Fiscal Year 2007  DRG Revisions and  ICD-9-CM Coding Changes Barry Libman, RHIA, CCS, CCS-P President Barry Libman Inc.
Inpatient PPS, FY 2007 <ul><li>Our objectives today: </li></ul><ul><li>Introduce the new DRGs </li></ul><ul><ul><li>Prelim...
Federal Register <ul><li>Federal Register, Vol. 71, No.160, August 18, 2006, Rules and Regulations, pp. 47870 – 48351 </li...
Codes Changes for FY 2007 <ul><li>Revisions and new codes will be implemented for discharges on or after October 1, 2006 <...
Inpatient PPS, FY 2007 <ul><li>Two major changes </li></ul><ul><li>1. move to cost-based weights </li></ul><ul><li>2. impr...
MDC 01  Nervous System <ul><li>Deleted: </li></ul><ul><ul><li>DRG 20 Nervous System Infection Except Viral Meningitis  Wt ...
MDC 01  Nervous System <ul><li>Deleted: </li></ul><ul><ul><li>DRG 24 Seizure and Headache Age >17 with CC  Wt .9970 </li><...
MDC 04  Respiratory System <ul><li>Deleted:  </li></ul><ul><ul><li>DRG 475 Respiratory System Diagnosis with Ventilator Su...
MDC 06 Digestive System <ul><li>113 Major Gastrointestinal Diagnoses </li></ul><ul><ul><li>See Appendix 2 for list </li></...
MDC 06 Digestive System <ul><li>Delete:  </li></ul><ul><ul><li>DRG 154 Stomach, Esophageal and Duodenal Procedures Wt 4.03...
MDC 06 Digestive System <ul><li>Delete:  </li></ul><ul><ul><li>DRG 148 Major Large and Small Bowel Procedures with CC Wt 3...
MDC 06 Digestive System <ul><li>New: </li></ul><ul><ul><li>DRG 571 Major Esophageal Disorders  Wt 1.1126 </li></ul></ul><u...
MDC 06 Digestive System <ul><li>New </li></ul><ul><ul><li>DRG 572 Major Gastrointestinal Disorders and Peritoneal Infectio...
MDC 11 Kidney and Urinary Tract <ul><li>New: </li></ul><ul><ul><li>DRG 573 Major Bladder Procedures Wt 3.3457 </li></ul></...
MDC 16  Blood and Immunological Disorders <ul><li>New: </li></ul><ul><ul><li>DRG 574 Major Hematologic and Immunoligic Dia...
MDC 16  Blood and Immunological Disorders <ul><ul><li>Diagnoses (continued) </li></ul></ul><ul><ul><ul><li>283.10  Non-aut...
MDC 18 Infectious and Parasitic Diseases <ul><li>Delete: </li></ul><ul><ul><li>DRG 416 Septicemia Age > 17 Wt 1.6774 </li>...
Comparison <ul><li>Respiratory Failure </li></ul><ul><li>Deleted DRG </li></ul><ul><li>DRG 475  Wt 3.6091 </li></ul><ul><l...
MDC 01 Nervous System <ul><li>New: </li></ul><ul><ul><li>DRG 577 Carotid Artery Stent Procedures Wt 1.7844 </li></ul></ul>...
MDC 18  Infectious and Parasitic Diseases <ul><li>Delete:  </li></ul><ul><ul><li>DRG 415 Operating Room Procedure for Infe...
MDC 18  Infectious and Parasitic Diseases <ul><li>Cases will be assigned to new DRG 578  Infectious and Parasitic Diseases...
Selected Tabular Changes <ul><li>See Appendix 5  </li></ul><ul><li>345.9 Epilepsy and recurrent seizures </li></ul><ul><ul...
Selected Tabular Changes <ul><li>585.5  Chronic kidney disease (CKD), Stage V </li></ul><ul><ul><li>Stage V requiring chro...
Selected Tabular Changes <ul><li>995.9  Systemic inflammatory response  syndrome (SIRS)  </li></ul><ul><ul><li>Code title ...
Codes Changes for FY 2007 <ul><li>New Diagnosis Codes </li></ul><ul><ul><li>3 Infectious and Parasitic Diseases   </li></u...
Infectious and Parasitic Diseases <ul><li>052.2  Postvaricella myelitis CC </li></ul><ul><li>053.14  Herpes zoster myeliti...
Neoplasms <ul><li>238.71  Essential thrombocythemia  </li></ul><ul><li>238.72  Low grade myelodysplastic syndrome  lesions...
Endocrine, Nutritional and Metabolic Diseases and Immunity Disorders <ul><li>277.30  Amyloidosis, unspecified  </li></ul><...
Blood and Blood-forming Organs <ul><li>284.01  Constitutional red blood cell aplasia  </li></ul><ul><li>284.09  Other cons...
Blood and Blood-forming Organs <ul><li>288.4  Hemophagocytic syndromes  </li></ul><ul><li>288.50  Leukocytopenia, unspecif...
Nervous System and Sense Organs <ul><li>323.01  Encephalitis and encephalomyelitis in viral  diseases classified elsewhere...
Nervous System and Sense Organs <ul><li>323.61  Infectious acute disseminated  encephalomyelitis (ADEM)  </li></ul><ul><li...
Nervous System and Sense Organs <ul><li>331.83  Mild cognitive impairment, so stated  </li></ul><ul><li>333.71  Athetoid c...
Nervous System and Sense Organs <ul><li>338.0  Central pain syndrome  </li></ul><ul><li>338.11  Acute pain due to trauma  ...
Nervous System and Sense Organs <ul><li>341.20  Acute (transverse) myelitis NOS  </li></ul><ul><li>341.21  … in conditions...
Circulatory System <ul><li>429.83  Takotsubo syndrome </li></ul><ul><li>Cardiomyopathy that mimics acute coronary syndrome...
Respiratory System <ul><li>478.11  Nasal mucositis (ulcerative)  </li></ul><ul><li>478.19  Other disease of nasal cavity a...
Digestive System <ul><li>521.81  Cracked tooth  </li></ul><ul><li>521.89  Other specific diseases of hard tissues of teeth...
Digestive System <ul><li>525.60  Unspecified unsatisfactory restoration of tooth  </li></ul><ul><li>525.61  Open restorati...
Digestive System <ul><li>528.00  Stomatitis and mucositis,  unspecified  </li></ul><ul><li>528.01  Mucositis (ulcerative) ...
Genitourinary System <ul><li>608.20  Torsion of testis, unspecified  </li></ul><ul><li>608.21  Extravaginal torsion of spe...
Pregnancy, Childbirth, and the Puerperium <ul><li>649.00-04  Tobacco use disorder  </li></ul><ul><li>649.10-14  Obesity </...
Musculoskeletal System and Connective Tissue <ul><li>729.71  Nontraumatic compartment  syndrome of upper extremity  </li><...
Perinatal Period <ul><li>768.7  Hypoxic-ischemic encephalopathy  (HIE)  </li></ul><ul><li>770.87  Respiratory arrest of ne...
Symptoms, Signs, and Ill-defined Conditions <ul><li>780.32  Complex febrile convulsions CC </li></ul><ul><li>780.96  Gener...
Symptoms, Signs, and Ill-defined Conditions <ul><li>793.91  Image test inconclusive due to excess  body fat  </li></ul><ul...
Injury and Poisoning <ul><li>958.90  Compartment syndrome, unspecified  </li></ul><ul><li>958.91  Traumatic compartment sy...
V-Codes <ul><li>V18.51  Family history, Colonic polyps  </li></ul><ul><li>V18.59  … Other digestive disorders  </li></ul><...
V-Codes <ul><li>V72.11  Encounter for hearing examination following failed  hearing screening  </li></ul><ul><li>V72.19  O...
Procedure Codes  <ul><li>Procedures and Interventions NEC   </li></ul><ul><li>00.44  Procedure on vessel bifurcation  </li...
Procedure Codes <ul><li>Operations on the Nervous System  </li></ul><ul><li>01.28  Placement of intracerebral catheter(s) ...
Procedure Codes <ul><li>Operations on the Respiratory System  </li></ul><ul><li>32.23  Open ablation of lung lesion or tis...
Procedure Codes <ul><li>Operations on the Cardiovascular System  </li></ul><ul><li>35.55  Repair of ventricular septal def...
Procedure Codes <ul><li>Operations on the Digestive System   </li></ul><ul><li>50.23  Open ablation of liver lesion or tis...
Procedure Codes <ul><li>Operations on the Female Genital Organs   </li></ul><ul><li>68.41  Laparoscopic total abdominal hy...
ICD-10  Really?  Yes! <ul><li>Senate bill:  S. 1418 - Wired for Health Care Quality Act </li></ul><ul><ul><li>$650 million...
Questions? <ul><li>Barry Libman, RHIA, CCS, CCS-P </li></ul><ul><li>President, Barry Libman Inc. </li></ul><ul><li>978-369...
Upcoming SlideShare
Loading in …5
×

Fiscal Year 2007 DRG Revisions and ICD-9-CM Coding Changes

1,271 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,271
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
6
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Fiscal Year 2007 DRG Revisions and ICD-9-CM Coding Changes

  1. 1. Fiscal Year 2007 DRG Revisions and ICD-9-CM Coding Changes Barry Libman, RHIA, CCS, CCS-P President Barry Libman Inc.
  2. 2. Inpatient PPS, FY 2007 <ul><li>Our objectives today: </li></ul><ul><li>Introduce the new DRGs </li></ul><ul><ul><li>Preliminary steps towards severity </li></ul></ul><ul><li>Explore selected changes to the index and tabular section of ICD-9-CM </li></ul><ul><li>Discuss new Codes </li></ul>
  3. 3. Federal Register <ul><li>Federal Register, Vol. 71, No.160, August 18, 2006, Rules and Regulations, pp. 47870 – 48351 </li></ul><ul><li>Essential Reading </li></ul><ul><ul><li>Refinement of DRGs Based on Severity of Illness, pp. 47898 – 47912 </li></ul></ul><ul><ul><li>Severity Refinements to CMS DRGs, pp. 47924 – 47939 </li></ul></ul>
  4. 4. Codes Changes for FY 2007 <ul><li>Revisions and new codes will be implemented for discharges on or after October 1, 2006 </li></ul><ul><ul><li>20 New DRGs </li></ul></ul><ul><ul><ul><li>See Appendix 1 for list </li></ul></ul></ul><ul><ul><li>192 New Diagnosis Codes </li></ul></ul><ul><ul><li>19 New V Codes </li></ul></ul><ul><ul><li>36 New Procedure Codes </li></ul></ul>
  5. 5. Inpatient PPS, FY 2007 <ul><li>Two major changes </li></ul><ul><li>1. move to cost-based weights </li></ul><ul><li>2. improvements to DRGs to better recognize severity </li></ul><ul><li>“ refinements create 20 new CMS DRGs, modify 32 others across 13 clinical areas involving 1,666,476 cases” page 47919 </li></ul><ul><li>“ we (CMS) believe we should not adopt severity DRGs in FY 2007, but rather evaluate severity DRG systems for adoption in FY 2008.” page 47922 </li></ul>
  6. 6. MDC 01 Nervous System <ul><li>Deleted: </li></ul><ul><ul><li>DRG 20 Nervous System Infection Except Viral Meningitis Wt 2.7865 </li></ul></ul><ul><li>New: </li></ul><ul><ul><li>DRG 560 Bacterial and Tuberculous Infections of the Nervous System Wt 2.9031 </li></ul></ul><ul><ul><li>DRG 561 Non-bacterial Infections of the Nervous System Except Viral Meningitis Wt 2.2176 </li></ul></ul><ul><li>page 47924 </li></ul>
  7. 7. MDC 01 Nervous System <ul><li>Deleted: </li></ul><ul><ul><li>DRG 24 Seizure and Headache Age >17 with CC Wt .9970 </li></ul></ul><ul><ul><li>DRG 25 Seizure and Headache Age>17 without CC Wt .6180 </li></ul></ul><ul><li>New: </li></ul><ul><ul><li>DRG 562 Seizure Age >17 with CC Wt 1.0582 </li></ul></ul><ul><ul><li>DRG 563 Seizure Age >17 without CC Wt .6432 </li></ul></ul><ul><ul><li>DRG 564 Headache Age >17 Wt .6933 </li></ul></ul><ul><li>page 47928 </li></ul>
  8. 8. MDC 04 Respiratory System <ul><li>Deleted: </li></ul><ul><ul><li>DRG 475 Respiratory System Diagnosis with Ventilator Support Wt 3.6091 </li></ul></ul><ul><li>New: </li></ul><ul><ul><li>DRG 565 Respiratory System Diagnosis with Ventilator Support 96+ hours Wt 5.2294 </li></ul></ul><ul><ul><ul><li>(requires a respiratory system diagnosis and procedure code 96.72) </li></ul></ul></ul><ul><ul><li>DRG 566 Respiratory System Diagnosis with Ventilator Support <96 hours Wt 2.3335 </li></ul></ul><ul><ul><ul><li>(requires a respiratory system diagnosis and procedure code 96.70 or 96.71) </li></ul></ul></ul><ul><li>page 47929 </li></ul>
  9. 9. MDC 06 Digestive System <ul><li>113 Major Gastrointestinal Diagnoses </li></ul><ul><ul><li>See Appendix 2 for list </li></ul></ul><ul><li>These diagnoses used as either Principal or Secondary Diagnoses will assign patients to one of two newly created DRGs </li></ul><ul><ul><li>567 </li></ul></ul><ul><ul><li>569 </li></ul></ul><ul><li>pages 47933, 47934 and 47935 </li></ul>
  10. 10. MDC 06 Digestive System <ul><li>Delete: </li></ul><ul><ul><li>DRG 154 Stomach, Esophageal and Duodenal Procedures Wt 4.0399 </li></ul></ul><ul><li>New: </li></ul><ul><ul><li>DRG 567 Stomach, Esophageal and Duodenal Procedures Age >17 with CC with Major Gastrointestinal Diagnosis Wt 5.2173 </li></ul></ul><ul><ul><li>DRG 568 Stomach, Esophageal and Duodenal Procedures Age >17 with CC without Major Gastrointestinal Diagnosis Wt.3.3635 </li></ul></ul><ul><li>Page 47935 </li></ul>
  11. 11. MDC 06 Digestive System <ul><li>Delete: </li></ul><ul><ul><li>DRG 148 Major Large and Small Bowel Procedures with CC Wt 3.4479 </li></ul></ul><ul><li>New: </li></ul><ul><ul><li>DRG 569 Major Large and Small Bowel Procedures with CC with Major Gastrointestinal Diagnosis Wt 4.3425 </li></ul></ul><ul><ul><li>DRG 570 Major Large and Small Bowel Procedures with CC without Major Gastrointestinal Diagnosis Wt. 2.6978 </li></ul></ul><ul><li>Page 47933 </li></ul>
  12. 12. MDC 06 Digestive System <ul><li>New: </li></ul><ul><ul><li>DRG 571 Major Esophageal Disorders Wt 1.1126 </li></ul></ul><ul><ul><li>Established by removing higher severity cases from DRGs 174, 175, 182, 183, 184, 188, 189, 190 </li></ul></ul><ul><ul><li>See Appendix 3 for list of Diagnoses </li></ul></ul><ul><li>page 47931 </li></ul>
  13. 13. MDC 06 Digestive System <ul><li>New </li></ul><ul><ul><li>DRG 572 Major Gastrointestinal Disorders and Peritoneal Infections Wt 1.3378 </li></ul></ul><ul><ul><li>Established by removing higher severity cases from DRGs 182, 183, 184, 188, 189, 190 </li></ul></ul><ul><ul><li>See Appendix 4 for list of diagnoses </li></ul></ul><ul><li>page 47931 </li></ul>
  14. 14. MDC 11 Kidney and Urinary Tract <ul><li>New: </li></ul><ul><ul><li>DRG 573 Major Bladder Procedures Wt 3.3457 </li></ul></ul><ul><ul><li>Procedures removed from DRGs 303, 304, 305, 308, 309 </li></ul></ul><ul><ul><ul><li>57.6 Partial cystectomy </li></ul></ul></ul><ul><ul><ul><li>57.71 Radical cystectomy </li></ul></ul></ul><ul><ul><ul><li>57.79 Other total cystectomy </li></ul></ul></ul><ul><ul><ul><li>57.83 Repair of fistula involving bladder and intestine </li></ul></ul></ul><ul><ul><ul><li>57.84 Repair of other fistula of bladder </li></ul></ul></ul><ul><ul><ul><li>57.85 Cystourethroplasty and plastic repair of bladder neck </li></ul></ul></ul><ul><ul><ul><li>57.86 Repair of bladder exstrophy </li></ul></ul></ul><ul><ul><ul><li>57.87 Reconstruction of urinary bladder </li></ul></ul></ul><ul><ul><ul><li>57.88 Other anastomosis of bladder </li></ul></ul></ul><ul><ul><ul><li>57.89 Other repair of bladder </li></ul></ul></ul><ul><li>page 47935 </li></ul>
  15. 15. MDC 16 Blood and Immunological Disorders <ul><li>New: </li></ul><ul><ul><li>DRG 574 Major Hematologic and Immunoligic Diagnoses Except Sickle Cell Crisis and Coagulation Disorders Wt 1.2698 </li></ul></ul><ul><ul><li>Established by removing higher severity cases from DRGs 395, 396, 398 and 399 </li></ul></ul><ul><ul><li>Diagnoses </li></ul></ul><ul><ul><ul><li>279.11 Digeorge’s syndrome </li></ul></ul></ul><ul><ul><ul><li>279.12 Wiskott-aldrich syndrome </li></ul></ul></ul><ul><ul><ul><li>279.13 Nezelof’s syndrome </li></ul></ul></ul><ul><ul><ul><li>279.19 Other deficiency of cell-mediated immunity </li></ul></ul></ul><ul><ul><ul><li>279.2 Combined immunity deficiency </li></ul></ul></ul><ul><ul><ul><li>283.0 Autoimmune hemolytic anemias </li></ul></ul></ul>
  16. 16. MDC 16 Blood and Immunological Disorders <ul><ul><li>Diagnoses (continued) </li></ul></ul><ul><ul><ul><li>283.10 Non-autoimmune hemolytic anemia, unspecified </li></ul></ul></ul><ul><ul><ul><li>283.19 Other non-autoimmune hemolytic anemias </li></ul></ul></ul><ul><ul><ul><li>283.2 Hemoglobinuria due to hemolysis from external causes </li></ul></ul></ul><ul><ul><ul><li>283.9 Acquired hemolytic anemia, unspecified </li></ul></ul></ul><ul><ul><ul><li>284.01 Constitutional red blood cell aplasia </li></ul></ul></ul><ul><ul><ul><li>284.09 Other constitutional aplastic anemia </li></ul></ul></ul><ul><ul><ul><li>284.8 Other specified aplastic anemias </li></ul></ul></ul><ul><ul><ul><li>284.9 Aplastic anemia, unspecified </li></ul></ul></ul><ul><ul><ul><li>288.00 Neutropenia, unspecified </li></ul></ul></ul><ul><ul><ul><li>288.01 Congenital neutropenia </li></ul></ul></ul><ul><ul><ul><li>288.02 Cyclic neutropenia </li></ul></ul></ul><ul><ul><ul><li>288.03 Drug induced neutropenia </li></ul></ul></ul><ul><ul><ul><li>288.04 Neutropenia due to infection </li></ul></ul></ul><ul><ul><ul><li>288.09 Other neutropenia </li></ul></ul></ul><ul><ul><ul><li>288.1 Functional disorders of polymorphonuclear neutrophils </li></ul></ul></ul><ul><ul><ul><li>288.2 Genetic anomalies of leukocytes </li></ul></ul></ul><ul><ul><ul><li>996.85 Complications of transplanted bone marrow </li></ul></ul></ul><ul><li>page 47937 </li></ul>
  17. 17. MDC 18 Infectious and Parasitic Diseases <ul><li>Delete: </li></ul><ul><ul><li>DRG 416 Septicemia Age > 17 Wt 1.6774 </li></ul></ul><ul><li>New: </li></ul><ul><ul><li>DRG 575 Septicemia with Mechanical Ventilation 96+ Hours Age>17 Wt 5.9388 </li></ul></ul><ul><ul><ul><li>Requires principal diagnosis from current DRG 416 and procedure code 96.72 </li></ul></ul></ul><ul><ul><li>DRG 576 Septicemia without Mechanical Ventilation 96+ Hours Age>17 Wt 1.5953 </li></ul></ul><ul><ul><ul><li>Requires principal diagnosis from current DRG 416 and does not have procedure code 96.72 </li></ul></ul></ul><ul><li>page 47938 </li></ul>
  18. 18. Comparison <ul><li>Respiratory Failure </li></ul><ul><li>Deleted DRG </li></ul><ul><li>DRG 475 Wt 3.6091 </li></ul><ul><li>New DRG </li></ul><ul><li>DRG 565 Wt 5.2294 </li></ul><ul><li>DRG 566 Wt 2.3335 </li></ul><ul><li>Sepsis </li></ul><ul><li>Deleted DRG </li></ul><ul><li>DRG 416 Wt 1.6774 </li></ul><ul><li>New DRG </li></ul><ul><li>DRG 575 Wt 5.9388 </li></ul><ul><li>DRG 576 Wt 1.5953 </li></ul>
  19. 19. MDC 01 Nervous System <ul><li>New: </li></ul><ul><ul><li>DRG 577 Carotid Artery Stent Procedures Wt 1.7844 </li></ul></ul><ul><li>DRG 577 requires both following procedure codes: </li></ul><ul><ul><li>00.61 Percutaneous Angioplasty or Atherectomy of Precerebral Extracranial Vessels </li></ul></ul><ul><ul><li>00.63 Percutaneous Insertion of Carotid Artery Stents </li></ul></ul><ul><li>Established by removing these cases from DRGs 533 Wt 1.5468 and 534 Wt .9932 </li></ul><ul><li>DRG 577 is ordered hierarchically above DRGs 533 and 534 </li></ul><ul><li>page 47942 </li></ul>
  20. 20. MDC 18 Infectious and Parasitic Diseases <ul><li>Delete: </li></ul><ul><ul><li>DRG 415 Operating Room Procedure for Infectious and Parasitic Diseases Wt 3.9890 </li></ul></ul><ul><li>New: </li></ul><ul><ul><li>DRG 578 Infectious and Parasitic Diseases with Operating Room Procedure Wt 4.8492 </li></ul></ul><ul><ul><li>DRG 579 Postoperative or Post-traumatic Infections with Operating Room Procedures Wt 2.8386 </li></ul></ul><ul><li>page 47938 </li></ul>
  21. 21. MDC 18 Infectious and Parasitic Diseases <ul><li>Cases will be assigned to new DRG 578 Infectious and Parasitic Diseases with Operating Room Procedure if </li></ul><ul><ul><li>previously assigned to DRG 415 </li></ul></ul><ul><ul><li>Excluding any of the principal diagnosis codes listed below </li></ul></ul><ul><li>Cases will be assigned to DRG 579 Postoperative or Post-traumatic Infections with Operating Room Procedures if </li></ul><ul><ul><li>previously assigned to DRG 415 </li></ul></ul><ul><ul><li>Must contain one of the four principal diagnosis codes listed below </li></ul></ul><ul><li>Excluded/Required principal diagnosis codes: </li></ul><ul><ul><li>958.3 Post-traumatic wound infection, not elsewhere classified </li></ul></ul><ul><ul><li>998.51 Infected postoperative seroma </li></ul></ul><ul><ul><li>998.59 Other postoperative infection </li></ul></ul><ul><ul><li>999.3 Infection complicating medical care, not elsewhere classified </li></ul></ul>
  22. 22. Selected Tabular Changes <ul><li>See Appendix 5 </li></ul><ul><li>345.9 Epilepsy and recurrent seizures </li></ul><ul><ul><li>Recurrent seizures are now classified with epilepsy </li></ul></ul><ul><li>403 Hypertensive chronic kidney disease </li></ul><ul><ul><li>Change in definition of fifth digits 0 and 1 </li></ul></ul><ul><ul><ul><li>0 CKD, stage I-IV and unspecified </li></ul></ul></ul><ul><ul><ul><li>1 CKD, stage V or end stage </li></ul></ul></ul>
  23. 23. Selected Tabular Changes <ul><li>585.5 Chronic kidney disease (CKD), Stage V </li></ul><ul><ul><li>Stage V requiring chronic dialysis is classified as end stage renal disease (585.6) </li></ul></ul><ul><li>440.24 Atherosclerosis of the extremities </li></ul><ul><ul><li>Instructional note: use additional code for any associated ulcerations (codes 707.10-707.9) </li></ul></ul><ul><li>600.01 Hypertrophy of prostate </li></ul><ul><ul><li>Text change to include “and other lower urinary tract symptoms (LUTS)” </li></ul></ul><ul><ul><li>Use additional codes to identify specific LUTS </li></ul></ul>
  24. 24. Selected Tabular Changes <ul><li>995.9 Systemic inflammatory response syndrome (SIRS) </li></ul><ul><ul><li>Code title changes to subcategory 995.9x codes </li></ul></ul><ul><ul><li>Instructional notes </li></ul></ul><ul><ul><ul><li>Code first underlying infection or condition </li></ul></ul></ul><ul><ul><ul><li>Code associated acute organ dysfunction </li></ul></ul></ul><ul><ul><li>New guidelines anticipated </li></ul></ul>
  25. 25. Codes Changes for FY 2007 <ul><li>New Diagnosis Codes </li></ul><ul><ul><li>3 Infectious and Parasitic Diseases </li></ul></ul><ul><ul><li>7 Neoplasms </li></ul></ul><ul><ul><li>3 Endocrine, Nutritional and Metabolic Diseases and </li></ul></ul><ul><ul><li>Immunity Disorders </li></ul></ul><ul><ul><li>23 Blood and Blood-forming Organs Mental Disorders </li></ul></ul><ul><ul><li>40 Nervous System and Sense Organs </li></ul></ul><ul><ul><li>1 Circulatory System </li></ul></ul><ul><ul><li>5 Respiratory System </li></ul></ul><ul><ul><li>31 Digestive System </li></ul></ul><ul><ul><li>11 Genitourniary System </li></ul></ul><ul><ul><li>33 Pregnancy, Childbirth and the Puerperium </li></ul></ul><ul><ul><li>5 Musculoskeletal System and Connective Tissue </li></ul></ul><ul><ul><li>6 Perinatal Period </li></ul></ul><ul><ul><li>13 Symptoms, Signs and ill-defined Conditions </li></ul></ul><ul><ul><li>11 Injury and Poisoning </li></ul></ul><ul><ul><li>19 V Codes </li></ul></ul>
  26. 26. Infectious and Parasitic Diseases <ul><li>052.2 Postvaricella myelitis CC </li></ul><ul><li>053.14 Herpes zoster myelitis CC </li></ul><ul><li>054.74 Herpes simplex myelitis CC </li></ul>
  27. 27. Neoplasms <ul><li>238.71 Essential thrombocythemia </li></ul><ul><li>238.72 Low grade myelodysplastic syndrome lesions </li></ul><ul><li>238.73 High grade myelodysplastic syndrome lesions </li></ul><ul><li>238.74 Myelodysplastic syndrome w/ 5q deletion </li></ul><ul><li>238.75 Myelodysplastic syndrome, unspecified </li></ul><ul><li>238.76 Myelofibrosis w/ myeloid metaplasia </li></ul><ul><li>238.79 Other lymphatic and hematopoietic tissues </li></ul>
  28. 28. Endocrine, Nutritional and Metabolic Diseases and Immunity Disorders <ul><li>277.30 Amyloidosis, unspecified </li></ul><ul><li>277.31 Familial Mediterranean fever </li></ul><ul><li>277.39 Other amyloidosis </li></ul>
  29. 29. Blood and Blood-forming Organs <ul><li>284.01 Constitutional red blood cell aplasia </li></ul><ul><li>284.09 Other constitutional aplastic anemia </li></ul><ul><li>284.1 Pancytopenia </li></ul><ul><li>284.2 Myelophthisis </li></ul><ul><li>288.00 Neutropenia, unspecified </li></ul><ul><li>288.01 Congenital … </li></ul><ul><li>288.02 Cyclic … </li></ul><ul><li>288.03 Drug induced … </li></ul><ul><li>288.04 … due to infection </li></ul><ul><li>288.09 Other … </li></ul>
  30. 30. Blood and Blood-forming Organs <ul><li>288.4 Hemophagocytic syndromes </li></ul><ul><li>288.50 Leukocytopenia, unspecified </li></ul><ul><li>288.51 Lymphocytopenia </li></ul><ul><li>288.59 Other decreased white blood cell count </li></ul><ul><li>288.60 Leukocytosis, unspecified </li></ul><ul><li>288.61 Lymphocytosis (symptomatic) </li></ul><ul><li>288.62 Leukemoid reaction </li></ul><ul><li>288.63 Monocytosis (symptomatic) </li></ul><ul><li>288.64 Plasmacytosis </li></ul><ul><li>288.65 Basophilia </li></ul><ul><li>288.69 Other elevated white blood cell count </li></ul><ul><li>289.53 Neutropenic splenomegaly </li></ul><ul><li>289.83 Myelofibrosis </li></ul>
  31. 31. Nervous System and Sense Organs <ul><li>323.01 Encephalitis and encephalomyelitis in viral diseases classified elsewhere </li></ul><ul><li>323.02 Myelitis in viral diseases classified elsewhere </li></ul><ul><li>323.41 Other encephalitis and encephalomyelitis due to infection classified elsewhere </li></ul><ul><li>323.42 Other myelitis due to infection classified elsewhere </li></ul><ul><li>323.51 Encephalitis and encephalomyelitis following immunization procedures </li></ul><ul><li>323.52 Myelitis following immunization procedures </li></ul>
  32. 32. Nervous System and Sense Organs <ul><li>323.61 Infectious acute disseminated encephalomyelitis (ADEM) </li></ul><ul><li>323.62 Other postinfectious encephalitis and encephalomyelitis </li></ul><ul><li>323.63 Postinfectious myelitis </li></ul><ul><li>323.71 Toxic encephalitis and encephalomyelitis </li></ul><ul><li>323.72 Toxic myelitis </li></ul><ul><li>323.81 Other causes of encephalitis and encephalomyelitis </li></ul><ul><li>323.82 Other causes of myelitis </li></ul>
  33. 33. Nervous System and Sense Organs <ul><li>331.83 Mild cognitive impairment, so stated </li></ul><ul><li>333.71 Athetoid cerebral palsy </li></ul><ul><li>333.72 Acute dystonia due to drugs </li></ul><ul><li>333.79 Other acquired torsion dystonia </li></ul><ul><li>333.85 Subacute dyskinesia due to drugs </li></ul><ul><li>333.94 Restless Legs Syndrome </li></ul>
  34. 34. Nervous System and Sense Organs <ul><li>338.0 Central pain syndrome </li></ul><ul><li>338.11 Acute pain due to trauma </li></ul><ul><li>338.12 Acute post-thoracotomy pain </li></ul><ul><li>338.18 Other acute postoperative pain </li></ul><ul><li>338.19 Other acute pain </li></ul><ul><li>338.21 Chronic pain due to trauma </li></ul><ul><li>338.22 Chronic post-thoracotomy pain </li></ul><ul><li>338.28 Other chronic postoperative pain </li></ul><ul><li>338.29 Other chronic pain </li></ul><ul><li>338.3 Neoplasm related pain (acute) (chronic) </li></ul><ul><li>338.4 Chronic pain syndrome </li></ul>
  35. 35. Nervous System and Sense Organs <ul><li>341.20 Acute (transverse) myelitis NOS </li></ul><ul><li>341.21 … in conditions classified elsewhere </li></ul><ul><li>341.22 Idiopathic transverse myelitis </li></ul><ul><li>377.43 Optic nerve hypoplasia </li></ul><ul><li>379.60 Inflammation (infection) of postprocedural bleb, unspecified </li></ul><ul><li>379.61 … stage 1 </li></ul><ul><li>379.62 … stage 2 </li></ul><ul><li>379.63 … stage 3 </li></ul><ul><li>389.15 Sensorineural hearing loss, unilateral </li></ul><ul><li>389.16 … asymmetrical </li></ul>
  36. 36. Circulatory System <ul><li>429.83 Takotsubo syndrome </li></ul><ul><li>Cardiomyopathy that mimics acute coronary syndrome </li></ul><ul><li>Ref.: New England Journal of Medicine, Vol 352:539-548, Feb 10, 2005 </li></ul><ul><li>A.K.A. </li></ul><ul><ul><li>stress cardiomyopathy </li></ul></ul><ul><ul><li>broken heart syndrome </li></ul></ul><ul><ul><li>Takotsubo cardiomyopathy </li></ul></ul>
  37. 37. Respiratory System <ul><li>478.11 Nasal mucositis (ulcerative) </li></ul><ul><li>478.19 Other disease of nasal cavity and sinuses </li></ul><ul><li>518.7 Transfusion related acute lung injury (TRALI) CC </li></ul><ul><li>519.11 Acute bronchospasm </li></ul><ul><li>519.19 Other diseases of trachea and bronchus </li></ul>
  38. 38. Digestive System <ul><li>521.81 Cracked tooth </li></ul><ul><li>521.89 Other specific diseases of hard tissues of teeth </li></ul><ul><li>523.00 Acute gingivitis, plaque induced </li></ul><ul><li>523.01 … non-plaque induced </li></ul><ul><li>523.10 Chronic gingivitis, plaque induced </li></ul><ul><li>523.11 … non-plaque induced </li></ul><ul><li>523.30 Aggressive periodontitis, unspecified </li></ul><ul><li>523.31 … localized </li></ul><ul><li>523.32 … generalized </li></ul><ul><li>523.33 Acute periodontitis </li></ul><ul><li>523.40 Chronic periodontitis, unspecified </li></ul><ul><li>523.41 … localized </li></ul><ul><li>523.42 … generalized </li></ul>
  39. 39. Digestive System <ul><li>525.60 Unspecified unsatisfactory restoration of tooth </li></ul><ul><li>525.61 Open restoration margins </li></ul><ul><li>525.62 Unrepairable overhanging of dental restorative materials </li></ul><ul><li>525.63 Fractured dental restorative material w/o loss of material </li></ul><ul><li>525.64 … w/ loss of material </li></ul><ul><li>525.65 Contour of existing restoration of tooth biologically incompatible w/ oral health </li></ul><ul><li>525.66 Allergy to existing dental restorative material </li></ul><ul><li>525.67 Poor aesthetics of existing restoration </li></ul><ul><li>525.69 Other unsatisfactory restoration of existing tooth </li></ul><ul><li>526.61 Perforation of root canal space </li></ul><ul><li>526.62 Endodontic overfill </li></ul><ul><li>526.63 … underfill </li></ul><ul><li>526.69 Other periradicular pathology associated w/ previous endodontic treatment </li></ul>
  40. 40. Digestive System <ul><li>528.00 Stomatitis and mucositis, unspecified </li></ul><ul><li>528.01 Mucositis (ulcerative) due to antineoplastic therapy </li></ul><ul><li>528.02 …other drugs </li></ul><ul><li>528.09 Other stomatitis and mucositis (ulcerative) </li></ul><ul><li>538 Gastrointestinal mucositis (ulcerative) </li></ul>
  41. 41. Genitourinary System <ul><li>608.20 Torsion of testis, unspecified </li></ul><ul><li>608.21 Extravaginal torsion of spermatic cord </li></ul><ul><li>608.22 Intravaginal torsion of spermatic cord </li></ul><ul><li>608.23 Torsion of appendix testis </li></ul><ul><li>608.24 Torsion of appendix epididymis </li></ul><ul><li>616.81 Mucositis (ulcerative) of cervix, vagina, and vulva </li></ul><ul><li>616.89 Other inflammatory disease of cervix, vagina and vulva </li></ul><ul><li>618.84 Cervical stump prolapse </li></ul><ul><li>629.29 Other female genital mutilation status </li></ul><ul><li>629.81 Habitual aborter w/o current pregnancy </li></ul><ul><li>629.89 Other specified disorders of female genital organs </li></ul>
  42. 42. Pregnancy, Childbirth, and the Puerperium <ul><li>649.00-04 Tobacco use disorder </li></ul><ul><li>649.10-14 Obesity </li></ul><ul><li>649.20-24 Bariatric surgery status </li></ul><ul><li>649.30-34 Coagulation defects </li></ul><ul><li>649.40-44 Epilepsy </li></ul><ul><li>649.50,51,53 Spotting </li></ul><ul><li>649.60-64 Uterine size date discrepancy </li></ul>
  43. 43. Musculoskeletal System and Connective Tissue <ul><li>729.71 Nontraumatic compartment syndrome of upper extremity </li></ul><ul><li>729.72 … lower extremity </li></ul><ul><li>729.73 … abdomen </li></ul><ul><li>729.79 … other sites </li></ul><ul><li>731.3 Major osseous defects </li></ul>
  44. 44. Perinatal Period <ul><li>768.7 Hypoxic-ischemic encephalopathy (HIE) </li></ul><ul><li>770.87 Respiratory arrest of newborn </li></ul><ul><li>770.88 Hypoxemia of newborn </li></ul><ul><li>775.81 Other acidosis of newborn </li></ul><ul><li>775.89 Other neonatal endocrine and metabolic disturbances </li></ul><ul><li>779.85 Cardiac arrest of newborn CC </li></ul>
  45. 45. Symptoms, Signs, and Ill-defined Conditions <ul><li>780.32 Complex febrile convulsions CC </li></ul><ul><li>780.96 Generalized pain </li></ul><ul><li>780.97 Altered mental status </li></ul><ul><li>784.91 Postnasal drip </li></ul><ul><li>784.99 Other symptoms involving head and neck </li></ul><ul><li>788.64 Urinary hesitancy </li></ul><ul><li>788.65 Straining on urination </li></ul>
  46. 46. Symptoms, Signs, and Ill-defined Conditions <ul><li>793.91 Image test inconclusive due to excess body fat </li></ul><ul><li>793.99 Other nonspecific abnormal findings on radiological and other examinations of body structure </li></ul><ul><li>795.06 Papanicolaou smear of cervix w/ cytologic evidence of malignancy </li></ul><ul><li>795.81 Elevated carcinoembryonic antigen [CEA] </li></ul><ul><li>795.82 Elevated cancer antigen 125 [CA 125] </li></ul><ul><li>795.89 Other abnormal tumor markers </li></ul>
  47. 47. Injury and Poisoning <ul><li>958.90 Compartment syndrome, unspecified </li></ul><ul><li>958.91 Traumatic compartment syndrome of upper extremity </li></ul><ul><li>958.92 … lower extremity </li></ul><ul><li>958.93 … abdomen </li></ul><ul><li>958.99 … other sites </li></ul><ul><li>995.20 Unspecified adverse effect of unspecified drug, medicinal and biological substance </li></ul><ul><li>995.21 Arthus phenomenon </li></ul><ul><li>995.22 Unspecified adverse effect of anesthesia </li></ul><ul><li>995.23 Unspecified adverse effect of insulin </li></ul><ul><li>995.27 Other drug allergy </li></ul><ul><li>995.29 Unspecified adverse effect of other drug, medicinal and biological substance </li></ul>
  48. 48. V-Codes <ul><li>V18.51 Family history, Colonic polyps </li></ul><ul><li>V18.59 … Other digestive disorders </li></ul><ul><li>V26.34 Testing of male for genetic disease carrier status </li></ul><ul><li>V26.35 Encounter for testing of male partner of habitual aborter </li></ul><ul><li>V26.39 Other genetic testing of male </li></ul><ul><li>V45.86 Bariatric surgery status </li></ul><ul><li>V58.30 Encounter for change or removal of non-surgical wound dressing </li></ul><ul><li>V58.31 … surgical wound dressing </li></ul><ul><li>V58.32 … sutures </li></ul>
  49. 49. V-Codes <ul><li>V72.11 Encounter for hearing examination following failed hearing screening </li></ul><ul><li>V72.19 Other examination of ears and hearing </li></ul><ul><li>V82.71 Screening for genetic disease carrier status </li></ul><ul><li>V82.79 Other genetic screening </li></ul><ul><li>V85.51 Body Mass Index, pediatric, < 5th percentile for age </li></ul><ul><li>V85.52 … 5th to < 85th percentile </li></ul><ul><li>V85.53 … 85th to < 95th percentile </li></ul><ul><li>V85.54 … >/= 95th percentile </li></ul><ul><li>V86.0 Estrogen receptor positive status [ER+] </li></ul><ul><li>V86.1 … negative status [ER-] </li></ul>
  50. 50. Procedure Codes <ul><li>Procedures and Interventions NEC </li></ul><ul><li>00.44 Procedure on vessel bifurcation </li></ul><ul><li>00.56 Insertion or replacement of implantable pressure sensor (lead) for intracardiac hemodynamic monitoring </li></ul><ul><li>00.57 … subcutaneous device … </li></ul><ul><li>00.77 Hip replacement bearing surface, ceramic- on-polyethylene </li></ul><ul><li>00.85 Resurfacing hip, total, acetabulum and femoral head </li></ul><ul><li>00.86 Resurfacing hip, partial, femoral head </li></ul><ul><li>00.87 Resurfacing hip, partial, acetabulum </li></ul>
  51. 51. Procedure Codes <ul><li>Operations on the Nervous System </li></ul><ul><li>01.28 Placement of intracerebral catheter(s) via burr hole(s) </li></ul><ul><li>Operations on the Eye </li></ul><ul><li>13.90 Operation on lens, Not Elsewhere Classified </li></ul><ul><li>13.91 Implantation of intraocular telescope prosthesis </li></ul>
  52. 52. Procedure Codes <ul><li>Operations on the Respiratory System </li></ul><ul><li>32.23 Open ablation of lung lesion or tissue </li></ul><ul><li>32.24 Percutaneous … </li></ul><ul><li>32.25 Thoracoscopic … </li></ul><ul><li>32.26 Other and unspecified … </li></ul><ul><li>33.71 Endoscopic insertion or replacement of bronchial valve(s) </li></ul><ul><li>33.78 Endoscopic removal of bronchial device(s) or substances </li></ul><ul><li>33.79 Endoscopic insertion of other bronchial device or substances </li></ul>
  53. 53. Procedure Codes <ul><li>Operations on the Cardiovascular System </li></ul><ul><li>35.55 Repair of ventricular septal defect with prosthesis, closed technique </li></ul><ul><li>36.33 Endoscopic transmyocardial revascularization </li></ul><ul><li>36.34 Percutaneous … </li></ul><ul><li>37.20 Noninvasive programmed electrical stimulation [NIPS] </li></ul><ul><li>39.74 Endovascular removal of obstruction from head and neck vessel(s) </li></ul>
  54. 54. Procedure Codes <ul><li>Operations on the Digestive System </li></ul><ul><li>50.23 Open ablation of liver lesion or tissue </li></ul><ul><li>50.24 Percutaneous … </li></ul><ul><li>50.25 Laparoscopic … </li></ul><ul><li>50.26 Other and unspecified … </li></ul><ul><li>Operations on the Urinary System </li></ul><ul><li>55.32 Open ablation of renal lesion or tissue </li></ul><ul><li>55.33 Percutaneous … </li></ul><ul><li>55.34 Laparoscopic … </li></ul><ul><li>55.35 Other and unspecified … </li></ul>
  55. 55. Procedure Codes <ul><li>Operations on the Female Genital Organs </li></ul><ul><li>68.41 Laparoscopic total abdominal hysterectomy </li></ul><ul><li>68.49 Other and unspecified … </li></ul><ul><li>68.61 Laparoscopic radical abdominal hysterectomy </li></ul><ul><li>68.69 Other and unspecified … </li></ul><ul><li>68.71 Laparoscopic radical vaginal hysterectomy (LRVH) </li></ul><ul><li>68.79 Other and unspecified … </li></ul>
  56. 56. ICD-10 Really? Yes! <ul><li>Senate bill: S. 1418 - Wired for Health Care Quality Act </li></ul><ul><ul><li>$650 million in grant authority </li></ul></ul><ul><li>House: H.R.4157 - Health Information Technology Promotion Act of 2006 </li></ul><ul><ul><li>$40 million in grant authority </li></ul></ul><ul><ul><li>Specifies ICD-10 </li></ul></ul><ul><li>Conference committee after November elections </li></ul><ul><li>Likely to have a 2 year implementation window after the effective date of the final rule </li></ul>
  57. 57. Questions? <ul><li>Barry Libman, RHIA, CCS, CCS-P </li></ul><ul><li>President, Barry Libman Inc. </li></ul><ul><li>978-369-7180 </li></ul><ul><li>Email: [email_address] </li></ul><ul><li>www.barrylibmaninc.com </li></ul>

×