ICD-9-Codes and DRG Updates FY 2005

ICD-9-Codes and DRG Updates FY 2005

Barry Libman, RHIA, CCS, CCS-P

President, Barry Libman Inc

Federal Register, August 11, 2004Volume 69, Number 154 Medicare Program; Changes to the Hospital

Inpatient Prospective Payment, Final Rule

http://www.access.gpo.gov/su_docs/fedreg/a040811c.html

effective on October 1, 2004

CMS DRG V.22

150 new diagnosis codes 21 new V codes 54 new procedure codes 3 new DRGs Changes in grouper logic Changes in code text

New Diagnosis Codes

6 Infectious Diseases 8 Endocrine Disorders 5 Nervous and Sense Organs 3 Circulatory System 2 Respiratory System 78 Digestive System 24 Genitourinary System 12 Skin and Subcutaneous Tissue 4 Congenital Anomalies 8 Symptoms, Signs and Ill-defined Conditions

Infectious Diseases

Arthropod-Borne Viral Diseases 066.40 West Nile Fever, unspecified 066.41 … w/ encephalitis 066.42 … w/ other neurologic manifestation 066.49 … w/ other complications

Viral Hepatitis 070.70 Unspecified viral hepatitis C w/o

hepatic coma, CC 070.71 …w/ hepatic coma, CC

Endocrine Disorders

Disorders of Parathyroid Gland 252.00 Hyperparathyroidism, unspecified 252.01 Primary hyperparathyroidism 252.02 Secondary hyperparathyroidism,

non-renal 252.08 Other hyperparathyroidism

Endocrine Disorders

Other Metabolic and Immunity Disorders

273.4Alpha-1-antitrypsin deficiency

277.85 Disorders of fatty acid oxidation 277.86 Peroxisomal disorders 277.87 Disorders of mitochondrial

metabolism

Nervous System and Sense Organs

Other disorders of the Central Nervous System 347.00 Narcolepsy, w/o cataplexy 347.01 …w/ cataplexy 347.10 …in conditions classified

elsewhere, w/o cataplexy 347.11 …in conditions classified

elsewhere, w/ cataplexy

Diseases of the Ear and Mastoid Process 380.03 Chondritis of pinna

Circulatory System

Diseases of Veins and Lymphatics, and Other Diseases of Circulatory System

453.40 Venous embolism and thrombosis of unspecified deep vessels

of lower extremity, CC 453.41 … of deep vessels of proximal

lower extremity, CC 453.42 … of deep vessels of distal lower

extremity, CC

Respiratory System

Other Diseases of the Upper Respiratory Tract 477.2Allergic rhinitis, due to animal (cat)

(dog) hair and dander

Chronic Obstructive Pulmonary Diseases and Allied Conditions

491.22 Obstructive chronic bronchitis w/ acute bronchitis, CC

Digestive System

Diseases of Oral Cavity, Salivary Glands, and Jaws 521.06-08 Dental caries 521.10-15 Excessive attrition 521.20-25 Abrasion 521.30-35 Erosion 521.40-42 Pathological resorption 521.49 Other pathological resorption 523.20-25 Gingival recession

Digestive System

Diseases of Oral Cavity, Salivary Glands, and Jaws (cont.) 524.07 Excessive tuberosity of jaw 524.20 Unspecified anomaly of dental arch

relationship 524.21-23 Angle’s class I-III 524.24 Open anterior occlusal relationship 524.25 Open posterior occlusal relationship 524.26 Excessive horizontal overlap 524.27 Reverse articulation 524.28 Anomalies of interarch distance 524.29 Other anomalies of dental arch

relationship 524.30-37, 39 Anomaly of tooth position

Digestive System

Diseases of Oral Cavity, Salivary Glands, and Jaws (cont.) 524.50 Dentofacial functional abnormality,

unspecified 524.51 Abnormal jaw closure 524.52 Limited mandibular range of motion 524.53 Deviation in opening and closing of the

mandible 524.54 Insufficient anterior guidance 524.55 Centric occlusion maximum

intercuspation discrepancy 524.56 Non-working side interference 524.57 Lack of posterior occlusal support 524.59 Other dentofacial functional

abnormalities

Digestive System

Diseases of Oral Cavity, Salivary Glands, and Jaws (cont.) 524.64 Temporomandibular joint sounds on

opening and/or closing the jaw 524.75 Vertical displacement of alveolus and

teeth 524.76 Occlusal plane deviation 524.81 Anterior soft tissue impingement 524.82 Posterior soft tissue impingement 524.89 Other specified dentofacial anomalies 525.20-26 Atrophy 528.71 Minimal keratinized residual ridge

mucosa 528.72 Excessive keratinized residual ridge

mucosa 528.79 Other disturbances of oral epithelium,

including tongue

Digestive System

Diseases of Esophagus, Stomach and Duodenum

530.86 Infection of esophagostomy, CC 530.87 Mechanical complication of

esophagostomy, CC

Genitourinary System

Nephritis, Nephrotic Syndrome, and Nephrosis 588.81 Secondary hyperparathyroidism

(of renal origin) 588.89 Other specified disorders resulting

from impaired renal function

Genitourinary System

Other Disorders of Female Genital Tract 618.00 Unspecified prolapse of vaginal walls 618.01 Cystocele, midline 618.02 Cystocele, lateral 618.03 Urethrocele 618.04 Rectocele 618.05 Perineocele 618.09 Other prolapse of vaginal walls w/o

mention of uterine prolapse

Genitourinary System

Other Disorders of Female Genital Tract (continued) 618.81 Incompetence or weakening of

pubocervical tissue 618.82 Incompetence or weakening of

rectovaginal tissue 618.83 Pelvic muscle wasting 618.89 Other specified genital prolapse 621.30 Endometrial hyperplasia, unspecified 621.31 Simple endometrial hyperplasia w/o

atypia 621.32 Complex endometrial hyperplasia w/o

atypia 621.33 Endometrial hyperplasia w/ atypia

Genitourinary System

Other Disorders of Female Genital Tract (continued)

622.10 Dysplasia of cervix, unspecified 622.11 Mild dysplasia of cervix 622.12 Moderate dysplasia of cervix

629.20-23 Female genital mutilation status

Skin and Subcutaneous Tissue

Other Inflammatory Conditions of Skin and Subcutaneous Tissue

692.84 Contact dermatitis and other eczema due to animal (cat)

(dog) dander

Other Diseases of Skin and Subcutaneous Tissue

705.21 Primary focal hyperhidrosis 705.22 Secondary focal hyperhidrosis

Skin and Subcutaneous Tissue

Other Diseases of Skin and Subcutaneous Tissue (cont.)

707.00 Decubitus ulcer, unspecified site, CC 707.01 … elbow, CC 707.02 … upper back, CC 707.03 … lower back, CC 707.04 … hip, CC 707.05 … buttock, CC 707.06 … ankle, CC 707.07 … heel, CC 707.09 … other site, CC

Congenital Anomalies

758.31 Cri-du-chat syndrome 758.32 Velo-cardio-facial syndrome 758.33 Other microdeletions 758.39 Other autosomal deletions

Symptoms, Signs, and Ill-Defined Conditions 780.58 Sleep related movement disorder

788.38 Overflow incontinence

790.95 Elevated C-reactive protein (CRP)

Symptoms, Signs, and Ill-Defined Conditions 795.03 Papanicolaou smear of cervix w/ low

grade squamous intraepithelial lesion (LGSIL)

795.04 …w/ high grade squamous intraepithelial lesion (HGSIL)

795.05 Cervical high risk human papillomavirus (HPV) DNA test positive

795.08 Nonspecific abnormal papanicolaou smear of cervix, unsatisfactory smear

796.6 Nonspecific abnormal findings on neonatal screening

New V Codes

V-Codes: Factors influencing Health Status and Contact with Health Services

Contact with or Exposure to Communicable Diseases

V01.71 Contact or exposure to varicella V01.79 … other viral diseases V01.83 … escherichia coli (E. coli) V01.84 … meningococcus

New V Codes

Other Dependence on Machines V46.11 Dependence on respirator, status, CC V46.12 Encounter for respirator dependence

during power failure, CC

Other Conditions Influencing Health Status V49.83 Awaiting organ transplant status, CC

New V Codes

Encounter for Other and Unspecified Procedures and Aftercare

V58.44 Aftercare following organ transplant V58.66 Long-term (current) use of aspirin V58.67 Long-term (current) use of insulin

Problems Related to Life Style V69.4 Lack of adequate sleep

New V Codes

Special Investigations and Examinations V72.31 Routine gynecological examination V72.32 Encounter for Papanicolaou cervical

smear to confirm findings of recent normal smear following initial abnormal smear

V72.40 Pregnancy examination or test, pregnancy unconfirmed

V72.41 … negative result

New V Codes

Genetic Susceptibility V84.01 Genetic susceptibility to malignant

neoplasm of breast V84.02 … malignant neoplasm of ovary V84.03 … malignant neoplasm of prostate V84.04 … malignant neoplasm of

endometrium V84.09 … other malignant neoplasm V84.8 … other disease

New Procedure Codes

00.16Pressurized treatment of venous bypass graft [conduit] w/

pharmaceutical substance E2F Decoy (edifoligide) procedure

00.17Infusion of vasopressor agent Intended for use w/ severe sepsis

codes

New Procedure Codes

00.21Intravascular imaging of extracranial cerebral vessels

00.22… intrathoracic vessels 00.23… peripheral vessels 00.24… coronary vessels 00.25… renal vessels 00.28… other specified vessel(s) 00.29… unspecified vessel(s)

New Procedure Codes

00.31Computer assisted surgery w/ CT/CTA

00.32… w/ MR/MRA 00.33… w/ fluoroscopy 00.34Imageless computer assisted

surgery 00.35Computer assisted surgery w/

multiple datasets 00.39Other computer assisted surgery

New Procedure Codes

00.61Percutaneous angioplasty or atherectomy of precerebral

(extracranial) vessel(s)

00.62…of intracranial vessel(s)

DRG 533, 534

Extracranial Procedures w/ and w/o CC

New Procedure Codes

00.63Percutaneous insertion of carotid artery stent(s)

00.64… other precerebral (extracranial) artery stent(s)

00.65… intracranial vascular stent(s)

New Procedure Codes

00.91Transplant from live related donor 00.92…live non-related donor 00.93…cadaver

27.64Insertion of palatal implant

New Procedure Codes

37.68 Insertion of percutaneous external heart assist device

DRG 104, 105

Cardiac Valve and Other Major Cardiothoracic Procedure w/ and w/o Cardiac Catheterization

37.90 Insertion of left atrial appendage device

DRG 518

Percutaneous Cardiovascular Procedure w/o Coronary Artery Stent or AMI

New Procedure Codes

Laparoscopic 44.38gastroenterostomy 44.67procedures for creation of

esophagogastric sphincteric competence

44.68gastroplasty

DRG 154, 155, 156Stomach, Esophageal and Duodenal

Procedures, w/ and w/o CC, and age 0-17

New Procedure Codes

Laparoscopic 44.95gastric restrictive procedure 44.96revision of gastric restrictive

procedure 44.97removal of gastric restrictive

device(s) 44.98adjustment of size of adjustable

gastric restrictive device

DRG 288

OR Procedures for Obesity

New Procedure Codes

81.65Vertebroplasty 81.66Kyphoplasty

DRG 233, 234

Other Musculoskeletal System and Connective Tissue OR Procedure w/ and w/o CC

DRG 442, 443

Other OR Procedures for Injuries, w/ and w/o CC

New Procedure Codes

84.53Implantation of internal limb lengthening device w/ kinetic

distraction 84.54Implantation of other internal limb

lengthening device 84.55Insertion of bone void filler

New Procedure Codes

84.59 Insertion of other spinal devices 84.60 … spinal disc prosthesis, not otherwise

specified 84.61 … partial spinal disc prosthesis, cervical 84.62 … total spinal disc prosthesis, cervical 84.63 … spinal disc prosthesis, thoracic 84.64 … partial spinal disc prosthesis,

lumbosacral 84.65 … total spinal disc prosthesis,

lumbosacralDRG 531, 532 Spinal Procedures, w/ and w/o CC

DRG 499, 500 Back and Neck Procedures Except Spinal Fusion, w/ and w/o CC

New Procedure Codes

84.66Revision or replacement of artificial spinal disc prosthesis, cervical

84.67… thoracic 84.68… lumbosacral 84.69… not otherwise specified

DRG 531, 532 Spinal Procedures, w/ and w/o CC

DRG 499, 500 Back and Neck Procedures Except Spinal Fusion, w/ and w/o CC

New Procedure Codes

86.94Insertion or replacement of single array neurostimulator pulse

generator 86.95…dual array neurostimulator pulse

generator 86.96…other neurostimulator pulse

generator

DRG 7, 8 Peripheral and Cranial Nerve and other

Nervous System Procedure, w/ and w/o CC

New Procedure Codes

89.49Automatic implantable cardioverter/ defibrillator (AICD) check

99.78Aquapheresis

New DRGs

DRG 541 and 542 Tracheostomy w/ Mechanical Ventilation

96+hours or Principal Diagnosis except Face Mouth and Neck Diagnosis, w/ and w/o Major OR Procedure

541 wt 20.0414 542 wt 12.0286

Replaces DRG 483 Tracheostomy w/ Mechanical Ventilation 96+

hours or Principal Diagnosis except Face, Mouth and Neck Diagnosis

New DRGs

DRG 543 Craniotomy w/ Implant of Chemotherapeutic Agent or

Acute Complex Central Nervous System Principal Diagnosis

543 wt 4.4579

FY 2004 DRG 1 Craniotomy, age>17, w/ CC wt 3.6186 DRG 2 … w/o CC wt 2.0850

FY 2005 DRG 1 wt 3.3344 DRG 2 wt 1.9467

Changes in Grouper LogicSpinal FusionProcedure Code 81.61 360º Spinal Fusion Single Incision

Moved out of DRG 496 Combined Anterior/Posterior Spinal Fusion 496 wt 5.8072

Moved to DRG 497 and 498 Spinal Fusion except w/ and w/o CC 497 wt 3.5251, 498 wt 2.6527

Changes in Grouper LogicNewborn DRGs

New codes added to major problem list for

DRG 387 Prematurity with Major Problems DRG 389 Full-term Neonate with Major

Problems

Changes in Grouper LogicNewborn DRGs 387 and 389 398.91 Rheumatic heart failure (congestive)

402.01 Malignant hypertensive heart disease, with heart failure

402.11 Benign hypertensive heart disease, with heart failure

402.91 Unspecified hypertensive heart disease, with heart failure

Changes in Grouper Logic Newborn DRGs 387 and 389 404.01 Malignant hypertensive heart and

renal disease, with heart failure 404.03 … with heart failure and renal failure 404.11 Benign hypertensive heart and renal

disease, with heart failure 404.13 …with heart failure and renal failure 404.91 Unspecified hypertensive heart and

renal disease, with heart failure 404.93 …with heart failure and renal failure

428.9 Heart failure, unspecified

Changes in Grouper LogicCRT-P Implantation or ReplacementPacemaker device and lead procedure code

combinations added to: DRG 115 Permanent Cardiac Pacemaker

Implant w/ Acute Myocardial Infarction, Heart Failure, or Shock or AICD Lead or Generator Procedures

DRG 116 Other Permanent Cardiac Pacemaker Implant

Moved out of DRG 118

Changes in Grouper LogicCRT-P -- DRGs 115 and 116Pacemaker device and lead procedure code

combinations 00.53 Implantation or Replacement of Cardiac

Resynchronization Pacemaker Pulse Generator Only (CRT-P)

00.53 & 37.70 00.53 & 37.71 00.53 & 37.72 00.53 & 37.73 00.53 & 37.74 00.53 & 37.76

Changes in Grouper LogicIntestinal Transplantation

46.97 Intestinal Transplantation

Moved out of DRGs 148 and 149 148 wt 3.3871, 149 wt 1.4352

Moved to DRG 480 480 wt 9.8696

DRG 480 renamed “Liver Transplant and/or Intestinal Transplant”

Changes in Grouper Logic Pancreatic Islet Cell Transplantation Pancreatic Islet Cell Transplantation 52.84 Autotransplantation 52.85 Allotransplantation

Moved to DRG 315 “Other Kidney and Urinary Tract OR Procedure”

315 wt 2.0861

Previously these codes had no surgical DRG assignment

Changes in Grouper LogicBurns w/ mechanical ventilation Cases with

PDX Extensive Third Degree Burns or Full Thickness Burns and

Procedure Code 96.72 continuous mechanical ventilation for 96+ hours

DRG 504 Extensive Burns or Full Thickness Burns w/ Mechanical Ventilation 96+ hrs w/ skin graft

DRG 505 … w/o skin graft Moved out of DRGs 506-509

Changes in Diagnosis Code Titles

203 changes to code titles – most minor

Includes Diabetes – 40 changes Mental Disorders - 144 changes Newborns – 8 changes CVA – 1 change

Changes in Diagnosis Code Titles

Diabetes – remove references to non-insulin dependent, insulin dependent, and to adult-onset

Example: 250.00 Diabetes Mellitus w/o Mention of Complication, Type II (Non-insulin Dependent Type) (NIDDM Type) (Adult-onset Type) or Unspecified Type, not Stated as Uncontrolled

Example: 250.01 Diabetes Mellitus w/o Mention of Complication, Type I (Insulin Dependent Type) (IDDM) (Juvenile Type), not Stated as Uncontrolled

(Italics indicates text no longer in title)

Changes in Diagnosis Code Titles

CVA

The inclusion terms of stroke and CVA under code 436 have been removed and re-indexed to code 434.91

Code 436 now reads “Acute, but ill-defined cerebrovascular disease”

What Now?

Read the Federal Register

Study the new coding book for text changes

Share this information with your peers departments that utilize coding medical staff

Questions?

contact:Barry Libman, RHIA, CCS, CCS-P

Barry Libman Inc.

blibman@barrylibmaninc.com

978-369-7180