The correct answer is C. The new H1N1 codes require specifying if the manifestation is pneumonia, other respiratory manifestations, or other manifestations. Fecal Impaction Has New Options Answer 2: False. Talking point: 787.6 is deleted and replaced with more specific codes for fecal incontinence symptoms like full incontinence, incomplete defecation, smearing, and urgency. Pain Gets 1 More Symptom Answer 3: C. Talking point: A new code (784.92) has been added for jaw pain.

1. ICD-9-CM2011
GET PREPPED FASTGET PREPPED FAST
Jen Godreau, BA, CPC, CPEDC, Content DirectorJen Godreau, BA, CPC, CPEDC, Content Director
Mary Compton, PhD, CPC, Editorial DirectorMary Compton, PhD, CPC, Editorial Director
Suzanne Leder, BA, M.Phil, CPC, COBGC, Editorial ManagerSuzanne Leder, BA, M.Phil, CPC, COBGC, Editorial Manager
The Coding Institute, LLC . SuperCoder.comThe Coding Institute, LLC . SuperCoder.com
Downloads
Handouts:
www.supercoder.com/conference/
www.scribd.com/doc/
AAPC CEU certificate
www.supercoder.com/icd92011-aapc-ceu/

2. The Trend for2011The Trend for2011
“Codes continue to become
more and more specific
necessitating a provider to
document clearly and
thoroughly
to allow for selection of the
most specific and accurate
code.”
-- JenniferSwindle, RHIT, CCS-P, CEMC, CFPC, CCP-P, PCS

3. H1N1: Lookat ManifestationH1N1: Lookat Manifestation
 Deletions: 488.0,
488.1
 New: Six five-digit
codes:
• 488.0x --Influe nz a due
to ide ntifie d avian
influe nz a virus
• 488.1x --Influe nz a due
to ide ntifie d no ve l
H1 N1 influe nz a virus
Pay attention to two
details:
 Influenza identified
in medical record
 manifestation
Changes Tips on Selecting New Codes

4. 488 Changes Mirror487 Details488 Changes Mirror487 Details
With the change “category 488
(Influe nz a due to ce rtain
ide ntifie d influe nz a viruse s )
would
mirrorthe structure of category
487 (Influe nz a).” The current
488.x
sub-category didn’t provide the
level of detail that category
487 (Influe nz a) does.
So urce : Sum m ary o f March 20 1 0 ICD-9 -CMCo o rdinatio n and Mainte nance
Co m m itte e Me e ting

5. 488.0x, 488.1x Cheat Sheet488.0x, 488.1x Cheat Sheet
Comorbid
Manifestation
Avian H1N1
Pneumonia 488.01 * 488.11 *
Other respiratory
manifestations
488.02 488.12
Other manifestations 488.09 488.19
488.01, 488.11 List Additional Note:
Identify pneumonia –
480.0-480.9, 481, 482.0-482.9, 483.0-483.8, 485
488.01, 488.11 List Additional Note:
Identify pneumonia –
480.0-480.9, 481, 482.0-482.9, 483.0-483.8, 485

6. Post Traumatic SeizuresPost Traumatic Seizures
 Definition: Acute, symptomatic seizures
following a head injury.
 Rationale: “A unique code for this type of
seizure is important because these
patients need to be followed for
treatment as well as prognostic and
epidemiologic considerations.”
So urce : ICD-9 -CMCo o rdinatio n and Mainte nance Co m m itte e ,
CDC re le ase

7. Traumatic Seizure ChangesTraumatic Seizure Changes
2010 way: Must use 780.3x (Convulsions) to report patient’s
symptoms.
New code: 780.33 (Post traumatic seizures) will further specify this
type of seizure.

8. 788.30 Helps TBI State788.30 Helps TBI State
ComplianceCompliance
 New state laws mandating specific care for
post-TBI (traumatic brain injury) patients and
diagnosis code changes coincide with a CDC
campaign aimed at prevention and early
diagnosis of TBI.
 “These laws and education have had a huge
impact on family medicine physicians who
see patients who have had head injuries
from sports or falls, indigent populations, and
returning military personnel.”
-- Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-I, CCC, COBGC
manager of compliance education
University of Washington Physicians and Children’s University Medical Group
Compliance Program

9. Late Effects CodeLate Effects Code
 Post-traumatic
seizures may not
occur until weeks or
months after the
injury.
 Delay means
seizure may be
considered a late
effect of the head
injury.
 Rely on documentation to
determine whether to code
late effects (such as 907.0,
Late e ffe ct o f intracranial
injury witho ut m e ntio n o f skull
fracture ) as a secondary
diagnosis.
 When to add on:
Documentation shows causal
relationship between the
current
condition/symptom/sign and
the underlying etiology.
The Condition Should You Add a Code?

10. Test YourselfTest Yourself
 Question: A 17-year-old male new patient presents with
spells of “blanking out” over the last several weeks. The
patient reports this started a few days after he was hit in the
head with a softball. The FP performs a comprehensive
history and exam, focusing on possible late effects of the
head injury; during moderate-complexity medical decision
making, the FP orders neurologic testing and requests an
evaluation from a local TBI clinic.
 Final diagnosis is “mild seizures, status post-TBI.” What ICD-
9 code(s) would you use?
Answer:
1.780.33
2.907.0 (Late e ffe cts o f injurie s to the ne rvo us syste m ; late e ffe ct o f
intracranialinjury witho ut m e ntio n o f skullfracture )
3.E007.3 (Activitie s invo lving o the r spo rts and athle tics playe d as a
te am o r g ro up; base ball; so ftball)
Answer:
1.780.33
2.907.0 (Late e ffe cts o f injurie s to the ne rvo us syste m ; late e ffe ct o f
intracranialinjury witho ut m e ntio n o f skullfracture )
3.E007.3 (Activitie s invo lving o the r spo rts and athle tics playe d as a
te am o r g ro up; base ball; so ftball)

11. More Specific Pain DiagnosisMore Specific Pain Diagnosis
 2010 way:
 No specific code exists for
jaw pain. Best bet may be
526.9 (Unspe cifie d dise ase s
o f the jaws)
 New code:
• 784.92 (Jaw pain)
 Benefit: Could help support
dental problem complaints.

12. CheckFecal IncontinenceCheckFecal Incontinence
SymptomsSymptoms
New 5-Digit Code Descriptor
787.60 Full incontinence of feces
787.61 Incomplete defecation
787.62 Fecal smearing
787.63 Fecal urgency
Deleted Code:
787.6 (Inco ntine nce o f
fe ce s)
Deleted Code:
787.6 (Inco ntine nce o f
fe ce s)

13. V13.2x SupportsV13.2x Supports
Dysplasia Check-UpDysplasia Check-Up
 Physician may see
patients who have
had vaginal or
vulvar dysplasia to
verify that there has
been no recurrence.
 2010 Problem: No
way to reflect history
as the sole reason
for the encounter.
 2011 Solution: New
codes for
• V13.23 -- Pe rso nal
histo ry o f vag inal
dysplasia
• V13.24 -- Pe rso nal
histo ry o f vulvar
dysplasia .
Suzanne Leder, CPC, COBGC

14. V49.8x Increases StatusV49.8x Increases Status
OptionsOptions
• V49.86 – Do no t
re suscitate status
• V49.87 – Physical
re straints status.
 Capture ‘status’ of a
patient
 Indicate DNRorder
 Show patient needs
restraining
 Useful in:
 inpatient (POS 21)
 NF (POS 31-32).
New Codes Usage Tips

15. More 40-Plus BMI CodesMore 40-Plus BMI Codes
 Past: One general V code (V85.4) to
represent a body mass index (BMI) index
greater than 40
 New: Five fifth-digit BMI codes allow
capturing of higher BMIs
V Code Short Descriptor
V85.41 40 . 0 – 44. 9 , adult
V85.42 45. 0 – 49 . 9 , adult
V85.43 50 . 0 – 59 . 9 , adult
V85.44 6 0 . 0 – 6 9 . 9 , adult
V85.45 7 0 and o ve r, adult

16. BMI Expansion ConsiderationsBMI Expansion Considerations
 Allow for better
tracking of heavier
individuals
 Help support weight
management
treatment
 Always report BMI
codes as secondary
diagnoses
 can be coded based
on clinical
assessment
 Before coding obesity
as primary diagnosis,
obesity must be
documented by the
physician
Benefits Warnings

17. Test YourselfTest Yourself
 A new patient with a BMI of 45 presents
complaining of shortness of breath and
related symptoms. The physician
determines that all of the symptoms are
related to the patient’s morbid obesity and
proceeds to counsel the patient on
options for addressing his weight. What
diagnoses should you report?Answer:
1.278.01 (Overweight, obesity, andother
hyperalimentation; overweight andobesity; morbid
obesity)
2.V85.42
Answer:
1.278.01 (Overweight, obesity, andother
hyperalimentation; overweight andobesity; morbid
obesity)
2.V85.42

18. V Codes Support MoreV Codes Support More
MonitoringMonitoring
 Problem: When a patient carrying twins has only one placenta with two
amniotic sacs, you currently have no way to reflect the higher risk of
complications.
 Solution: New V category
• V91.00 – Twin g e statio n, unspe cifie d num be r o f place nta, unspe cifie d num be r o f am nio tic
sacs
• V91.01 – Twin g e statio n, m o no cho rio nic/m o no am nio tic (o ne place nta, o ne am nio tic sac)
• V91.02 – Twin g e statio n, m o no cho rio nic/diam nio tic (o ne place nta, two am nio tic sacs)
• V91.03 – Twin g e statio n, dicho rio nic/diam nio tic (two place nta, two am nio tic sacs)
• V91.09 – Twin g e statio n, unable to de te rm ine num be r o f place nta and num be r o f am nio tic
sacs.
 Bonus: You’ll find similar V codes for triplet gestations (V91.10-V91.19), quadruplet
gestations (V91.20-29), and other unspecified multiple gestations (V91.91-V91.99).
 Benefits:
 Allows for better data collection
 When reported during the antepartum period, may help establish medical need for
interventions or closer monitoring that cannot be adequately captured using the V23 high
riskcodes.

19. Test YourselfTest Yourself
 Question: An ob-gyn delivers twins vaginally
with two placentae and two amniotic sacs. How
would you report the delivery global care
package?
Answer:
1.59400 (Ro utine o bste tric care including ante partum care ,
vag inal de live ry [with o r witho ut e pisio to m y, and/o r fo rce ps]
and po stpartum care ) for the first baby
2.59409-51 (Vag inal de live ry o nly [with o r witho ut e pisio to m y
and/o r fo rce ps]; Multiple pro ce dure s ) for the second
3.651.01 (Twin pre g nancy; de live re d)
4.V91.03
5.V27.2 (Twins, bo th live bo rn)
Answer:
1.59400 (Ro utine o bste tric care including ante partum care ,
vag inal de live ry [with o r witho ut e pisio to m y, and/o r fo rce ps]
and po stpartum care ) for the first baby
2.59409-51 (Vag inal de live ry o nly [with o r witho ut e pisio to m y
and/o r fo rce ps]; Multiple pro ce dure s ) for the second
3.651.01 (Twin pre g nancy; de live re d)
4.V91.03
5.V27.2 (Twins, bo th live bo rn)

20. Military Wanted V90Military Wanted V90
 Rationale: The Department of Defense
requested codes to help identify retained
objects resulting from explosion injuries, but
the codes could prove useful in other cases,
as well.
 Example: An embedded magnetic object
(V90.11) is a contraindication to an MRI exam.
So urce : CDC ICD-9 -CM
Update s

21. Is FBRDx Allowed?Is FBRDx Allowed?
 Pieces of wood, glass, or bullet shrapnel might
be left in during foreign body removal. The
fragment may break or split, making removing
the entire foreign body impossible.
 With splinter removal, sometimes the
procedure removes some foreign body, but
not all of it.

22. V90 Solves Partial RemovalV90 Solves Partial Removal
 V90.xx indicates a foreign body was partially
removed.
 Explain a follow-up check for infection after
complete removal with V15.53 (Pe rso nal
histo ry o f re taine d fo re ig n bo dy fully re m o ve d).
ICD-9
codes for
retained
fragment
s of:

23. ICD-9-CM 2011 Staff Quiz
H1N1 Gains Specificity
Question 1: What new info will you need to correctly assign a diagnosis of H1N1 starting Oct. 1?
A. if the patient has previously had H1N1
B. if the H1N1 involves fever, aching
C. if the H1N1 involves pneumonia, other respiratory manifestations, or other manifestations
D. no new info is needed
Fecal Impaction Has New Options
Question 2: True/False: Encopresis, NOS, fecal impaction is sufficient to have the claim paid without the code (787.6) triggering a denial.
Pain Gets 1 More Symptom
Question 3: ICD-9 2011 provides a new specific pain location:
A. arm
B. breast
C. jaw
D. vagina

24. Staff Quiz Answer Key
H1N1 Gains Specificity
Answer 1: C.
Talking point: The new codes for H1N1 (488.1x) have fifth digits to indicate if the H1N1 involves pneumonia (1), other respiratory
manifestations (2), or other manifestations (9) occurring with this type of influenza.
Fecal Impaction Has New Options
Answer 2: False.
Talking point: Fecal impaction is now broken into more detail and requires a fifth digit (787.6x) to indicate full incontinence of feces (0),
incomplete defecation (1), fecal smearing (2), or fecal urgency (3).
Pain Gets 1 More Symptom
Answer: C.
Talking point: Jaw pain did not previously have a specific code to use. ICD-9 2011 solves that riddle with 784.92 (Jaw pain).

25. ResourcesResources
 Fam ily Practice Co ding Ale rt, The Coding Institute.
 ICD-9-CM CD-ROM. Ninth Version. Centers for Disease Control & Prevention and
the National Center for Health Statistics.
 ICD-9-CM Coordination and Maintenance Committee release, Centers for Disease
Control & Prevention and the National Center for Health Statistics.
 ICD-9-CM – Updates. Centers for Disease Control & Prevention and the National
Center for Health Statistics. May 26, 2010
 Ob-Gyn Co ding Ale rt, The Coding Institute.
 Part BInside r, The Coding Institute.
 Summary of March 2010 ICD-9-CM Coordination and Maintenance Committee
Meeting

26. Save the Date!Save the Date!
Modifier59: BreakBundles When You Should
FREE Webinar
Tuesday, Oct 19
12:00 pm EST
Speakers: Mary Compton, PhD, CPC
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Suzanne Leder, M.Phil., CPC, COBGC
• Rules to follow for proper CCI compliance
• Review cases to test your skills
• Collect deserved monies without penalty.
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27. You’reinvitedto…You’reinvitedto…CHOOSE FROM:
2011 ICD-9-CMUpdate forOb-Gyn
September 30, 2010
presenter: Melanie Witt, RN, CPC, COBGC, MA
2011 ICD-9-CMUpdate forPrimary Care
October 5, 2010
presenter: Jennifer Godreau, BA, CPC, CPEDC
2011 ICD-9-CMUpdate forRadiology
On-demand October 11 - 15, 2010
presenter: Deborah Dorton, JD, MA, CPC
ICD-9 Changes for 2011
On-demand October 11 – 29, 2010 (30
minutes)
presenter: Torrey Kim, MA, CPC
2011 ICD-9-CMUpdate for Cardiology
On-demand October 18 - 22, 2010
presenter: Deborah Dorton , JD, MA, CPC
2011 ICD-9-CMUpdate forPathology and
Oncology
On-demand October 25 - 29,
presenter: Deborah Dorton , JD, MA, CPC
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28. Ensuring reimbursement. Insuring coders.Ensuring reimbursement. Insuring coders.
Questions:
Mary Compton, Editorial Director
Neurosurgery
Jen Godreau, Content Director, Supercoder.com
Family Practice, Pediatrics, Otolaryngology
Suzanne Leder, Executive Editor
Ob-Gyn , Orthopedics
www.supercoder.com/forum/