
Resources <ul><li>ICD-9-CM Book 2008 published by Ingenix </li></ul><ul><li>http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9...
Sandy Giangreco, CPC, CPC-H  Coding & Reimbursement Educator/Membership Director  [email_address] 608-442-3776 Thank You
The information presented and responses to the questions posed are not intended to serve as coding or legal advice.  Many ...
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October 1, 2007 ICD-9-CM Changes

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  • I will have all of the New codes on the slides in Red so you can more easily identify those!
  • Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum. There are 3 main kinds of botulism. Foodborne botulinum is caused by eating foods containing the botulism toxin. Wound botulinum is caused by toxin produced from a wound infected with Clos. Botulinum. Infant botulinum is caused by consuming the spores of the botulinium bacteria, which then grow in the intestines and release the toxins. All forms of botulinum can be fatal. The mortality rate dropped from 50% to 8% during the past 5 years due to the physician’s ability to treat, monitor, and maintain the patient from the point at which they determined the dx. Botulism, which results from traumatic injury or a deep puncture wound and is often caused by abscess, is broken down into the 2 new codes within the subcategory. (See above) These are for the botulism that are not caused by or assoc with food poisoning Instead CMS created the categories because of the increased number of patients who are coming in to the clinics with puncture wounds, in many cases, unfortunately, due to an increase in drug usage. Due to needing to know more about the epidemiology of diseases due to the risk of terrorism, these codes were created. If we know what the appropriate toxins are we can help the patient’s survival rate by using the appropriate anti-toxins and having the ability to inject these in to the patient.
  • The Infant Botulism: symptoms often occur 2 weeks after first exposure Foodborne and wound botulism: involve intestinal tract
  • Roseola infantum is a viral illness in young children, most commonly affecting those between the ages of 6 mos and 2 years. It generally is marked by several days of high fever followed by a distinctive rash just as the fever breaks. Two common and closely related viruses can cause roseola. HHV type 6 and 7.
  • These codes were added in to further specify these. Remember all of the herpes encephalitis codes that were added in last year?
  • Doesn’t this sound like a Valtrax commercial?
  • The parvovirus is unique and looks just like these pictures. The child will possibly have the “slapped” red cheeks and or the characteristic lacy rash that spreads up and down the arms. This is highly contagious and can be diagnosed by lab test. All of my children and my nephew (who they had not seen in months) all came down with this just as school was getting out in June. Originally we thought it was due to the fact that they were out in sun.
  • These are becoming more and more in the forefront of research with disease tracking We are wanting to see what the long term effects of viral illnesses may be. In the hospital setting we may not see these viruses unless the patients come in with encephalitis or organ failure, etc. Patients with Renal transplant or any organ transplants in general may have severe complications due to these
  • Lymphoma is a type of cancer involving cells of the immune system called lymphocytes. Approximately 35 different types of lymphomas fall into 2 major categories: Hodgkins lymphoma 2. All other types of lymphomas (also known as non-hodgkins lymphomas or NHL’s) The NHL’s can be further broken down into aggressive (fastgrowing) or indolent (slow growing) types and classified as either B cell or T cell NHL’s There are 54 new codes in these categories we are about to discuss.
  • Revised European-American Lymphoma classification (REAL) We need a breakdown of all of the Non-Hodgkins’. Hodgkins is Hodgkins. All of the others are non-Hodgkins lymphoma. These are broken down by malignancy. WHO wants to have better ICD-9 codes.
  • The Burkitt lymphoma/leukemia was discovered by the same physician who discovered that with eating raw bran and putting it in your cereal it would lower your colon CA risk.
  • The Reed Stenberg Cell – as seen on this slide is a massive cell. Usually larger than 10 cells together.
  • They added new cell types that complete cell types. In the first column these are so named
  • Underlined text is changed
  • We now have a larger breakdown than we had prior. The right hand column is the actual site. You will need to have your physician give you this information. The .X8 is actually seen quite frequently for example: inquinal and spleen, etc.
  • 200.3X – Marginal Zone – are B cell lymphomas. Involve the lymph nodes they are called “nodal marginal zone B-Cell lymphoas. If outside of the lymph nodes then they are “mucosa assoc lymphatic tissue lymphomas” or MALT. 200.4X – Mantle cell aggressive type of B-cell NHL. Marked by small to medium sized ca cells that may be in the lymph nodes, spleen, bone marrow, blood or GI system. 200.5x = Primary Central Nerv System – Younger pts may have brain dysfunction, while older pts may present with NHL related dementia. Malignant ca cells form in the lymph tissue of the brain and/or spinal cord. Because the eye is so close to the brain, primary CNS can also start in the eye (called ocular lymphoma). Primary CNS lymphoma MAY occur in pts who have AIDS or other disorders of the immune system OR who have had an organ transplant and are immunocompromised.
  • 200.6X – If the protein is positive ALK-1+ there is a direct correlation to younger age and better prognosis. Usually a T cell type of lymphoma. Usually appears in the lymph nodes, skin, bones, soft tissue, lungs or liver. 200.7X – Large Cell are most common type comprising 20-30% of all NHL’s.
  • Peripheral T cell is also classified as aggressive and begins in mature T lymphocytes, usually occurs in approx 7% of all lymphomas. Tumor type carries the worst prognosis of all lymphomas and typically is assoc. with extranodal presentation which means that the tumor is involving organs in addition to lymph nodes. Also called Mature T cell lymphoma
  • Again this year as there was in 2005, numerous changes to the female reproductive health codes. You can look these up in the alphabetic index using Neoplasm, by site, malignant CA insitu.
  • These are used generally for the patients who have death after these insufficiencies or deficiencies
  • Patients with heart failure.
  • Systemic inflamatory response If you can process these you are ok – When you have insufficiency you can die.
  • Caused by some other problem in body
  • Waterhouse Friedrichsen – hemorrhage into adrenal glands.
  • Pay attention to all of the notes listed below!
  • You may also see this as MEA – Adenoma or Adenomatosis Use add’l note in ICD-9 and applicable to all the codes in that category
  • We never had a way of reporting these in the past. Typically going to be seen by endocrinologists. If not chronic kidney dz physicians will continue looking. May be ulcers that won’t heal for example.
  • Most include medullary malignancy. Highest mortality rate. May have extremely high B/P. Hyperchromatosis
  • They have now expanded these codes out to the 5 digit level to show what types of aplasia and aplastic anemias. Pay attn to the note about the additional E code for drugs, radiation, or an infection,etc if know.
  • Use only if unknown – probably while they are trying to determine cause.
  • These are muscular dystrophy codes. The only one of these that is reversable is the drug induce 359.24. Some are congenital, some are acquired. Herpes may cause some of these.
  • The Lasix may actually cause myotonic contractions.
  • This is also know as the IFIS – Intraoperative Floppy Iris Syndrome Ads have now been changed to have patients tell their phyisicians, etc.
  • Please note that the second code on this slide is out of order due to the significance that it has to the other code.
  • Any embolisms in peripheral system can go to the lungs. These may result from an old infected IV site. Cellulitis can cause the clot to travel to the heart. Look for infective endocarditis. Atrial may cause arterial embolism 449 – It causes lung abscesses and/or empyema. Just remember the circulation. If the septic clot ends in an artery, it’s from the left heart – look for a valve. If the septic clot ends in the lungs, it’s probably related to a venous catheter infection. Look for a reason! In documentation you may see septic embolism and lung abscess – these conditions may not be related. Only when result is linked.
  • Differentiate acute vs. Chronic occlusion. Acute have their own set of codes. 444.21-444.22. That is why they are listed in the excludes notes. Occlusions of the extremities!
  • Bird flu infection when it is caused by avian influenza virus
  • To show med necess For those pts who now have to have tx for the fecal incontnence, etc.
  • 624.0 is deleted Dystrophy of vulva which specifically EXCLUDES CIN of the vulva. VIN of the vulva is not the same as CIN of the vulva 233.32 – but they can be mistaken.
  • Must have code clinical documentation.
  • A question was posed whether or not a speech therapist could provide the type of dysphagia in order to have the greatest specificity of the code. The Physician ordering the therapy really needs to provide specificity.
  • V12.53 – this code may be very useful in those pts who have an automatic defibrillator implanted. One of the covered indications for an implantable auto defibrillator is a “documented episode of cardiac arrest due to ventricular fibrillation VF not due to a transient or reversible cause” according to the NCD 20.4 effective January 27, 2005. This code could be used to show that this pt really meets this indication.
  • Has anyone been to Lake Manona or Lake Mendota? Unfortunately, many of the lakes in WI are infected with these algaes. Interesting, it must not just be WI that is dealing with this.
  • A is the correct answer. According to the Coding Clinic 2 nd quarter 1993 pp 3-4 If lymph nodes in more than one region of the body (eg head and thorax, neck and abdomen, axilla and lower limb and pelvis) are involved, the fifth digit “8” should be assigned. 200.38 should be assigned because this is the Marginal zone lymphoma of specific sites.
  • B is the correct answer
  • D is the correct answer as the patient came in for abdominal pain and we have no radiology findings at this time. According to the Coding Clinic, 2 nd quarter 1992, pp 3-4 Lymphoma pts who are in remission are still considered to have lymphoma and should be assigned the appropriate codes from categories 200-202. Code 202.74 should be assigned to represent Peripheral T cell lymphoma of the axillary region lymph nodes.
  • That’s it….now everyone can relax and enjoy the rest of their day. Thank you for coming to this session….I hope you have walked away with a better understanding of E/M coding.
  • October 1, 2007 ICD-9-CM Changes

    1. 1. October 1, 2007 ICD-9-CM Changes Webcast September 27, 2007 Sandy Giangreco, CPC, CPC-H Coding & Reimbursement Educator/Regional Membership Director Wisconsin Medical Society, Copyright 2007 CPT codes, descriptions and material only are Copyright 2006 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in applicable FARS/DFARS restrictions to government use
    2. 2. What is the impact for FY 2008? <ul><li>144 New Diagnosis Codes </li></ul><ul><li>17 Deleted Diagnosis Codes </li></ul><ul><li>5 Revised Diagnosis Codes </li></ul><ul><li>Remember – We no longer have a grace period!!!! </li></ul><ul><li>Get these codes loaded and ready to go for encounters for dos 10.1.2007 and after! </li></ul><ul><li>Let’s Get Excited and Get Started! </li></ul><ul><li>Let the Fun Begin! </li></ul>
    3. 3. Rationale of Coding Changes <ul><li>Greater specificity </li></ul><ul><ul><li>Some due to technology </li></ul></ul><ul><li>More of the “NOS” or “Unspecified” code sets are subdivided into specific categories in preparation for our conversion to ICD-10 </li></ul><ul><li>New technologies require tracking for effectiveness in dealing with disease or for complications of the new technologies </li></ul><ul><ul><li>ICD-9 Procedures will not be discussed during our session today </li></ul></ul>
    4. 4. New Subcategory 040.4 Other specified botulism <ul><li>Non-foodborne intoxication due to toxins of Clostridium botulinum [C. botulinum] </li></ul><ul><ul><li>Excludes: botulism NOS (005.1) </li></ul></ul><ul><ul><ul><ul><ul><li> food poisoning due to toxins of Clostridium botulinum (005.1) </li></ul></ul></ul></ul></ul><ul><li>New code 040.41 Infant botulism </li></ul><ul><li>New code 040.42 Wound botulism </li></ul><ul><ul><li>Non-foodborne botulism NOS </li></ul></ul><ul><ul><ul><li>Use additional code to identify complicated open wound </li></ul></ul></ul>
    5. 5. From a Clinical Perspective <ul><li>S/S of infant botulism </li></ul><ul><li>include: </li></ul><ul><li>Constipation </li></ul><ul><li>Floppy weakness due to muscle weakness, and trouble controlling the head </li></ul><ul><li>Weak cry </li></ul><ul><li>Drooping of eyelids </li></ul><ul><li>Tiredness </li></ul><ul><li>Difficulty sucking or feeding </li></ul><ul><li>Paralysis </li></ul><ul><li>S/S of food-borne and </li></ul><ul><li>wound botulism include: </li></ul><ul><li>Difficulty swallowing or speaking </li></ul><ul><li>Facial weakness </li></ul><ul><li>Double vision </li></ul><ul><li>Trouble breathing </li></ul><ul><li>Nausea, vomiting and abdominal cramps </li></ul><ul><li>Paralysis </li></ul>
    6. 6. New Codes for Viral Illnesses <ul><li>New Section and Category: OTHER HUMAN HERPES VIRUSES 058 </li></ul><ul><li>New 058 Other human herpes virus category </li></ul><ul><ul><li>Excludes: congenital herpes (771.2) </li></ul></ul><ul><ul><ul><ul><ul><li>cytomegalovirus (078.5) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Epstein-Barr virus (075) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>herpes NOS (054.0-054.9) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>herpes simplex (054.0-054.9) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>herpes zoster (053.0-053.9) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>human herpesvirus NOS (054.0-054.9) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>human herpesvirus 1 (054.0-054.9) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li> human herpesvirus 2 (054.0-054.9) </li></ul></ul></ul></ul><ul><ul><ul><ul><li> human herpesvirus 3 (052.0-053.9) </li></ul></ul></ul></ul><ul><ul><ul><ul><li> human herpesvirus 4 (075) </li></ul></ul></ul></ul><ul><li> human herpesvirus 5 (078.5) </li></ul><ul><li> varicella (052.0-052.9) </li></ul><ul><ul><ul><ul><ul><li>varicella-zoster virus (052.0-053.9) </li></ul></ul></ul></ul></ul>
    7. 7. Roseola Infantum <ul><li>New code 058.10 Roseola infantum, Exanthema subitum [sixth disease], unspecified </li></ul><ul><li>New code 058.11 Roseola infantum due to human herpes virus 6 </li></ul><ul><li>New code 058.12 Roseola infantum due to human herpes virus 7 </li></ul>
    8. 8. New Herpes Encephalitis Codes <ul><li>New subcategory 058.2 Other human herpes virus encephalitis </li></ul><ul><ul><li>Excludes: herpes encephalitis NOS (054.3) </li></ul></ul><ul><ul><ul><ul><ul><li>herpes simplex encephalitis (054.3) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>human herpes virus encephalitis NOS (054.3) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li> simian B herpes virus encephalitis (054.3) </li></ul></ul></ul></ul></ul><ul><li>New code 058.21 Human herpes virus 6 encephalitis </li></ul><ul><li>New code 058.29 Other human herpes virus encephalitis </li></ul><ul><ul><li>Human herpesvirus 7 encephalitis </li></ul></ul>
    9. 9. More Herpes Codes <ul><li>New subcategory 058.8 Other human herpes virus infections </li></ul><ul><li>New code 058.81 Human herpes virus 6 infection </li></ul><ul><li>New code 058.82 Human herpes virus 7 infection </li></ul><ul><li>New code 058.89 Other human herpes virus infection </li></ul><ul><ul><li>Human herpes virus 8 infection </li></ul></ul><ul><ul><ul><li>Kaposi’s sarcoma-associated herpes virus infection </li></ul></ul></ul>
    10. 10. Respiratory System Virus <ul><li>New code 079.83 Parvovirus B19 </li></ul><ul><ul><ul><li>AKA: Human parvovirus </li></ul></ul></ul><ul><ul><ul><ul><li>Parvovirus NOS </li></ul></ul></ul></ul><ul><ul><li>Excludes: erythema infectiosum [fifth disease] (057.0) </li></ul></ul>www.accesskent.com www.robynsnest.com
    11. 11. Clinical Aspects of Viral Illnesses <ul><li>DNA Analysis is being used to identify more diseases and further differentiating the viruses causing those </li></ul><ul><li>Two variants of the herpes virus 6-A causes no disease, B can cause roseola </li></ul><ul><li>Varying severities are seen with roseola </li></ul><ul><ul><li>Most have no symptoms </li></ul></ul><ul><ul><li>May be cause of febrile convulsions </li></ul></ul><ul><ul><li>Can be as severe as encephalitis and failure of organs </li></ul></ul><ul><ul><li>Dangerous to immunocompromised patients </li></ul></ul><ul><ul><ul><li>May use antiviral drugs such as gancyclovir or acyclovir in patients with pityriasis, also caused by these viruses </li></ul></ul></ul>
    12. 12. Clinical Information about Human Herpes Virus <ul><li>Signs and Symptoms include: Rash or roseola, and chronic fatigue syndrome </li></ul><ul><li>Roseola infantum – the patient may not have any noticable symptoms </li></ul><ul><li>If the patient develops encephalitis (maybe they are immunocompromised) they may become symptomatic the day after the disease is gone </li></ul>
    13. 13. Lymphoma Code Changes <ul><li>Lymphomas have been named by their discoverer, or by some difference in their activity, related to their diseases or manifestations </li></ul><ul><li>Recently these were divided in to 4 categories: </li></ul><ul><ul><li>Hodgkin’s </li></ul></ul><ul><ul><li>High-Grade </li></ul></ul><ul><ul><li>Intermediate Grade </li></ul></ul><ul><ul><li>And Low Grade Non-Hodgkin’s Lymphoma </li></ul></ul><ul><li>World Health Organization (WHO) has standardized the nomenclature proposed by the Revised European-American Lymphoma classification (REAL) </li></ul>
    14. 14. Clinical Aspects of REAL <ul><li>First classified by cell type – the cell which, if it is normal, most closely looks like the tumor cell </li></ul><ul><ul><li>B-cell tumors </li></ul></ul><ul><ul><li>T-cell tumors </li></ul></ul><ul><ul><li>Natural killer cell tumors </li></ul></ul><ul><ul><li>And other minor tumors </li></ul></ul>www.bbc.co.uk
    15. 15. Mature B-Cell Tumors (NHL) <ul><li>Chronic lymphocytic leukemia/small lymphocytic lymphoma </li></ul><ul><li>B-cell prolymphocytic leukemia </li></ul><ul><li>Lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia </li></ul><ul><li>Splenic marginal zone lymphoma </li></ul><ul><li>Plasma cell neoplasms – plasma cell myeloma, plasmacytoma, heavy chain diseases, monoclonal deposit disease </li></ul><ul><li>Extranodal marginal zone B cell lymphoma (mucosa associated lymphoid tissue, MALT lymphoma) </li></ul><ul><li>Nodal marginal zone B cell lymphoma </li></ul><ul><li>Follicular lymphoma </li></ul><ul><li>Mantle cell lymphoma </li></ul><ul><li>Diffuse large B cell lymphoma </li></ul><ul><li>Mediastinal (thymic) large B cell lymphoma </li></ul><ul><li>Intravascular large B cell lymphoma </li></ul><ul><li>Primary effusion lymphoma </li></ul><ul><li>Burkitt lymphoma/leukemia </li></ul><ul><li>Lymphomatoid granulomatosis </li></ul>
    16. 16. Mature T-Cell and Natural Killer Cell Tumors (NHL) <ul><li>T cell prolymphocytic leukemia </li></ul><ul><li>T cell large granular lymphocytic leukemia </li></ul><ul><li>Aggressive NK cell leukemia </li></ul><ul><li>Adult T cell leukemia/lymphoma </li></ul><ul><li>Extranodal NK/T cell lymphoma, nasal type </li></ul><ul><li>Enteropathy-type T cell lymphoma </li></ul><ul><li>Hepatosplenic T cell lymphoma </li></ul><ul><li>Blastic NK cell lymphoma </li></ul><ul><li>Mycosis fungoides/Sezary syndrome </li></ul><ul><li>Primary cutaneous CD30-positive T cell lymphoproliferative disorders </li></ul><ul><ul><li>Primary cutaneous anaplastic large cell lymphoma </li></ul></ul><ul><ul><li>Lymphomatoid Papulosis </li></ul></ul><ul><li>Angioimmunoblastic T cell lymphoma </li></ul><ul><li>Peripheral T cell lymphoma, unspecified </li></ul><ul><li>Anaplastic large cell lymphoma </li></ul>
    17. 17. Hodgkin’s Lymphoma <ul><li>Nodular lymphocyte-predominant Hodgkin lymphoma </li></ul><ul><li>Classical Hodgkin lymphoma </li></ul><ul><ul><li>Nodular sclerosis </li></ul></ul><ul><ul><li>Mixed cellularity </li></ul></ul><ul><ul><li>Lymphocyte-rich </li></ul></ul><ul><ul><li>Lymphocyte depleted or not depleted </li></ul></ul>www.medstudents.com.br
    18. 18. Immunodeficiency-Associated Lymphoproliferative Disorders <ul><li>Associated with a primary immune disorder </li></ul><ul><li>Associated with the Human Immunodeficiency Virus (HIV) </li></ul><ul><li>Post-transplant </li></ul><ul><li>Associated with Methotrexate therapy </li></ul>
    19. 19. Histiocytic and Dendritic Cell Neoplasms (CNS) <ul><li>Histiocytic sarcoma </li></ul><ul><li>Langerhans cell histiocytosis </li></ul><ul><li>Langerhans cell sarcoma </li></ul><ul><li>Interdigititating dendritic cell sarcoma/tumor </li></ul><ul><li>Follicular dendritic cell sarcoma/tumor </li></ul><ul><li>Dendritic cell sarcoma, unspecified </li></ul>
    20. 20. Classification by Immunologic Subtype and Aggressiveness <ul><li>B Cell </li></ul><ul><ul><li>Small lymphocytic </li></ul></ul><ul><ul><li>Lymphoplasmacytic </li></ul></ul><ul><ul><li>Follicular </li></ul></ul><ul><ul><li>Marginal zone, MALT </li></ul></ul><ul><ul><li>Marginal zone, nodal </li></ul></ul><ul><ul><li>Mantle cell </li></ul></ul><ul><ul><li>Diffuse large B cell </li></ul></ul><ul><ul><li>Primary mediastinal large B cell </li></ul></ul><ul><ul><li>Burkitt’s like </li></ul></ul><ul><li>T Cell </li></ul><ul><ul><li>Peripheral T–cell </li></ul></ul><ul><ul><li>Anaplastic large T/null cell </li></ul></ul><ul><ul><li>lymphoblastic </li></ul></ul>
    21. 21. Revision to Code 200 <ul><li>Revise 200 Lymphosarcoma and reticulosarcoma and other specified malignant tumors of lymphatic tissue </li></ul>
    22. 22. Our New Subdivisions for Lymphomas <ul><li>200.3X Marginal zone </li></ul><ul><li>200.4X Mantle zone </li></ul><ul><li>200.5X Primary CNS </li></ul><ul><li>200.6X Anaplastic large cell </li></ul><ul><li>200.7X Large cell Lymphoma </li></ul><ul><li>200.8X Peripheral T-cell </li></ul><ul><li>.X0 Unspecified site </li></ul><ul><li>.X1 Head, face, neck nodes </li></ul><ul><li>.X2 Intrathoracic nodes </li></ul><ul><li>.X3 Intra-abdominal nodes </li></ul><ul><li>.X4 Nodes axilla, upper limb </li></ul><ul><li>.X5 Inguinal, lower limb </li></ul><ul><li>.X6 Pelvic nodes </li></ul><ul><li>.X7 Spleen </li></ul><ul><li>.X8 Multiple Sites </li></ul>
    23. 23. Further Breakdown of These Codes <ul><li>200.3X Marginal Zone Lymphoma – typically indolent and accounts for approx. 10% of all lymphomas </li></ul><ul><li>200.4X Mantle Cell Lymphoma – aggressive tumor type and represents about 6% of all lymphomas </li></ul><ul><ul><li>Typically described as incurable with traditional tx but stem cell transplant may be provided </li></ul></ul><ul><li>200.5X Primary CNS Lymphoma – also aggressive type but only accounts for about 1-2% of all cases </li></ul><ul><ul><li>Requires different chemo options than other NHL’s and in many cases also requires radiation to brain. </li></ul></ul>
    24. 24. More Information <ul><li>200.6X Anaplastic Large Cell Lymphoma – also aggressive and accounts for 2% of all lymphomas. </li></ul><ul><ul><li>Pts are tested for ALK-1 which is fusion protein. </li></ul></ul><ul><li>200.7X Large Cell Lymphoma – considered very aggressive, grows extremely quickly and accounts for approximately 20-30% of all lymphomas </li></ul><ul><li>Metastatic lymph node tumors are classified to category 196.X (Secondary and unspecified malignant neoplasm of lymph node) </li></ul>
    25. 25. Peripheral T-Cell Lymphoma <ul><li>New code 202.7X Peripheral T-cell lymphoma </li></ul><ul><li>.X0 Unspecified site </li></ul><ul><li>.X1 Head, face, neck nodes </li></ul><ul><li>.X2 Intrathoracic nodes </li></ul><ul><li>.X3 Intra-abdominal nodes </li></ul><ul><li>.X4 Nodes axilla, upper limb </li></ul><ul><li>.X5 Inguinal, lower limb </li></ul><ul><li>.X6 Pelvic nodes </li></ul><ul><li>.X7 Spleen </li></ul><ul><li>.X8 Multiple Sites </li></ul>
    26. 26. Carcinoma In-Situ (CIS) <ul><li>Deleted 233.3 – other and unspecified- greater specificity desired with HPV connection with CIS </li></ul><ul><li>New code 233.30 Unspecified female genital organ </li></ul><ul><li>New code 233.31 Vagina </li></ul><ul><ul><li>Severe dysplasia of vagina </li></ul></ul><ul><ul><li>Vaginal intraepithelial neoplasia III [VAIN III] </li></ul></ul><ul><li>New code 233.32 Vulva </li></ul><ul><ul><li>Severe dysplasia of vulva </li></ul></ul><ul><ul><li>Vulvar intraepithelial neoplasia III [VIN III] </li></ul></ul><ul><li>New code 233.39 Other female genital organ </li></ul>
    27. 27. Endocrine Specific Codes <ul><li>Deleted 255.4 Corticoadrenal insufficiency which included both glucocorticoid (cortisone, etc.) and mineralocorticoid (aldosterone, etc.) problems </li></ul><ul><li>New code 255.41 Glucocorticoid deficiency </li></ul><ul><ul><ul><li>Addisonian crisis </li></ul></ul></ul><ul><ul><ul><li>Addison’s disease NOS </li></ul></ul></ul><ul><ul><ul><li>Adrenal atrophy (autoimmune) </li></ul></ul></ul><ul><ul><ul><li>Adrenal calcification </li></ul></ul></ul><ul><ul><ul><li>Adrenal crisis </li></ul></ul></ul><ul><ul><ul><li>Adrenal hemorrhage </li></ul></ul></ul><ul><ul><ul><li>Adrenal infarction </li></ul></ul></ul><ul><ul><ul><li>Adrenal insufficiency NOS </li></ul></ul></ul><ul><ul><ul><ul><li>Combined glucocorticoid and mineralocorticoid deficiency </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Corticoadrenal insufficiency NOS </li></ul></ul></ul></ul><ul><li>New code 255.42 Mineralocorticoid deficiency Hypoaldosteronism </li></ul><ul><ul><li>Excludes: combined glucocorticoid and mineralocorticoid deficiency (255.41) </li></ul></ul>
    28. 28. Clinical Perspective of Endocrine Changes <ul><li>The adrenal cortex produces 50 hormones including 98% of the corticosteroids (mostly cortisone) and mineralcorticoids (mostly aldosterone) </li></ul><ul><li>Adrenal medulla produces adrenaline (epi and norepi) </li></ul><ul><li>Primary adrenal insufficiency includes lack of production of both cortisones (corticosteroids) and mineralcorticoids </li></ul><ul><li>Secondary retains production of mineralcorticoids </li></ul>
    29. 29. Clinical Aspects of Hormones <ul><li>Effects of corticosteroids </li></ul><ul><ul><li>Stimulates production of glucose from protein (glucogenesis) and decreases cellular glucose usage </li></ul></ul><ul><ul><li>Mobilizes amino acids </li></ul></ul><ul><ul><li>Increases pts red cell and platelet counts </li></ul></ul><ul><ul><li>Inhibits effects of insulin </li></ul></ul><ul><ul><li>Massive effects in inflammation to fight SIRS </li></ul></ul><ul><li>Effects of aldosterone </li></ul><ul><ul><li>Responds to renin angiotensin cycle in maintenance of blood pressure </li></ul></ul><ul><ul><li>Effect on kidneys, intestines, sweat glands to maintain electrolyte balance </li></ul></ul><ul><ul><li>Excesses of aldosterone result in picture of sodium retention, hypokalemia and alkalosis </li></ul></ul>
    30. 30. 2 types of Adrenal Insufficiency <ul><li>Primary Adrenal Insufficiency </li></ul><ul><ul><li>Reduction of both aldosterone and cortisol </li></ul></ul><ul><ul><li>Results from destruction of adrenal glands (TB, fungal replacement, hemorrhage, malignancy) </li></ul></ul><ul><ul><li>May result from congenital hypoplasia or from toxicity to adrenal glands </li></ul></ul><ul><li>Secondary Adrenal Insufficiency </li></ul><ul><ul><li>Pituitary tumors, not stimulating adrenals to produce the hormones </li></ul></ul><ul><ul><li>Long term usage of steroids clinically as in chemo, COPD, allergic dx and autoimmune dz </li></ul></ul>
    31. 31. Acute Adrenal Insufficiency <ul><li>Can result in shock and possible rapid death </li></ul><ul><li>May result from rapid cessation of long term steroid usage </li></ul><ul><li>Can result from sepsis or surgical stresses </li></ul><ul><li>Most common known cause of hemorrhage is Waterhouse Friedrichsen syndrome – bilateral adrenal hemorrhages from menigococcemia </li></ul><ul><li>Autoimmmune adrenal insufficiency likely will have its own breakdown of polyglandular autoimmune disorders (PGA’s) codes in future </li></ul>
    32. 32. Actual Codes <ul><li>New code 255.41 Glucocorticoid deficiency </li></ul><ul><ul><li>Addisonian crisis </li></ul></ul><ul><ul><li>Addison’s disease NOS </li></ul></ul><ul><ul><li>Adrenal atrophy (autoimmune) </li></ul></ul><ul><ul><li>Adrenal calcification </li></ul></ul><ul><ul><li>Adrenal crisis </li></ul></ul><ul><ul><li>Adrenal hemorrhage </li></ul></ul><ul><ul><li>Adrenal infarction </li></ul></ul><ul><ul><li>Adrenal insufficiency NOS </li></ul></ul><ul><ul><ul><li>Combined glucocorticoid and mineralocorticoid deficiency </li></ul></ul></ul><ul><ul><ul><li>Corticoadrenal insufficiency NOS </li></ul></ul></ul><ul><li>New code 255.42 Mineralocorticoid deficiency </li></ul><ul><ul><li>Hypoaldosteronism </li></ul></ul><ul><ul><ul><li>Excludes: combined glucocorticoid and mineralocorticoid deficiency (255.41) </li></ul></ul></ul>
    33. 33. A Few Good MEN <ul><li>New code 258.01 Multiple endocrine neoplasia [MEN] type I </li></ul><ul><ul><li>Wermer’s syndrome </li></ul></ul><ul><li>New code 258.02 Multiple endocrine neoplasia [MEN] type IIA </li></ul><ul><ul><li>Sipple’s syndrome </li></ul></ul><ul><li>New code 258.03 Multiple endocrine neoplasia [MEN] type IIB </li></ul><ul><ul><li>Use additional codes to identify any malignancies and other conditions associated with the syndromes </li></ul></ul>
    34. 34. MEN May be in Women <ul><li>Long known groupings of endocrine tumors with genetic cause </li></ul><ul><li>MEN I – parathyroid adenomas causing hyperparathyroidism, kidney stones, pancreatic adenomas, anterior pituitary tumors and skin tumors </li></ul><ul><li>Mostly benign but can have malignancy </li></ul>
    35. 35. MEN May be in Women cont. <ul><li>MEN II – Medullary carcinoma of thyroid [bad acting thyroid cancer, worse than papillary or follicular], pheochromocytoma [excessive adrenaline and dangerous hypertension] of adrenal gland </li></ul><ul><ul><li>IIA may also have hyperparathyroidism [with kidney stones] due to parathyroid adenoma </li></ul></ul><ul><ul><li>IIB won’t </li></ul></ul>
    36. 36. New Anemia Codes <ul><li>New code 284.81 Red cell aplasia (acquired) (adult) (with thymoma) </li></ul><ul><ul><li>Red cell aplasia NOS </li></ul></ul><ul><li>New code 284.89 Other specified aplastic anemias </li></ul><ul><ul><li>Aplastic anemia (due to): </li></ul></ul><ul><ul><ul><li>chronic systemic disease </li></ul></ul></ul><ul><ul><ul><li>drugs </li></ul></ul></ul><ul><ul><ul><li>infection </li></ul></ul></ul><ul><ul><ul><li>radiation </li></ul></ul></ul><ul><ul><ul><li>toxic (paralytic) </li></ul></ul></ul><ul><ul><li>Use additional E code to identify cause </li></ul></ul>
    37. 37. One solo Code <ul><li>New code 288.66 Bandemia </li></ul><ul><ul><li>Bandemia without diagnosis of specific infection </li></ul></ul><ul><ul><ul><li>Excludes: confirmed infection – code to infection leukemia (204.00-208.9) </li></ul></ul></ul>
    38. 38. Developmental Delays <ul><li>New code 315.34 Speech and language developmental delay due to hearing loss </li></ul><ul><ul><li>Use additional code to identify type of hearing loss (389.00-389.9) </li></ul></ul>
    39. 39. Hydrocephalus Code <ul><li>New code 331.5 Idiopathic normal pressure hydrocephalus (INPH) </li></ul><ul><ul><li>Normal pressure hydrocephalus NOS </li></ul></ul><ul><ul><ul><li>Excludes: congenital hydrocephalus (742.3) </li></ul></ul></ul><ul><ul><ul><ul><li>secondary normal pressure hydrocephalus (331.3) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>spina bifida with hydrocephalus (741.0) </li></ul></ul></ul></ul>
    40. 40. Myotonic Conditions <ul><li>New code 359.21 Myotonic muscular dystrophy </li></ul><ul><ul><ul><li>Dystrophia myotonica </li></ul></ul></ul><ul><ul><ul><li>Myotonia atrophica </li></ul></ul></ul><ul><ul><ul><li>Myotonic dystrophy </li></ul></ul></ul><ul><ul><ul><li>Proximal myotonic myopathy (PROMM) </li></ul></ul></ul><ul><ul><ul><li>Steinert’s disease </li></ul></ul></ul><ul><li>New code 359.22 Myotonia congenita </li></ul><ul><ul><ul><li>Acetazolamide responsive myotonia congenita </li></ul></ul></ul><ul><ul><ul><li>Dominant form (Thomsen’s disease) </li></ul></ul></ul><ul><ul><ul><li>Recessive form (Becker’s disease) </li></ul></ul></ul><ul><li>New code 359.23 Myotonic chondrodystrophy </li></ul><ul><ul><ul><li>Congenital myotonic chondrodystrophy </li></ul></ul></ul><ul><ul><ul><li>Schwartz-Jampel disease </li></ul></ul></ul><ul><li>New code 359.24 Drug-induced myotonia </li></ul><ul><ul><ul><li>Use additional E code to identify drug </li></ul></ul></ul><ul><li>New code 359.29 Other specified myotonic disorder </li></ul><ul><ul><ul><li>Myotonia fluctuans </li></ul></ul></ul><ul><ul><ul><li>Myotonia levior </li></ul></ul></ul><ul><ul><ul><li>Myotonia permanens </li></ul></ul></ul><ul><ul><ul><li>Paramyotonia congenita (of von Eulenburg) </li></ul></ul></ul>
    41. 41. Clinical Perspective <ul><li>Excessive tone or spasms to muscles, impairs movements </li></ul><ul><li>Myotonic muscular dystrophy is most common form of adult onset MD – high risk during and after anesthesia </li></ul><ul><li>Drug induced known adverse effect of Lasix (furosemide) and Atromid-S (clofibrate) </li></ul>
    42. 42. Floppy Iris Syndrome <ul><li>Variant of small pupil syndrome </li></ul><ul><li>A complication of TV ads – telling men to ask their physicians for drugs </li></ul><ul><li>Alpha-1 blocking agents are present in some antihypertensives and is present as Flomax </li></ul><ul><li>Patients undergoing cataract surgery by phacoemulsification are in danger of permanent small pupils because of flaccid iris and drugs usually used in surgery </li></ul><ul><li>Can be prevented (if known) with iris hooks and dilators </li></ul>
    43. 43. Eye Codes <ul><li>New code 364.81 Floppy iris syndrome </li></ul><ul><ul><li>Intraoperative floppy iris syndrome (IFIS) </li></ul></ul><ul><ul><li>Use additional E code to identify cause, such as: sympatholytics [antiadrenergics] causing adverse effect in therapeutic use (E941.3) </li></ul></ul><ul><li>New code 364.89 Other disorders of iris and ciliary body </li></ul><ul><ul><li>Prolapse of iris NOS </li></ul></ul><ul><ul><ul><li>Excludes: prolapse of iris in recent wound (871.1) </li></ul></ul></ul>
    44. 44. Hearing Codes <ul><li>New code 388.45 Acquired auditory processing disorder </li></ul><ul><ul><li>Auditory processing disorder NOS </li></ul></ul><ul><ul><ul><li>Excludes: central auditory processing disorder (315.32) </li></ul></ul></ul><ul><li>New code 389.05 Conductive hearing loss, unilateral </li></ul><ul><li>New code 389.06 Conductive hearing loss, bilateral </li></ul><ul><li>New code 389.13 Neural hearing loss, unilateral </li></ul><ul><li>New code 389.17 Sensory hearing loss, unilateral </li></ul>
    45. 45. More Hearing Codes <ul><li>New code 389.20 Mixed hearing loss, unspecified </li></ul><ul><li>New code 389.21 Mixed hearing loss, unilateral </li></ul><ul><li>New code 389.22 Mixed hearing loss, bilateral </li></ul>
    46. 46. Cardiac Codes <ul><li>New Code 414.2 Chronic total occlusion of coronary artery </li></ul><ul><ul><li>Complete occlusion of coronary artery </li></ul></ul><ul><ul><li>Total occlusion of coronary artery </li></ul></ul><ul><ul><li>Code first coronary atherosclerosis (414.00-414.07) </li></ul></ul><ul><ul><ul><li>Excludes: acute coronary occlusion with myocardial infarction (410.00-410.92) </li></ul></ul></ul><ul><ul><ul><ul><ul><li>acute coronary occlusion without myocardial infarction (411.81) </li></ul></ul></ul></ul></ul>
    47. 47. Septic Embolism <ul><li>Septic embolism is a venous blood clot that can be present because of stasis from prolonged occlusion, inflammation (phlebitis) or infection. </li></ul><ul><li>A venous clot in the peripheral circulation can embolize to the lungs </li></ul><ul><li>A clot in the left side of the heart or originating from an infected mitral or aortic valve can embolize to the arteries in the periphery (legs, organs, brain, etc) </li></ul><ul><li>Such an infected clot is a septic embolus. If it goes to the brain – stroke, if leg- causes dead leg. </li></ul>
    48. 48. Septic Embolism Codes <ul><li>New code 415.12 Septic pulmonary embolism </li></ul><ul><ul><li>Septic embolism NOS </li></ul></ul><ul><ul><ul><li>Code first underlying infection, such as: septicemia (038.0-038.9) </li></ul></ul></ul><ul><ul><ul><ul><li>Excludes: septic arterial embolism (449) </li></ul></ul></ul></ul><ul><li>New code 449 Septic arterial embolism </li></ul><ul><ul><li>Code first underlying infection, such as: infective endocarditis (421.0), lung abscess (513.0) </li></ul></ul><ul><ul><li>Use additional code to identify the site of the embolism (433.0-433.9, 444.0-444.9) </li></ul></ul><ul><ul><ul><ul><li>Excludes: septic pulmonary embolism (415.12) </li></ul></ul></ul></ul>
    49. 49. Septic Embolism <ul><li>415.12 is septic pulmonary embolism – from peripheral venous circulatory system, usually related to an indwelling venous access device, through the right heart to the lungs </li></ul><ul><li>449 is septic arterial embolism, from the left side of heart OR heart valves from endocarditis, through the aorta – even more rare would be an infected venous clot going through an atrial septal defect </li></ul>
    50. 50. More Heart Codes <ul><li>New code 423.3 Cardiac tamponade </li></ul><ul><ul><li>Code first the underlying cause </li></ul></ul><ul><li>New code 440.4 Chronic total occlusion of artery of the extremities </li></ul><ul><ul><li>Complete occlusion of artery of the extremities </li></ul></ul><ul><ul><li>Total occlusion of artery of the extremities </li></ul></ul><ul><ul><ul><li>Code first atherosclerosis of arteries of the extremities (440.20-440.29, 440.30-440.32) </li></ul></ul></ul><ul><ul><ul><ul><li>Excludes: acute occlusion of artery of extremity (444.21- 444.22) </li></ul></ul></ul></ul>
    51. 51. Influenza <ul><li>New code 488 Influenza due to identified avian influenza virus </li></ul><ul><li>Note: Influenza caused by influenza viruses that normally infect only birds and, less commonly, other animals </li></ul><ul><ul><ul><li>Excludes: influenza caused by other influenza viruses (487) </li></ul></ul></ul>
    52. 52. Dental Codes <ul><li>New code 525.71 Osseointegration failure of dental implant </li></ul><ul><ul><ul><li>Hemorrhagic complications of dental implant placement </li></ul></ul></ul><ul><ul><ul><li>Iatrogenic osseointegration failure of dental implant </li></ul></ul></ul><ul><ul><ul><li>Osseointegration failure of dental implant due to complications of systemic disease </li></ul></ul></ul><ul><ul><ul><li>Osseointegration failure of dental implant due to poor bone quality </li></ul></ul></ul><ul><ul><ul><li>Pre-integration failure of dental implant NOS </li></ul></ul></ul><ul><ul><ul><li>Pre-osseointegration failure of dental implant </li></ul></ul></ul><ul><li>New code 525.72 Post-osseointegration biological failure of dental implant </li></ul><ul><ul><ul><li>Failure of dental implant due to lack of attached gingiva </li></ul></ul></ul><ul><ul><ul><li>Failure of dental implant due to occlusal trauma (caused by poor prosthetic design) </li></ul></ul></ul><ul><ul><ul><li>Failure of dental implant due to parafunctional habits </li></ul></ul></ul><ul><ul><ul><li>Failure of dental implant due to periodontal infection (peri-implantitis) </li></ul></ul></ul><ul><ul><ul><li>Failure of dental implant due to poor oral hygiene </li></ul></ul></ul><ul><ul><ul><li>Iatrogenic post-osseointegration failure of dental implant </li></ul></ul></ul><ul><ul><ul><li>Post-osseointegration failure of dental implant due to complications of systemic disease </li></ul></ul></ul>
    53. 53. More Dental Codes <ul><li>New code 525.73 Post-osseointegration mechanical failure of dental implant </li></ul><ul><ul><li>Failure of dental prosthesis causing loss of dental implant </li></ul></ul><ul><ul><li>Fracture of dental implant </li></ul></ul><ul><ul><ul><ul><li>Excludes: cracked tooth (521.81) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>fractured dental restorative material with loss of material (525.64) </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>fractured dental restorative material without loss of material (525.63) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>fractured tooth (873.63, 873.73) </li></ul></ul></ul></ul></ul><ul><li>New code 525.79 Other endosseous dental implant failure </li></ul><ul><ul><li>Dental implant failure NOS </li></ul></ul>
    54. 54. Anal Sphincter Tear <ul><li>New code 569.43 Anal sphincter tear (healed) (old) </li></ul><ul><ul><li>Tear of anus, nontraumatic </li></ul></ul><ul><ul><li>Use additional code for any associated fecal incontinence (787.6) </li></ul></ul><ul><ul><ul><li>Excludes: anal fissure (565.0) </li></ul></ul></ul><ul><ul><li>anal sphincter tear (healed) (old) complicating delivery (654.8) </li></ul></ul>
    55. 55. VIN and CIN are NOT the same <ul><li>New code 624.01 Vulvar intraepithelial neoplasia I [VIN I] </li></ul><ul><ul><li>Mild dysplasia of vulva </li></ul></ul><ul><li>New code 624.02 Vulvar intraepithelial neoplasia II [VIN II] </li></ul><ul><ul><li>Moderate dysplasia of vulva </li></ul></ul><ul><li>New code 624.09 Other dystrophy of vulva </li></ul><ul><ul><li>Kraurosis of vulva </li></ul></ul><ul><ul><li>Leukoplakia of vulva </li></ul></ul>
    56. 56. Anal Sphincter Tear w/ Pregnancy <ul><li>New code 664.6X Anal sphincter tear complicating delivery, not associated with third-degree perineal laceration [0,1,4] </li></ul><ul><ul><ul><li>Excludes: third-degree perineal laceration (664.2) </li></ul></ul></ul><ul><li>Must assign 5 th digit dependant upon if patient has delivered, still pregnant or unknown </li></ul>
    57. 57. Aseptic Necrosis of Bone <ul><li>New code 733.45 Aseptic Necrosis of Bone, Jaw </li></ul><ul><ul><li>Use additional E code to identify drug, if drug-induced </li></ul></ul><ul><ul><ul><li>Excludes: osteoradionecrosis of jaw (526.89) </li></ul></ul></ul>
    58. 58. Hard to Swallow Codes <ul><li>New code 787.20 Dysphagia, unspecified </li></ul><ul><ul><li>Difficulty in swallowing NOS </li></ul></ul><ul><li>New code 787.21 Dysphagia, oral phase </li></ul><ul><li>New code 787.22 Dysphagia, oropharyngeal phase </li></ul><ul><li>New code 787.23 Dysphagia, pharyngeal phase </li></ul><ul><li>New code 787.24 Dysphagia, pharyngoesophageal phase </li></ul><ul><li>New code 787.29 Other dysphagia </li></ul><ul><ul><li>Cervical dysphagia </li></ul></ul><ul><ul><li>Neurogenic dysphagia </li></ul></ul><ul><li>Identify what are the issues being assisted </li></ul>
    59. 59. Greater Definition of Dysphagias <ul><li>787.21 Oral Phase </li></ul><ul><ul><li>Impaired structure/physiology of palate, tongue, lips, cheeks </li></ul></ul><ul><li>787.22 Oropharyngeal Phase </li></ul><ul><ul><li>Impaired structure/physiology of tongue base and pharyngeal walls </li></ul></ul><ul><li>787.23 Pharyngeal Phase </li></ul><ul><ul><li>Impaired structure/physiology of pharynx and larynx </li></ul></ul><ul><li>787.24 Pharyngoesophageal Phase </li></ul><ul><ul><li>Impaired structure/physiology of upper esophageal sphincter </li></ul></ul><ul><li>787.25 Dysphagia, unspecified – became 787.20 </li></ul>
    60. 60. Implications of Dysphagia Phases <ul><li>Some implications of dysphagia </li></ul><ul><ul><li>Aspiration (pneumonia, bronchitis, pneumonitis) </li></ul></ul><ul><ul><li>Dehydration </li></ul></ul><ul><ul><li>Malnutrition </li></ul></ul><ul><li>Diseases cause various phases to be affected </li></ul><ul><li>Treatments differ, dependent on phase affected </li></ul>
    61. 61. Expansion of Ascites <ul><li>Code 789.5 Ascites has been deleted </li></ul><ul><li>New code 789.51 Malignant ascites </li></ul><ul><ul><li>Code first malignancy, such as: malignant neoplasm of ovary (183.0) </li></ul></ul><ul><ul><li>secondary malignant neoplasm of retroperitoneum and peritoneum (197.6) </li></ul></ul><ul><li>New code 789.59 Other ascites </li></ul><ul><ul><li>Right heart failure, cirrhosis, renal failure, hypothyroidism, peritoneal infections, hypoproteinemia from any source, pancreatitis, congenital deformities of portal vein, liver, heart </li></ul></ul>
    62. 62. Clinical Aspect <ul><li>Malignant Ascites </li></ul><ul><ul><li>Adenocarcinoma deposits on the peritoneum which cause leakage of fluid </li></ul></ul><ul><ul><li>Colon ca, pancreatic ca, liver ca, ovarian ca </li></ul></ul><ul><ul><li>May be active </li></ul></ul><ul><ul><li>Clear, yellow fluid </li></ul></ul><ul><ul><li>Reaction of infection, outpouring of fluid </li></ul></ul>
    63. 63. V Codes <ul><li>New code V12.53 Sudden cardiac arrest </li></ul><ul><ul><li>Sudden cardiac death successfully resuscitated </li></ul></ul><ul><li>New code V12.54 Transient ischemic attack (TIA), and cerebral infarction without residual deficits </li></ul><ul><ul><li>Prolonged reversible ischemic neurological deficit (PRIND) </li></ul></ul><ul><ul><li>Reversible ischemic neurologic deficit (RIND) </li></ul></ul><ul><ul><li>Stroke NOS without residual deficits </li></ul></ul><ul><ul><ul><li>Excludes: late effects of cerebrovascular disease (438.0-438.9) </li></ul></ul></ul>
    64. 64. OB V Code <ul><li>New code V13.22 Personal history of cervical dysplasia </li></ul><ul><ul><li>Personal history of conditions classifiable to 622.10-622.12 </li></ul></ul><ul><ul><ul><li>Excludes: personal history of malignant neoplasm of cervix uteri (V10.41) </li></ul></ul></ul>
    65. 65. More Family Hx V Codes! <ul><li>Revise Family history of condition classifiable to 188– 189 </li></ul><ul><li>New code V16.52 Bladder </li></ul><ul><li>New code V17.41 Family history of sudden cardiac death (SCD) </li></ul><ul><ul><ul><li>Excludes: family history of ischemic heart disease (V17.3) </li></ul></ul></ul><ul><ul><ul><ul><ul><li>family history of myocardial infarction (V17.3) </li></ul></ul></ul></ul></ul><ul><li>New code V17.49 Family history of other cardiovascular diseases </li></ul><ul><ul><li>Family history of cardiovascular disease NOS </li></ul></ul>
    66. 66. Endrocrine V Codes <ul><li>New code V18.11 Multiple endocrine neoplasia [MEN] syndrome </li></ul><ul><li>New code V18.19 Other endocrine and metabolic diseases </li></ul>
    67. 67. Contraception and Procreative Mgmt <ul><li>New code V25.04 Counseling and instruction in natural family planning to avoid pregnancy </li></ul><ul><li>New code V26.41 Procreative counseling and advice using natural family planning </li></ul><ul><li>New code V26.49 Other procreative management counseling and advice </li></ul><ul><li>New code V26.81 Encounter for assisted reproductive fertility procedure cycle </li></ul><ul><ul><li>Patient undergoing in vitro fertilization cycle </li></ul></ul><ul><ul><li>Use additional code to identify the type of infertility </li></ul></ul><ul><ul><ul><li>Excludes: pre-cycle diagnosis and testing – code to reason for encounter </li></ul></ul></ul><ul><li>New code V26.89 Other specified procreative mgmt </li></ul>
    68. 68. More V Codes! <ul><li>New code V49.85 Dual sensory impairment </li></ul><ul><ul><li>Blindness with deafness </li></ul></ul><ul><ul><li>Combined visual hearing impairment </li></ul></ul><ul><ul><li>Code first: </li></ul></ul><ul><ul><ul><li>hearing impairment (389.00-389.9) </li></ul></ul></ul><ul><ul><ul><li>visual impairment (369.00-369.9) </li></ul></ul></ul><ul><li>Revised V58.69 Long-term (current) use of other medications </li></ul><ul><ul><ul><li>Other h High-risk medications </li></ul></ul></ul>
    69. 69. Disability Evals/Exams <ul><li>New code V68.01 Disability examination </li></ul><ul><ul><li>Use additional code(s) to identify: </li></ul></ul><ul><ul><li>specific examination(s), screening and testing performed (V72.0-V82.9) </li></ul></ul><ul><li>New code V68.09 Other issue of medical certificates </li></ul>
    70. 70. Misc V Codes <ul><li>New code V72.12 Encounter for hearing conservation and treatment </li></ul><ul><li>New code V73.81 Human papillomavirus (HPV) </li></ul>
    71. 71. Genetic Susceptibility V Codes <ul><li>New code V84.81 Genetic susceptibility to multiple endocrine neoplasia [MEN] </li></ul><ul><li>New code V84.89 Genetic susceptibility to other disease </li></ul>
    72. 72. New E Codes!!!!! <ul><li>New code E928.6 Environmental exposure to harmful algae and toxins </li></ul><ul><li>Includes: </li></ul><ul><ul><li>Algae bloom NOS </li></ul></ul><ul><ul><li>Blue-green algae bloom </li></ul></ul><ul><ul><li>Brown tide </li></ul></ul><ul><ul><li>Cyanobacteria bloom </li></ul></ul><ul><ul><li>Florida red tide </li></ul></ul><ul><ul><li>Harmful algae bloom </li></ul></ul><ul><ul><li>Pfisteria piscicida </li></ul></ul><ul><ul><li>Red tide </li></ul></ul>
    73. 73. E code for Bisphosphonates <ul><li>E933 Primarily systemic agents </li></ul><ul><li>New code E933.6 Oral bisphosphonates </li></ul><ul><li>New code E933.7 Intravenous bisphosphonates </li></ul>
    74. 74. Case Scenarios
    75. 75. Case Scenario # 1 <ul><li>A 58 year old female patient is seen for biopsy of masses found in both the chest and her groin lymph nodes. The pathology report comes back as nodal marginal zone B-cell lymphoma. What would the appropriate diagnosis be for this patient? </li></ul><ul><li>A. 200.38 </li></ul><ul><li>B. 195.1, 200.35 </li></ul><ul><li>C. 200.23, 200.35 </li></ul><ul><li>D. 200.83 </li></ul>
    76. 76. Case Scenario # 2 <ul><li>Patient is admitted to the Emergency Room after having spent the day at the beach. Family members stated that they told him to stay out of the water due to the blue green algae that had been reported at the lake. What is the appropriate E code to use for the ER visit? </li></ul><ul><li>A. E926.0 </li></ul><ul><li>B. E928.6 </li></ul><ul><li>C. E999 </li></ul><ul><li>D. E927 </li></ul>
    77. 77. Case Scenario # 3 <ul><li>45 year old patient presents to the clinic for a work-up of left lower quadrant abdominal pain. He has Peripheral T-Cell lymphoma of the axilla, in remission. At the beginning of the encounter (before any radiology findings are available from the hospital radiology department) what would the diagnosis code be for this encounter? </li></ul><ul><li>202.74, 789.04 </li></ul><ul><li>789.00, 202.70 </li></ul><ul><li>789.04, V10.79 </li></ul><ul><li>789.04, 202.74 </li></ul>
    78. 78. Resources <ul><li>ICD-9-CM Book 2008 published by Ingenix </li></ul><ul><li>http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdtab_addenda08.pdf </li></ul><ul><li>HcPro Audioconference “The Impact of the New and Revised 2008 ICD-9-CM Diagnosis and Procedure Codes” 8.24.07 </li></ul><ul><li>Advance Magazine 7.16.07 issue Coding for Non-Hodgkin’s Lymphoma </li></ul><ul><li>AAPC Coding Edge August 2007 issue “What’s Your ICD-9 Game Plan” by Catherine Gray, RHIT, CCS, CPC, CPC-CS </li></ul>
    79. 79. Sandy Giangreco, CPC, CPC-H Coding & Reimbursement Educator/Membership Director [email_address] 608-442-3776 Thank You
    80. 80. The information presented and responses to the questions posed are not intended to serve as coding or legal advice. Many variables affect coding decisions and any response to the limited information provided in a question is intended only to provide general information that might be considered in resolving coding issues. All coding must be considered on a case-by-case basis and must be supported by appropriate documentation in the medical record. Therefore, the Wisconsin Medical Society recommends consulting directly with payers to determine specific payers’ guidance regarding appropriate coding and claim submission. The CPT codes that are utilized in coding claims are produced and copyrighted by the American Medical Association (AMA). Specific questions regarding the use of CPT codes may be directed to the AMA. Disclaimer

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