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© Copyright 2009 American Health Information Management Association. All rights reserved. FY10 ICD-9-CM Diagnosis Code Updates Audio Seminar/Webinar September 10, 2009 Practical Tools for Seminar Learning

FY10 ICD-9-CM Diagnosis Code Updates

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FY10 ICD-9-CM Diagnosis Code Updates

Audio Seminar/WebinarSeptember 10, 2009

Practical Tools for Seminar Learning Copyright 2009 American Health Information Management Association. All rights reserved.

DisclaimerThe American Health Information Management Association makes no representation or guarantee with respect to the contents herein and specifically disclaims any implied guarantee of suitability for any specific purpose. AHIMA has no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this audio seminar, including but not limited to any loss of revenue, interruption of service, loss of business, or indirect damages resulting from the use of this program. AHIMA makes no guarantee that the use of this program will prevent differences of opinion or disputes with Medicare or other third party payers as to the amount that will be paid to providers of service. As a provider of continuing education the American Health Information Management Association (AHIMA) must assure balance, independence, objectivity and scientific rigor in all of its endeavors. AHIMA is solely responsible for control of program objectives and content and the selection of presenters. All speakers and planning committee members are expected to disclose to the audience: (1) any significant financial interest or other relationships with the manufacturer(s) or provider(s) of any commercial product(s) or services(s) discussed in an educational presentation; (2) any significant financial interest or other relationship with any companies providing commercial support for the activity; and (3) if the presentation will include discussion of investigational or unlabeled uses of a product. The intent of this requirement is not to prevent a speaker with commercial affiliations from presenting, but rather to provide the participants with information from which they may make their own judgments.

AHIMA 2009 Audio Seminar Series http://campus.ahima.org/audio American Health Information Management Association 233 N. Michigan Ave., 21st Floor, Chicago, Illinois

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FacultyLizabeth Fisher, RHIA Lizabeth Fisher is a medical systems specialist at the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC) in Hyattsville, MD. NCHS is responsible for maintenance of Volumes 1 and 2 of ICD-9-CM as well as development and preparation for implementation of ICD-10-CM. Ms. Fisher has over 25 years experience in the HIM field.

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Table of ContentsDisclaimer ..................................................................................................................... i Faculty ......................................................................................................................... ii Objectives ..................................................................................................................... 1 ICD-9-CM Maintenance Cycle .......................................................................................... 1 The International Classification of Diseases 9th Revision illustration .................................. 2 Highlights of October 1, 2009 (FY10) ICD-9-CM Diagnosis Code Changes Highlights of Diagnosis Changes ...................................................................................... 3 Additional Changes......................................................................................................... 3 Influenza Due to Certain Indentified Influenza Viruses....................................................... 4 Influenza Due to Certain Indentified Influenza Viruses Category 488 Tabular Changes ...... 4 Chapter 2 Neoplasms ................................................................................................... 5 Chapter 3 Endocrine, Nutritional and Metabolic Diseases, and Immunity Disorders ......... 6-7 Chapter 4 Diseases of the Blood and Blood-forming Organs ............................................ 7 Case Study .................................................................................................................... 8 Chapter 6 Neurology.................................................................................................... 8 Chapter 6 Neurology (Eye and Adnexa) ......................................................................... 9 Chapter 7 Diseases of the Circulatory System ............................................................9-10 Case Study ...................................................................................................................11 Chapter 9 Digestive System.........................................................................................11 Chapter 10 Diseases of the Genitourinary System..........................................................12 Chapter 11 Pregnancy, Childbirth, and the Puerperium ............................................. 12-13 Chapter 14 Certain Conditions Originating in the Perinatal Period............................... 13-15 Chapter 16 Signs and Symptoms ............................................................................ 15-16 Chapter 17 Injury and Poisoning ............................................................................. 16-18 Case Study .............................................................................................................. 18-19 Chapter 17 Injury and Poisoning ..................................................................................19 Supplementary Classification of Factors ...........................................................................20 Case Study ...................................................................................................................20 E Codes and the Federal Register ...................................................................................21 Supplementary Classification of External Causes of Injury and Poisoning (E Codes).............21 E Codes New in 2009 ..................................................................................................22 Index Change to Note ...................................................................................................23 Resource/Reference List ........................................................................................... 23-24 Audio Seminar Discussion ..............................................................................................24 Become an AHIMA Member Today! .................................................................................25 Audio Seminar Information Online ..................................................................................25 Upcoming Audio Seminars ............................................................................................26 Thank You/Evaluation Form and CE Certificate (Web Address) ..........................................26 Appendix ..................................................................................................................27

Resource/Reference List .......................................................................................28 (CONTINUED) AHIMA 2009 Audio Seminar Series

Table of ContentsRevised Diagnosis Code Titles New Diagnosis Codes Invalid Diagnosis Codes CE Certificate Instructions

AHIMA 2009 Audio Seminar Series

FY10 ICD-9-CM Diagnosis Code Updates

Notes/Comments/Questions

GoalsReview ICD-9-CM maintenance process Highlight October 1, 2009 diagnosis code changes including rationale for changes Review appropriate clinical documentation to use the code changes Illustrate code updates through case scenarios Provide further resources1

ICD-9-CM Maintenance CycleICD-9-CM Coordination and Maintenance CommitteeJoint chair by NCHS and CMS Open public meetings twice per year Proposals and summaries posted online

Public comment period following meetings Changes published in Federal RegisterProposed Rule April 30, 2009 Final Rule August 27, 2009

Complete addenda posted see references at end

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AHIMA 2009 Audio Seminar Series

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FY10 ICD-9-CM Diagnosis Code Updates

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Highlights of October 1, 2009 (FY10) ICD-9-CM Diagnosis Code Changes

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AHIMA 2009 Audio Seminar Series

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FY10 ICD-9-CM Diagnosis Code Updates

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Highlights of Diagnosis ChangesEffective October 1, 2009143 new diagnosis and V-codes 23 invalid codesInvalid codes are not deleted but expanded Important if you maintain a superbill

45 revised code titles 140 New external cause of injury codes (E codes)New E-codes for activity status at time of injury New E-codes for wrong patient/wrong site

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Additional ChangesIndex changes - ~ 1800

New codes indexed Existing index entries revised Requests to add or revise existing entries Additions/revisions to Table of Drugs and Chemicals Other than in your clinical chapter Conversion table if you do studies Guidelines updated

Review all addenda documents

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Influenza Due to Certain Identified Influenza VirusesInfluenza due to H1N1 influenza virus (swine flu)http://www.cdc.gov/h1n1flu

Influenza due to identified avian influenza virus (bird flu)CDC influenza website: http://www.cdc.gov/flu/avian/ Code only confirmed cases based on the providers diagnostic statement of the patient having the specific type of influenza If suspected, possible or probable is used with this diagnosis then a code from category 488 should NOT be assigned 7

Influenza Due to Certain Identified Influenza Viruses Category 488 Tabular changes488 Influenza Due to Certain Identified Influenza VirusesExcludes: influenza caused by unspecified influenza viruses (487.0-487.8)488.0 Influenza due to identified avian influenza virus Avian influenza Bird flu Influenza A/H5N1 Influenza due to identified novel H1N1 influenza virus 2009 H1N1 [swine] influenza virus Novel 2009 influenza H1N1 Novel H1N1 influenza Novel influenza A/H1N1 Swine flu

488.1

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Chapter 2 NeoplasmsMerkel Cell Carcinoma Aggressive neuroendocrine skin cancer; rising incidence About 1500 new cases per year 33% disease specific mortality higher than melanoma Most common sites affected have unique codes Face, scalp/neck, limbs, trunk areas with sun exposure

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Chapter 2 NeoplasmsSecondary neuroendocrine tumorsContinuation of neuroendocrine tumor codes implementation last year 209.7x Secondary neuroendocrine tumors Also V code for personal history of neuroendocrine tumors V10.91 Personal history of malignant neuroendocrine tumor10

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Chapter 3 Endocrine, Nutritional and Metabolic Diseases, and Immunity Disorders274.0x Gouty arthropathy Urate (uric acid) crystals deposit in joints and soft tissues Inflammation and degenerative changes 4 progressive stages of gout: Asymptomatic urate deposition or accumulation Acute gout Intercritical gout Chronic tophaceous gout

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Chapter 3 Endocrine, Nutritional and Metabolic Diseases, and Immunity Disorders274.0x Gouty arthropathyFirst changes to the category 274 in 30 years Codes created to recognize acute vs. chronic Chronic codes are split between with and without tophi274.00 Gouty arthropathy, unspecified 274.01 Acute gouty arthropathy 274.02 Chronic gouty arthropathy without mention of tophus (tophi) 274.03 Chronic gouty arthropathy with tophus (tophi)

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Chapter 3 Endocrine, Nutritional and Metabolic Diseases, and Immunity DisordersTumor lysis syndromeSerious/life-threatening complication of cancer therapy Metabolic complications that can occur after treatment of cancer Complications caused by breakdown products of dying cancer cells Pretreatment spontaneous tumor lysis syndrome is different Previous coding advice use code 584.8, with Ecode for adverse effect of chemotherapy New code 277.88 Tumor lysis syndrome 13

Chapter 4 Diseases of the Blood and Blood-forming Organs285.3 Antineoplastic chemotherapy induced anemiaChemotherapy induced anemia one of most common side effects (20%-60% patients) Rarely a hemolytic process and is not usually an aplastic process Patients usually have fatigue and inability to perform everyday activities Different than 285.22, Anemia in neoplastic disease Both 285.3 and 285.22 can be used on one admission/encounter 14

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FY10 ICD-9-CM Diagnosis Code Updates

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Case StudyQ: A patient presents to the oncologist for follow- up care and the diagnosis listed is anemia of chemotherapy. What code do you assign and what is the principal diagnosis, the anemia code or the code for the malignancy? A: Use code 285.3, Antineoplastic chemotherapy induced anemia. Additional, secondary code(s) would also be assigned for the malignancy.

ICD-9-CM Official Guidelines for Coding and Reporting, revised and effective October 1, 2009, I.C.2.c.2 Anemia associated with chemotherapy, immunotherapy and radiation therapy:When the admission/encounter is for management of an anemia associated with chemotherapy, immunotherapy or radiotherapy and the only treatment is for the anemia, the anemia is sequenced first. The appropriate neoplasm code should be assigned as an additional code. 15

Chapter 6 NeurologyTemporal Sclerosis 348.81Localization related epilepsy can be an acquired condition Largest number of focal seizures arise from temporal lobes Often due to structural change in brain such as:Tumors, vascular malformations, developmental malformations, scarring Structures in this region prone to traumatic or hypoxic injury resulting in sclerosis Most common is mesial temporal sclerosis Often, surgical removal reduces or eliminates seizures 16

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Chapter 6 Neurology (Eye and Adnexa)Chemical conjunctivitisCan result when a substance enters the eye Differentiating this type of pink eye from serous Common cause is that due to chlorine in pool New code 372.06, Acute chemical conjunctivitis

Not the same as burn due to chemicals Use category 940, Burn confined to eye and adnexa17

Chapter 7 Diseases of the Circulatory SystemChanges related to venous embolism and thrombosisIncreased use of PICC lines, central catheters, tunnel dialysis catheters and wired cardiac devices Deep vein thrombosis of major veins in thorax and upper extremities more common Chronic pulmonary embolism in patients receiving anticoagulation treatment but no longer in initial episode Patients with these conditions often require subsequent hospital admission for:

Extension of the initial thrombosis Anticoagulant related bleeding

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Chapter 7 Diseases of the Circulatory SystemGoals of new codes:Create codes for venous thrombosis of vessels in thorax, neck and upper extremities Create codes for superficial thromboses of lower extremities similar to those for deep vessels of lower extremity Track patients with acute or chronic DVT or chronic pulmonary embolism Need to track patients

Receiving anticoagulation treatment No longer in initial care

High risk for recurrence of thrombosis or embolism Especially 1-3 months after initial diagnosis 19

Chapter 7 Diseases of the Circulatory SystemMany changes and new codes to review and be aware of in category 453:453.4 Acute venous embolism and thrombosis of deep vessels of lower extremity 453.5 Chronic venous embolism and thrombosis of deep vessels of lower extremity 453.6 Venous embolism and thrombosis of superficial vessels of lower extremity 453.7 Chronic venous embolism and thrombosis of other specified vessels 453.8 Acute venous embolism and thrombosis of other specified veins 20

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Case StudyQ: A patient is admitted with deep vein thrombosis following a 15 hour flight. What code do you assign for this? A: DVT, or deep vein thrombosis is indexed to default to code 453.40, Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity. If the physician does not state acute or chronic for this condition the default is to this acute code. You can also assign code V58.61, Long-term (current) use of anticoagulants if the patient is prescribed this medication to prevent future occurrence of this condition.

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Chapter 9 Digestive System569.71 Pouchitis Internal ileoanal pouch created following proctocolectomy Proctocolectomy often treatment of ulcerative colitis or familial adenomatous polyposis Pouch means patient does not need permanent ileostomy, and can have preserved continence Pouchitis (inflammation) common complication Usually be treated successfully with antibiotics Cause of pouchitis is not well understood 22

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Chapter 10 Diseases of the Genitourinary SystemBenign endometrial hyperplasia (621.34) and Endometrial intraepithelial neoplasia [EIN] (621.35) Both endometrial hormonal responses and localized premalignant lesions have been lumped to endometrial hyperplasia No uniform meaning to modifiers mild, moderate, severe, and atypical Pathologists and gynecologists increasingly distinguishing

Non-overlapping terminology and discrete criteria 23

Benign hormonal effects of unopposed estrogens (benign hyperplasia) Emergent precancerous lesions (endometrial intraepithelial neoplasia [EIN])

Chapter 11 Pregnancy, Childbirth, and the Puerperium670.0 Major puerperal infection Needed improved specificity contained over 100 index entries

Venous thrombosis and septic pelvic thrombophlebitis were together under 671.4x Septic pelvic thrombophlebitis - inflammatory condition affecting adnexa in the pelvis

Needed to define deep vein thrombosis Needed to show pulmonary embolism in pregnancy and postpartum

Infectious complication following delivery, especially C-section New code for septic pelvic thrombophlebitis was requested to separate from postpartum DVT

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Chapter 11 Pregnancy, Childbirth, and the PuerperiumCoding changes:671.3x Deep phlebothrombosis, antepartum 671.4x Deep phlebothrombosis, postpartum Added: Use additional code to identify the deep vein thrombosis (DVT) (453.40-453.42, 453.50453.52, 453.72-453.79, 453.82-453.89) 670 Major puerperal infection (5th digits 0, 2, 4 apply) 670.1x Puerperal endometritis 670.2x Puerperal sepsis 670.3x Puerperal septic thrombophlebitis 670.8x Other major puerperal infection

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Chapter 14 Certain Conditions Originating in the Perinatal PeriodAnomalies of the abdominal wall: 756.72 OmphaloceleVentral wall defect Intestines usually covered by membranous sac intestine Intestines are exposed if the sac ruptures 1-2 per 10,000 births Frequently being associated with other structural and chromosomal anomalies

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Chapter 14 Certain Conditions Originating in the Perinatal PeriodAnomalies of the abdominal wall: 786.73 Gastroschisis Congenital ventral body wall defect Adjacent and usually to the right of the umbilical cord insertion Results from failure of developing abdominal wall to close completely Allows the extrusion of the fetal intestines from the defect 2-5 per 10,000 births with higher incidence in younger mothers 27

Chapter 14 Certain Conditions Originating in the Perinatal Period768.7 Hypoxic-ischemic encephalopathy (HIE)This was added to ICD-9-CM on Oct 1, 2006 This condition has well defined clinical definitions

Mild, moderate, severe

Difficult to track specific clinical conditions due to lack of specific diagnostic terms in the classification Expanded 768.7 to 5th digits to show these stages Clinical presentation and imaging findings determines staging28

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Chapter 14 Certain Conditions Originating in the Perinatal Period779.3 Feeding problems in newborn Expanded this code to 5th digits for more specificity 779.31 Feeding problems in newborn 779.32 Bilious vomiting in newborn Excludes: bilious vomiting in child over 28 days old (787.04) 779.33 Other vomiting in newborn 779.34 Failure to thrive in newborn Related change: Subcategory 787.0 Nausea and vomiting Excludes new code 569.87 Vomiting of fecal matter 29

Chapter 16 Signs and SymptomsDysphonia (784.42)

Dysphonia is a disorder of phonation

Hypernasality (784.43) Hyponasality (784.44)

Disorders of resonance Dense breasts included here30

Inconclusive mammogram (793.82)

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Chapter 16 Signs and Symptoms799.82 Apparent life threatening event (ALTE)NIH definition - combination of:

Cause - variety of congenital or acquired conditions Previously used terminology

Apnea (central or obstructive), Color change (cyanotic, pallid, erythematous or plethoric) Change in muscle tone (usually diminished), and Choking or gagging 50% no concrete cause is determined despite workup

Additional code(s) should be reported for associated signs and symptoms

Near-miss sudden infant death syndrome (SIDS) Aborted crib death

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Chapter 17 Injury and PoisoningTraumatic Brain Injury (TBI) tabular changes: 800-804, Fracture of Skull and 850-854, Intracranial injury, excluding those with skull fracture Added inclusion term for traumatic brain injury 854, Intracranial injury of other and unspecified nature Includes traumatic brain injury NOS New codes V15.52 History of traumatic brain injury V80.01 Screening for traumatic brain injury 32

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Chapter 17 Injury and PoisoningTraumatic Brain Injury (TBI) tabular changes: 799.2 Signs and symptoms involving emotional state Expanded to 5th digits for symptoms associated with TBI 799.21 Nervousness 799.22 Irritability 799.23 Impulsiveness 799.24 Emotional lability 799.25 Demoralization and apathy 799.29 Other signs and symptoms involving emotional state Review exclusion terms at memory loss (780.93), and alteration of consciousness (780.0) 33

Chapter 17 Injury and PoisoningTraumatic Brain Injury (TBI) index changes Injury 959.9- brain (traumatic) NEC (see also Injury, intracranial) 854.0 - due to fracture of skull - see Fracture, skull, by site

- with skull fracture - see Fracture, skull, by site Traumatic - see also condition - brain injury (TBI) (see also Injury, intracranial) 854.0-- with skull fracture - see Fracture, skull, by site

-- intracranial (traumatic) 854.0 TBI (traumatic brain injury) (see also Injury, intracranial) 854.0

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Chapter 17 Injury and PoisoningCurrent injury

Use injury codes and external cause codes

Subsequent treatment following initial injury treatment

Code symptom codes such as nervousness V codes for history of TBI Sequelae/late effects907.0 Late effect of intracranial injury without mention of skull fracture 905.0 Late effect of fracture of skull and face bones

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Case StudyQ: Patient is admitted and final diagnosis is traumatic brain injury due to a closed fracture of the base of the skull from being hit by fragments of roadside IEDs. There was no documented loss of consciousness. A: Assign codes: 801.41 Closed with intracranial injury of other and unspecified nature, with no loss of consciousness E991.7 Injury due to fragments from other improvised explosive device [IED] 36

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Case StudyQ: Patient is seen to be assessed for possible TBI because of being stationed in Iraq. He has no symptoms but documentation indicates that the screening is mandatory, following the end of deployment, for all soldiers who were stationed in Iraq. A: Assign code: V80.01, Special screening for traumatic brain injury Note: If there were any symptoms documented they should also be coded. 37

Chapter 17 Injury and PoisoningAdditional changes to review in Chapter 17: 813.4x Torus fractures of radius and ulna 832.2 Nursemaids elbow Expansion of codes 969.0 Poisoning by antidepressents 969.7 Poisoning by psychostimulants caffeine vs. amphetamines 995.24 Failed moderate sedation during procedure

Related to that change V15.80 History of failed conscious sedation

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Supplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)V20.3

Newborn health supervision

Age of infant is important here now

V26.42 Encounter for fertility preservation counseling V26.82 Encounter for fertility preservation procedure

Prior to cancer therapy

V53.51 Fitting and adjustment of gastric lap band V60 and V61 Numerous new codes

For family disruption and parent/child problems 39

V87.4x Personal history of drug therapy

Case StudyQ: A 10 day old baby is seen in the pediatricians office for a weight check and is noted also to have feeding problems. What are the appropriate diagnosis codes? A: Assign code V20.32, Health supervision for newborn 8 to 28 days old, for the first listed diagnosis. Assign code 779.31, Feeding problems in newborn, as an additional diagnosis.40

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E Codes and the Federal RegisterFrequently asked question: Q: Why dont new and revised E codes appear in the Federal Register notice that has the Inpatient Prospective Payment System (IPPS) changes with the new and revised code tables (Tables 6A-6E)? A: Since E codes are not used in the IPPS they do not appear in this notice. They DO always appear in the diagnosis addenda (tabular and index changes) each year. Comments regarding these codes and all other proposed changes to ICD-9-CM can be made during the open comment period following an ICD-9-CM Coordination and Maintenance Committee meeting. This year because there are numerous changes to the E codes (including 140 new E-codes) a separate Federal Register, under the CDC, will be published with these changes. You can also find these codes listed at the CMS website given as a reference at the end of this presentation. This is another good reason to always check the full addenda, posted on the NCHS web site, in addition to the new and revised code lists in the Federal Register. 41

Supplementary Classification of External Causes of injury and Poisoning (E Codes)Never Events Wrong procedure/wrong patient/wrong part or side of body E876.5 Performance of wrong operation (procedure) correct patient

Example: replaced the right hip on Mrs. Jones but she was scheduled for a hysterectomy

E876.6 Performance of operation (procedure) on a patient not scheduled for surgery

Example: replaced right hip on Mrs. Smith, but this procedure should have been done on Mrs. Jones

E876.7 Performance of operation (procedure) on wrong side/body part

Example: replaced the right hip on Mrs. Jones it but should have been the left hip

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FY10 ICD-9-CM Diagnosis Code Updates

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E Codes New in 2009E000 External cause statusIndicates status of the person at the time the (injury) event occurred

E001-E030 ActivityTo indicate what activity the person was doing at the time of the injury Extensive list of categories here

Athletics, household maintenance, hobbies, etc.

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E Codes New in 2009E830-E838 Water Transport Accidents Fourth digit .7 added for occupant of military watercraft Additions and expansion to external cause of injury for Injury due to war operations

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Index Change to NoteEpilepsy, epileptic (idiopathic) 345.9Note: use the following fifth-digit subclassifications with categories 345.0, 345.1, 345.4-345.9 0 without mention of intractable epilepsy 1 with intractable epilepsy Add pharmacoresistant (pharmacologically resistant) Add poorly controlled Add treatment resistant Add refractory (medically)45

Resources/ReferencesICD-9-CM Diagnosis Coding Changes 10/01/2009NCHS Classification of Diseases and Functioning & Disability web site includes Diagnosis (Volumes 1 &2) addenda:http://www.cdc.gov/nchs/icd9.htm

Link to FY10 CD-ROM published by Government Printing Office:http://bookstore.gpo.gov/actions/GetPublication.do?stocknumber= 017-022-01611-7

ICD-9-CM Coordination and Maintenance Committee (background about changes)http://www.cdc.gov/nchs/about/otheract/icd9/maint/maint.htm

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Resources/ReferencesICD-9-CM Diagnosis Coding Changes 10/01/2009Tables 6A-6F: New/Revised/Invalid codes (CMS web site):http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_s ummarytables.asp

Federal Register scheduled to publish August 27, 2009, Final Rule FY 2010 Inpatient Prospective Payment System (including new code lists and DRG changes): Link to rule on display as of August 4, 2009:http://www.federalregister.gov/inspection.aspx#spec_C

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Audio Seminar DiscussionFollowing todays live seminar Available to AHIMA members atwww.AHIMA.orgClick on Communities of Practice (CoP) icon on top right AHIMA Member ID number and password required for members only

Join the Coding Community from your Personal Page under Community Discussions, choose the Audio Seminar Forum You will be able to: Discuss seminar topics Network with other AHIMA members Enhance your learning experience

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FY10 ICD-9-CM Diagnosis Code Updates

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Become an AHIMA Member Today!To learn more about becoming a member of AHIMA, please visit our website at ahima.org/membership to Join Now!

AHIMA Audio SeminarsVisit our Web site http://campus.AHIMA.org for information on the 2009 seminar schedule. While online, you can also register for seminars or order CDs, pre-recorded Webcasts, and *MP3s of past seminars.*Select audio seminars only

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FY10 ICD-9-CM Diagnosis Code Updates

Notes/Comments/Questions

Upcoming Seminars/WebinarsFY10 CMS IPPS Update September 15, 2009 FY10 ICD-9-CM Procedure Code Updates September 17, 2009 FY10 Rehabilitation Coding and IRF PPS Update September 24, 2009

Thank you for joining us today!Remember sign on to the AHIMA Audio Seminars Web site to complete your evaluation form and receive your CE Certificate online at:http://campus.ahima.org/audio/2009seminars.html Each person seeking CE credit must complete the sign-in form and evaluation in order to view and print their CE certificate Certificates will be awarded for AHIMA Continuing Education Credit

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AppendixResource/Reference List .......................................................................................27 Revised Diagnosis Code Titles New Diagnosis Codes Invalid Diagnosis Codes CE Certificate Instructions

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Appendix Resource/Reference Listhttp://www.cdc.gov/nchs/icd9.htm http://bookstore.gpo.gov/actions/GetPublication.do?stocknumber=017-022-01611-7 http://www.cdc.gov/nchs/about/otheract/icd9/maint/maint.htm http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp http://www.federalregister.gov/inspection.aspx#spec_C

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REVISED DIAGNOSIS CODE TITLES Effective October 1, 2009 The final addendum providing complete information on changes to the diagnosis part of ICD-9-CM is posted on CDCs webpage at: www.cdc.gov/nchs/icd9.htm Diagnosis Code 008.65 041.3 041.86 453.2* 453.40 453.41 453.42 572.2 584.5 584.6 584.7** 584.8 584.9 639.3 669.30 669.32 669.34 670.00 670.02 670.04 757.6 772.0 776.9 784.40 784.49 793.0 793.1 793.2 793.3 Description Enteritis due to calicivirus Klebsiella pneumoniae Helicobacter pylori [H. pylori] Other venous embolism and thrombosis of inferior vena cava Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity Acute venous embolism and thrombosis of deep vessels of proximal lower extremity Acute venous embolism and thrombosis of deep vessels of distal lower extremity Hepatic encephalopathy Acute kidney failure with lesion of tubular necrosis Acute kidney failure with lesion of renal cortical necrosis Acute kidney failure with lesion of renal medullary [papillary] necrosis Acute kidney failure with other specified pathological lesion in kidney Acute kidney failure, unspecified Kidney failure following abortion and ectopic and molar pregnancies Acute kidney failure following labor and delivery, unspecified as to episode of care or not applicable Acute kidney failure following labor and delivery, delivered, with mention of postpartum complication Acute kidney failure following labor and delivery, postpartum condition or complication Major puerperal infection, unspecified, unspecified as to episode of care or not applicable Major puerperal infection, unspecified, delivered, with mention of postpartum complication Major puerperal infection, unspecified, postpartum condition or complication Specified congenital anomalies of breast Fetal blood loss affecting newborn Unspecified hematological disorder specific to newborn Voice and resonance disorder, unspecified Other voice and resonance disorders Nonspecific (abnormal) findings on radiological and other examination of skull and head Nonspecific (abnormal) findings on radiological and other examination of lung field Nonspecific (abnormal) findings on radiological and other examination of other intrathoracic organs Nonspecific (abnormal) findings on radiological and other examination of biliary tract

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REVISED DIAGNOSIS CODE TITLES Effective October 1, 2009 Diagnosis Code 793.4 793.5 793.6 793.7 793.89 793.99 813.45 996.43 E876.5 V15.06 V15.84 V15.85 Description Nonspecific (abnormal) findings on radiological and other examination of gastrointestinal tract Nonspecific (abnormal) findings on radiological and other examination of genitourinary organs Nonspecific (abnormal) findings on radiological and other examination of abdominal area, including retroperitoneum Nonspecific (abnormal) findings on radiological and other examination of musculoskeletal system Other (abnormal) findings on radiological examination of breast Other nonspecific (abnormal) findings on radiological and other examination of body structure Torus fracture of radius (alone) Broken prosthetic joint implant Performance of wrong operation (procedure) on correct patient Allergy to insects and arachnids Personal history of contact with and (suspected) exposure to asbestos Personal history of contact with and (suspected) exposure to potentially hazardous body fluids Personal history of contact with and (suspected) exposure to lead Care involving speech-language therapy Other parent-child problems Pediatric pre-birth visit for expectant parent(s)

V15.86 V57.3 V61.29 V65.11 Notes: * This diagnosis code was discussed at the March 11-12, 2009 ICD-9-CM Coordination and Maintenance Committee meeting and was not finalized in time to include in the proposed rule. However, it will be implemented on October 1, 2009. ** The code title has changed from the proposed rule.

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NEW DIAGNOSIS CODES Effective October 1, 2009 The final addendum providing complete information on changes to the diagnosis part of ICD-9-CM is posted on CDCs webpage at: www.cdc.gov/nchs/icd9.htm Diagnosis Code 209.31 209.32 209.33 209.34 209.35 209.36 209.70 209.71 209.72 209.73 209.74 209.75* 209.79 239.81 239.89 274.00 274.01 274.02 274.03 277.88 279.41 279.49 285.3 348.81 348.89 359.71 359.79 372.06 416.2 438.13 438.14 453.50 453.51 453.52 453.6 453.71 453.72 Description Merkel cell carcinoma of the face Merkel cell carcinoma of the scalp and neck Merkel cell carcinoma of the upper limb Merkel cell carcinoma of the lower limb Merkel cell carcinoma of the trunk Merkel cell carcinoma of other sites Secondary neuroendocrine tumor, unspecified site Secondary neuroendocrine tumor of distant lymph nodes Secondary neuroendocrine tumor of liver Secondary neuroendocrine tumor of bone Secondary neuroendocrine tumor of peritoneum Secondary Merkel cell carcinoma Secondary neuroendocrine tumor of other sites Neoplasms of unspecified nature, retina and choroid Neoplasms of unspecified nature, other specified sites Gouty arthropathy, unspecified Acute gouty arthropathy Chronic gouty arthropathy without mention of tophus (tophi) Chronic gouty arthropathy with tophus (tophi) Tumor lysis syndrome Autoimmune lymphoproliferative syndrome Autoimmune disease, not elsewhere classified Antineoplastic chemotherapy induced anemia Temporal sclerosis Other conditions of brain Inclusion body myositis Other inflammatory and immune myopathies, NEC Acute chemical conjunctivitis Chronic pulmonary embolism Late effects of cerebrovascular disease, dysarthria Late effects of cerebrovascular disease, fluency disorder Chronic venous embolism and thrombosis of unspecified deep vessels of lower extremity Chronic venous embolism and thrombosis of deep vessels of proximal lower extremity Chronic venous embolism and thrombosis of deep vessels of distal lower extremity Venous embolism and thrombosis of superficial vessels of lower extremity Chronic venous embolism and thrombosis of superficial veins of upper extremity Chronic venous embolism and thrombosis of deep veins of upper extremity

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NEW DIAGNOSIS CODES Effective October 1, 2009 Diagnosis Code 453.73 453.74** 453.75 453.76 453.77 453.79 453.81 453.82 453.83 453.84 453.85 453.86 453.87 453.89 488.0*** 488.1*** 569.71 569.79 569.87 621.34 621.35 670.10 670.12 670.14 670.20 670.22 670.24 670.30 670.32 670.34 670.80 670.82 670.84 756.72 756.73 768.70 768.71 768.72 768.73 779.31 Description Chronic venous embolism and thrombosis of upper extremity, unspecified Chronic venous embolism and thrombosis of axillary veins Chronic venous embolism and thrombosis of subclavian veins Chronic venous embolism and thrombosis of internal jugular veins Chronic venous embolism and thrombosis of other thoracic veins Chronic venous embolism and thrombosis of other specified veins Acute venous embolism and thrombosis of superficial veins of upper extremity Acute venous embolism and thrombosis of deep veins of upper extremity Acute venous embolism and thrombosis of upper extremity, unspecified Acute venous embolism and thrombosis of axillary veins Acute venous embolism and thrombosis of subclavian veins Acute venous embolism and thrombosis of internal jugular veins Acute venous embolism and thrombosis of other thoracic veins Acute venous embolism and thrombosis of other specified veins Influenza due to identified avian influenza virus Influenza due to identified novel H1N1 influenza virus Pouchitis Other complications of intestinal pouch Vomiting of fecal matter Benign endometrial hyperplasia Endometrial intraepithelial neoplasia [EIN] Puerperal endometritis, unspecified as to episode of care or not applicable Puerperal endometritis, delivered, with mention of postpartum complication Puerperal endometritis, postpartum condition or complication Puerperal sepsis, unspecified as to episode of care or not applicable Puerperal sepsis, delivered, with mention of postpartum complication Puerperal sepsis, postpartum condition or complication Puerperal septic thrombophlebitis, unspecified as to episode of care or not applicable Puerperal septic thrombophlebitis, delivered, with mention of postpartum complication Puerperal septic thrombophlebitis, postpartum condition or complication Other major puerperal infection, unspecified as to episode of care or not applicable Other major puerperal infection, delivered, with mention of postpartum complication Other major puerperal infection, postpartum condition or complication Omphalocele Gastroschisis Hypoxic-ischemic encephalopathy, unspecified Mild hypoxic-ischemic encephalopathy Moderate hypoxic-ischemic encephalopathy Severe hypoxic-ischemic encephalopathy Feeding problems in newborn

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NEW DIAGNOSIS CODES Effective October 1, 2009 Diagnosis Code 779.32 779.33 779.34 784.42 784.43 784.44 784.51 784.59 787.04 789.7 793.82 799.21 799.22 799.23 799.24 799.25 799.29 799.82 813.46 813.47 832.2 969.00 969.01 969.02 969.03 969.04 969.05 969.09 969.70 969.71 969.72 969.73 969.79 995.24 E000.0 E000.1 E000.8 E000.9 E001.0 E001.1 E002.0 E002.1 E002.2 Description Bilious vomiting in newborn Other vomiting in newborn Failure to thrive in newborn Dysphonia Hypernasality Hyponasality Dysarthria Other speech disturbance Bilious emesis Colic Inconclusive mammogram Nervousness Irritability Impulsiveness Emotional lability Demoralization and apathy Other signs and symptoms involving emotional state Apparent life threatening event in infant Torus fracture of ulna (alone) Torus fracture of radius and ulna Nursemaid's elbow Poisoning by antidepressant, unspecified Poisoning by monoamine oxidase inhibitors Poisoning by selective serotonin and norepinephrine reuptake inhibitors Poisoning by selective serotonin reuptake inhibitors Poisoning by tetracyclic antidepressants Poisoning by tricyclic antidepressants Poisoning by other antidepressants Poisoning by psychostimulant, unspecified Poisoning by caffeine Poisoning by amphetamines Poisoning by methylphenidate Poisoning by other psychostimulants Failed moderate sedation during procedure Civilian activity done for income or pay Military activity Other external cause status Unspecified external cause status Activities involving walking, marching and hiking Activities involving running Activities involving swimming Activities involving springboard and platform diving Activities involving water polo

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NEW DIAGNOSIS CODES Effective October 1, 2009 Diagnosis Code E002.3 E002.4 E002.5 E002.6 E002.7 E002.8 E002.9 E003.0 E003.1 E003.2 E003.3 E003.9 E004.0 E004.1 E004.2** E004.3** E004.4 E004.9 E005.0 E005.1 E005.2 E005.3 E005.4 E005.9 E006.0 E006.1 E006.2 E006.3 E006.4 E006.5** E006.6 E006.9 E007.0 E007.1 E007.2 E007.3 E007.4 E007.5 E007.6 E007.7 E007.8 Description Activities involving water aerobics and water exercise Activities involving underwater diving and snorkeling Activities involving rowing, canoeing, kayaking, rafting and tubing Activities involving water skiing and wake boarding Activities involving surfing, windsurfing and boogie boarding Activities involving water sliding Other activity involving water and watercraft Activities involving ice skating Activities involving ice hockey Activities involving snow (alpine) (downhill) skiing, snow boarding, sledding, tobogganing and snow tubing Activities involving cross country skiing Other activity involving ice and snow Activities involving mountain climbing, rock climbing and wall climbing Activities involving rappelling Activities involving BASE jumping Activities involving bungee jumping Activities involving hang gliding Other activity involving climbing, rappelling and jumping off Activities involving dancing Activities involving yoga Activities involving gymnastics Activities involving trampoline Activities involving cheerleading Other activity involving dancing and other rhythmic movements Activities involving roller skating (inline) and skateboarding Activities involving horseback riding Activities involving golf Activities involving bowling Activities involving bike riding Activities involving jumping rope Activities involving non-running track and field events Other activity involving other sports and athletics played individually Activities involving american tackle football Activities involving american flag or touch football Activities involving rugby Activities involving baseball Activities involving lacrosse and field hockey Activities involving soccer Activities involving basketball Activities involving volleyball (beach) (court) Activities involving physical games generally associated with school recess, summer camp and children

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NEW DIAGNOSIS CODES Effective October 1, 2009 Diagnosis Code E007.9 E008.0 E008.1 E008.2 E008.3 E008.4 E008.9** E009.0 E009.1 E009.2 E009.3 E009.4 E009.5 E009.9 E010.0 E010.1 E010.2 E010.3 E010.9 E011.0 E011.1 E011.9 E012.0 E012.1 E012.2 E012.9 E013.0 E013.1 E013.2 E013.3 E013.4 E013.5 E013.8 E013.9 E014.0 E014.1 E014.9 E015.0 E015.1 E015.2 E015.9 E016.0 E016.1 Description Other activity involving other sports and athletes played as a team or group Activities involving boxing Activities involving wrestling Activities involving racquet and hand sports Activities involving frisbee Activities involving martial arts Other specified sports and athletics activity Activity involving exercise machines primarily for cardiorespiratory conditioning Activity involving calisthenics Activity involving aerobic and step exercise Activity involving circuit training Activity involving obstacle course Activity involving grass drills Other activity involving cardiorespiratory exercise Activity involving exercise machines primarily for muscle strengthening Activity involving push-ups, pull-ups, sit-ups Activity involving free weights Activity involving pilates Other activity involving other muscle strengthening exercises Activities involving computer keyboarding Activities involving hand held interactive electronic device Other activity involving computer technology and electronic devices Activities involving knitting and crocheting Activities involving sewing Activities involving furniture building and finishing Activity involving other arts and handcrafts Activities involving personal bathing and showering Activities involving laundry Activities involving vacuuming Activities involving ironing Activities involving floor mopping and cleaning Activities involving residential relocation Other personal hygiene activity Other household maintenance Caregiving involving bathing Caregiving involving lifting Other activity involving person providing caregiving Activities involving food preparation and clean up Activities involving grilling and smoking food Activities involving cooking and baking Other activity involving cooking and grilling Activities involving digging, shoveling and raking Activities involving gardening and landscaping

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NEW DIAGNOSIS CODES Effective October 1, 2009 Diagnosis Code E016.2 E016.9 E017.0 E017.9 E018.0 E018.1 E018.2 E018.3 E019.0 E019.1 E019.2 E019.9 E029.0 E029.1 E029.2 E029.9 E030 E830.7 E831.7 E832.7 E833.7 E834.7 E835.7 E836.7 E837.7 E838.7 E876.6 E876.7 E928.7 E990.1 E990.2 E990.3 E991.4 E991.5** Description Activities involving building and construction Other activity involving property and land maintenance, building and construction Activities involving roller coaster riding Other activity involving external motion Activities involving piano playing Activities involving drum and other percussion instrument playing Activities involving string instrument playing Activities involving winds and brass instrument playing Activities involving walking an animal Activities involving milking an animal Activities involving grooming and shearing an animal Other activity involving animal care Refereeing a sports activity Spectator at an event Rough housing and horseplay Other activity Unspecified activity Accident to watercraft causing submersion, occupant of military watercraft, any type Accident to watercraft causing other injury, occupant of military watercraft, any type Other accidental submersion or drowning in water transport accident, occupant of military watercraft, any type Fall on stairs or ladders in water transport, occupant of military watercraft, any type Other fall from one level to another in water transport, occupant of military watercraft, any type Other and unspecified fall in water transport, occupant of military watercraft, any type Machinery accident in water transport, occupant of military watercraft, any type Explosion, fire, or burning in watercraft, occupant of military watercraft, any type Other and unspecified water transport accident, occupant of military watercraft, any type Performance of operation (procedure) on patient not scheduled for surgery Performance of correct operation (procedure) on wrong side/body part Environmental and accidental causes, mechanism or component of firearm and air gun Injury due to war operations from flamethrower Injury due to war operations from incendiary bullet Injury due to war operations from fire caused indirectly from conventional weapon Injury due to war operations by fragments from munitions Injury due to war operations by fragments from person-borne improvised explosive device [IED]

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NEW DIAGNOSIS CODES Effective October 1, 2009 Diagnosis Code E991.6** E991.7** E991.8 E992.0 E992.1 E992.2 E992.3 E992.8 E992.9 E993.0 E993.1 E993.2 E993.3** E993.4** E993.5** E993.6 E993.7 E993.8 E993.9 E994.0 E994.1 E994.2 E994.3 E994.8 E994.9 E995.0 E995.1 E995.2 E995.3 E995.4 E995.8 E995.9 E996.0 E996.1 E996.2 E996.3** Description Injury due to war operations by fragments from vehicle-borne improvised explosive device [IED] Injury due to war operations by fragments from other improvised explosive device [IED] Injury due to war operations by fragments from weapons Injury due to torpedo Injury due to depth charge Injury due to marine mines Injury due to sea-based artillery shell Injury due to war operations by other marine weapons Injury due to war operations by unspecified marine weapon Injury due to war operations by aerial bomb Injury due to war operations by guided missile Injury due to war operations by mortar Injury due to war operations by person-borne improvised explosive device [IED] Injury due to war operations by vehicle-borne improvised explosive device [IED] Injury due to war operations by other improvised explosive device [IED] Injury due to war operations by unintentional detonation of own munitions Injury due to war operations by unintentional discharge of own munitions launch device Injury due to war operations by other specified explosion Injury due to war operations by unspecified explosion Injury due to war operations by destruction of aircraft due to enemy fire or explosives Injury due to war operations by unintentional destruction of aircraft due to own onboard explosives Injury due to war operations by destruction of aircraft due to collision with other aircraft Injury due to war operations by destruction of aircraft due to onboard fire Injury due to war operations by other destruction of aircraft Injury due to war operations by unspecified destruction of aircraft Injury due to war operations by unarmed hand-to-hand combat Injury due to war operations, struck by blunt object Injury due to war operations by piercing object Injury due to war operations by intentional restriction of air and airway Injury due to war operations by unintentional drowning due to inability to surface or obtain air Injury due to war operations by other forms of conventional warfare Injury due to war operations by unspecified form of conventional warfare Injury due to war operations by direct blast effect of nuclear weapon Injury due to war operations by indirect blast effect of nuclear weapon Injury due to war operations by thermal radiation effect of nuclear weapon Injury due to war operations by nuclear radiation effects

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NEW DIAGNOSIS CODES Effective October 1, 2009 Diagnosis Code E996.8 E996.9 E997.3** E998.0 E998.1 E998.8 E998.9 V10.90* V10.91 V15.52 V15.80 V15.83 V20.31** V20.32 V26.42 V26.82 V53.50 V53.51 V53.59 V60.81 V60.89 V61.07 V61.08 V61.23 V61.24 V61.25 V61.42 V72.60 V72.61 V72.62 V72.63 V72.69 V80.01 V80.09 V87.32 V87.43 V87.44 V87.45 V87.46 Notes: Description Injury due to war operations by other effects of nuclear weapons Injury due to war operations by unspecified effect of nuclear weapon Injury due to war operations by weapon of mass destruction [WMD], unspecified Injury due to war operations but occurring after cessation of hostilities by explosion of mines Injury due to war operations but occurring after cessation of hostilities by explosion of bombs Injury due to other war operations but occurring after cessation of hostilities Injury due to unspecified war operations but occurring after cessation of hostilities Personal history of unspecified malignant neoplasm Personal history of malignant neuroendocrine tumor Personal history of traumatic brain injury Personal history of failed moderate sedation Personal history of underimmunization status Health supervision for newborn under 8 days old Health supervision for newborn 8 to 28 days old Encounter for fertility preservation counseling Encounter for fertility preservation procedure Fitting and adjustment of intestinal appliance and device Fitting and adjustment of gastric lap band Fitting and adjustment of other gastrointestinal appliance and device Foster care (status) Other specified housing or economic circumstances Family disruption due to death of family member Family disruption due to other extended absence of family member Counseling for parent-biological child problem Counseling for parent-adopted child problem Counseling for parent (guardian)-foster child problem Substance abuse in family Laboratory examination, unspecified Antibody response examination Laboratory examination ordered as part of a routine general medical examination Pre-procedural laboratory examination Other laboratory examination Special screening for traumatic brain injury Special screening for other neurological conditions Contact with and (suspected) exposure to algae bloom Personal history of estrogen therapy Personal history of inhaled steroid therapy Personal history of systemic steroid therapy Personal history of immunosuppressive therapy

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NEW DIAGNOSIS CODES Effective October 1, 2009 These diagnosis codes were discussed at the March 11-12, 2009 ICD-9-CM Coordination and Maintenance Committee meeting and were not finalized in time to include in the proposed rule. They will be implemented on October 1, 2009. Please note that the code title for 209.75 has changed from the proposed rule to the final rule. ** The code title has changed from the proposed rule. *** CDC created new flu codes to better capture H1N1 flu cases in response to the recent flu outbreak.*

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INVALID DIAGNOSIS CODES Effective October 1, 2009 The final addendum providing complete information on changes to the diagnosis part of ICD-9-CM is posted on CDCs webpage at: www.cdc.gov/nchs/icd9.htm Diagnosis Code 239.8 274.0 279.4 348.8 453.8 488*** 768.7 779.3 784.5 799.2 969.0 969.7 E992 E993 E994 E995 Description

Neoplasm of unspecified nature of other specified sites Gouty arthropathy Autoimmune disease, not elsewhere classified Other conditions of brain Other venous embolism and thrombosis of other specified veins Influenza due to identified avian influenza virus Hypoxic-ischemic encephalopathy (HIE) Feeding problems in newborn Other speech disturbance Nervousness Poisoning by antidepressants Poisoning by psychostimulants Injury due to war operations by explosion of marine weapons Injury due to war operations by other explosion Injury due to war operations by destruction of aircraft Injury due to war operations by other and unspecified forms of conventional warfare E996 Injury due to war operations by nuclear weapons E998 Injury due to war operations but occurring after cessation of hostilities V10.9 Unspecified personal history of malignant neoplasm V53.5 Fitting and adjustment of other intestinal appliance V60.8 Other specified housing or economic circumstances V72.6 Laboratory examination V80.0 Special screening for neurological conditions *** CDC created new flu codes to better capture H1N1 flu cases in response to the recent flu outbreak. As a result, code 488 was deleted.

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