1. ICD-9-Codes and DRG Updates FY 2005 Barry Libman, RHIA, CCS, CCS-P President, Barry Libman Inc

2. Federal Register, August 11, 2004 Volume 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

3. 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

4. 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

5. 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/ohepatic coma, CC

070.71 w/ hepatic coma, CC

6. Endocrine Disorders

Disorders of Parathyroid Gland

252.00 Hyperparathyroidism, unspecified

252.01 Primary hyperparathyroidism

252.02 Secondary hyperparathyroidism,non-renal

252.08 Other hyperparathyroidism

7. Endocrine Disorders

Other Metabolic and Immunity Disorders

273.4 Alpha-1-antitrypsin deficiency

277.85 Disorders of fatty acid oxidation

277.86 Peroxisomal disorders

277.87 Disorders of mitochondrialmetabolism

8. 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

9. Circulatory System

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

453.40 Venous embolism and thrombosisof unspecified deep vessels of lowerextremity, CC

453.41 of deep vessels of proximal lowerextremity, CC

453.42 of deep vessels of distal lowerextremity, CC

10. Respiratory System

Other Diseases of the Upper Respiratory Tract

477.2 Allergic 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

11. 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

12. Digestive System

Diseases of Oral Cavity, Salivary Glands, and Jaws (cont.)

524.07 Excessive tuberosity of jaw

524.20 Unspecified anomaly of dental archrelationship

524.21-23 Angles 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 archrelationship

524.30-37, 39 Anomaly of tooth position

13. 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 themandible

524.54 Insufficient anterior guidance

524.55 Centric occlusion maximum intercuspationdiscrepancy

524.56 Non-working side interference

524.57 Lack of posterior occlusal support

524.59 Other dentofacial functional abnormalities

14. Digestive System

Diseases of Oral Cavity, Salivary Glands, and Jaws (cont.)

524.64 Temporomandibular joint sounds onopening and/or closing the jaw

524.75 Vertical displacement of alveolus andteeth

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 ridgemucosa

528.79 Other disturbances of oral epithelium,including tongue

15. Digestive System

Diseases of Esophagus, Stomach and Duodenum

530.86 Infection of esophagostomy, CC

530.87 Mechanical complication ofesophagostomy, CC

16. Genitourinary System

Nephritis, Nephrotic Syndrome, and Nephrosis

588.81 Secondary hyperparathyroidism (ofrenal origin)

588.89 Other specified disorders resultingfrom impaired renal function

17. 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/omention of uterine prolapse

18. Genitourinary System

Other Disorders of Female Genital Tract (continued)

618.81 Incompetence or weakening ofpubocervical tissue

618.82 Incompetence or weakening ofrectovaginal 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/oatypia

621.33 Endometrial hyperplasia w/ atypia

19. 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

20. Skin and Subcutaneous Tissue

Other Inflammatory Conditions of Skin and Subcutaneous Tissue

692.84 Contact dermatitis and othereczema due to animal (cat) (dog)dander

Other Diseases of Skin and Subcutaneous Tissue

705.21 Primary focal hyperhidrosis

705.22 Secondary focal hyperhidrosis

21. 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

22. Congenital Anomalies

758.31 Cri-du-chat syndrome

758.32 Velo-cardio-facial syndrome

758.33 Other microdeletions

758.39 Other autosomal deletions

23. Symptoms, Signs, and Ill-Defined Conditions

780.58 Sleep related movement disorder

788.38 Overflow incontinence

790.95 Elevated C-reactive protein (CRP)

24. Symptoms, Signs, and Ill-Defined Conditions

795.03 Papanicolaou smear of cervix w/ lowgrade squamous intraepithelial lesion(LGSIL)

795.04 w/ high grade squamous intraepitheliallesion (HGSIL)

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

795.08 Nonspecific abnormal papanicolaousmear of cervix, unsatisfactory smear

796.6 Nonspecific abnormal findings on neonatalscreening

25. 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

26. 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

27. 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

28. 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

29. New V Codes

Genetic Susceptibility

V84.01Genetic susceptibility to malignantneoplasm of breast

V84.02 malignant neoplasm of ovary

V84.03 malignant neoplasm of prostate

V84.04 malignant neoplasm ofendometrium

V84.09 other malignant neoplasm

V84.8 other disease

30. New Procedure Codes

00.16 Pressurized treatment of venousbypass graft [conduit] w/pharmaceutical substance

• • • • E2F Decoy (edifoligide) procedure

00.17 Infusion of vasopressor agent

• • • • Intended for use w/ severe sepsis codes

31. New Procedure Codes

00.21 Intravascular imaging of extracranialcerebral 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)

32. New Procedure Codes

00.31 Computer assisted surgery w/CT/CTA

00.32 w/ MR/MRA

00.33 w/ fluoroscopy

00.34 Imageless computer assistedsurgery

00.35 Computer assisted surgery w/multiple datasets

00.39 Other computer assisted surgery

33. New Procedure Codes

00.61 Percutaneous angioplasty oratherectomy of precerebral(extracranial) vessel(s)

00.62 of intracranial vessel(s)

DRG 533, 534

Extracranial Procedures w/ and w/o CC

34. New Procedure Codes

00.63 Percutaneous insertion of carotidartery stent(s)

00.64 other precerebral (extracranial)artery stent(s)

00.65 intracranial vascular stent(s)

35. New Procedure Codes

00.91 Transplant from live related donor

00.92 live non-related donor

00.93 cadaver

27.64 Insertion of palatal implant

36. New Procedure Codes

37.68 Insertion of percutaneous externalheart assist device

DRG 104, 105

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

37.90 Insertion of left atrial appendagedevice

DRG 518

Percutaneous Cardiovascular Procedure w/o Coronary Artery Stent or AMI

37. New Procedure Codes

Laparoscopic

44.38 gastroenterostomy

44.67 procedures for creation ofesophagogastric sphinctericcompetence

44.68 gastroplasty

DRG 154, 155, 156

Stomach, Esophageal and Duodenal Procedures, w/ and w/o CC, and age 0-17

38. New Procedure Codes

Laparoscopic

44.95 gastric restrictive procedure

44.96 revision of gastric restrictiveprocedure

44.97 removal of gastric restrictivedevice(s)

44.98 adjustment of size of adjustablegastric restrictive device

DRG 288

OR Procedures for Obesity

39. New Procedure Codes

81.65 Vertebroplasty

81.66 Kyphoplasty

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

40. New Procedure Codes

84.53 Implantation of internal limblengthening device w/ kineticdistraction

84.54 Implantation of other internal limblengthening device

84.55 Insertion of bone void filler

41. New Procedure Codes

84.59 Insertion of other spinal devices

84.60 spinal disc prosthesis, not otherwisespecified

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,lumbosacral

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

42. New Procedure Codes

84.66 Revision or replacement of artificialspinal 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

43. New Procedure Codes

86.94 Insertion or replacement of singlearray neurostimulator pulsegenerator

86.95 dual array neurostimulator pulsegenerator

86.96 other neurostimulator pulsegenerator

DRG 7, 8

Peripheral and Cranial Nerve and other Nervous System Procedure, w/ and w/o CC

44. New Procedure Codes

89.49 Automatic implantable cardioverter/defibrillator (AICD) check

99.78 Aquapheresis

45. 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

46. 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

47. Changes in Grouper Logic Spinal Fusion

Procedure Code 81.61

360 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

48. Changes in Grouper Logic Newborn DRGs

New codes added to major problem list for

• DRG 387 Prematurity with Major Problems

• DRG 389 Full-term Neonate with Major Problems

49. Changes in Grouper Logic Newborn 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

50. Changes in Grouper LogicNewborn 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

51. Changes in Grouper Logic CRT-P Implantation or Replacement

Pacemaker 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

52. Changes in Grouper Logic CRT-P -- DRGs 115 and 116

Pacemaker 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

53. Changes in Grouper Logic Intestinal 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

54. Changes in Grouper LogicPancreatic 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

55. Changes in Grouper Logic Burns 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

56. 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

57. 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

( Italicsindicates text no longer in title)

58. 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

59. 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

60. Questions?

contact:

• Barry Libman, RHIA, CCS, CCS-P

• Barry Libman Inc.

• [email_address] arrylibmaninc.com

• 978-369-7180