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

ICD-9-Codes and DRG Updates FY 2005

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  • 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