ICD-9 Medical Coding Update: Choose your Hyperplasia Codes Wisely


There are end numbers of ICD-9 codes and rules changes every year. Some of these changes could really affect your reimbursement. Let us talk about such few changes in this expert medical coding and billing article.  The first changes were the addition of two new codes for hyperplasia. We have a new code for benign endometrial hyperplasia. And this is usually the code that's going to be used when the patient is taking unopposed estrogen.

It's considered a benign condition not a malignant condition. But it may show up as a problem on an ultrasound or on a biopsy. The second condition is endometrial intraepithelial neoplasia or EIN. This is new wording. In other words, we used to talk about dysplasia and hyperplasia as being mild or moderate or severe. Then we went to wording such as atypical or complex and simple.

And none of those terminologies are very accurate when it comes to triaging these patients when they're trying to decide what kind of treatments they should be having. So in recent years, physicians and pathologists began to distinguish the difference between hormonal effects and pre-cancerous lesions which would be an EIN.

And so, therefore, we do have this new coding and compliance information in ICD-9. They kept the old ICD-9 codes for hyperplasia because there is still physicians out there of course who've been practicing a long time who are going to still be using the older terminology. But the hope is that within the next ten years, those older codes will be totally removed from the book.

Also, there is a note in ICD-9 that instructs you that if the patient is in fact given a diagnosis of cancer and also has a diagnosis of EIN in some other place, some other part of the uterus as part of the pathology report, you only code the cancer code because that is the most specific diagnosis.

We also have a new code for inconclusive mammogram. And the reason this one was added is because a lot of payers won't pay for an additional mammogram or even for their testing if you don’t have a real diagnosis. And the problem is that when a patient has a condition termed a dense breast, that really is not considered an abnormal condition, it's a finding which could mean that you would have to do further testing to eliminate a malignant condition.

But the diagnosis of dense breast by itself is not actually a disease process. So they added a new code to make that a distinction between them. And then they changed the title for the 793 code category to read instead of just nonspecific abnormal findings, it's more general to nonspecific findings. So some abnormal and some just simply nonspecific will now appear under that 793 category heading.

Then they added some new ICD-9 codes for fertility preservation prior to (anti-neoplastic) therapy. Now, that would be cancer therapy of course.

AS per the ICD-9 medical coding guidelines, we have one code, V26.42 which is an encounter for fertility preservation counseling. In other words, you're talking to the patient about what might occur and what treatments might be recommended in order to preserve her fertility before they start the therapy.

And then we have a V26.82 which is an encounter for fertility preservation procedure. Now, the procedure, generally speaking, could be something like an ovarian transposition where they go in and remove the ovaries outside of the and away from the area of cancer treatment or radiation to protect those ovaries so that the woman can remain fertile.

And so that would be the code that you would use because you're not actually doing it for treatment of cancer. You're doing it for the preservation.

We have some new codes for laboratory exams. Now, these are lab codes that you would report for nondiagnostic reasons. In other words, the patient is coming in for a pre-procedural lab exam. She's having surgery done. And there's a battery of routine tests that are being done in addition because of the surgery. So V72.63 would be the code that you would use.

If the patient is coming in for her routine general exam, her annual well woman exam and a battery of laboratory tests that are routine are ordered for the patient, you could now add V72.62 to indicate that as why you have been using it for that reason. And then of course they’ve added one for anybody response exam and then just any other lab examination that you might be done. So these might come in handy as an explanation as to why some of these are being done.

We also have some personal history codes that were added for estrogen therapy, inhaled steroid therapy. In that case, it might be the patient who's on one of the inhalers for her asthma, for instance, that has a steroid in it. That would be a reason for using this code.

Systemic steroid therapy, of course the patient who's actually taking some kind of prednisone for some other kind of steroid and then a history of immunosuppressive therapy. So that would be a reason for seeing the patient and follow-up. So particularly, for the estrogen therapy, these might be good codes for you to think about for the E/M service.

Then we have some ICD-9 medical coding changes to the OB codes. We have some new codes for puerperal infections. We used to only have one 670.0 which was any puerperal infection. And now, your physician is going to have to give you more information. We need to know whether it's endometritis, whether it's sepsis, whether it's a septic tromboflebitis and/or some other major infection. So again, we're getting much more specific with our ICD-9 medical coding and billing.

There was also a change to the notes after the venous complications of pregnancy that when you bill for this condition, you need to add a secondary code that talks about the thrombus that the patient actually has. And then also if she is on long-term anti-coagulant therapy, then you also need to add a V26.81 code to indicate this. So more information again is being required in order to report just that single code.

We also had some miscellaneous stuff added. Of course the swine flu is a biggie this year. And we now have a new code for 88.1. This code is used when the patient has tested positive for influenza. This is not the code you would use for a patient who's receiving the swine flu virus vaccine.

We have an additional code 995.24 for failed moderate sedation during a procedure. This is a complication code of course and something may have to be done with the patient because of this.

We have some personal history codes for that failed moderate sedation and a non-specified type of neoplasm. For instance, if the patient just comes in to the office and says, “Well, I had cancer two years ago. But I don’t remember what kind of it was” you would use this code.

V61.07 is disruption due to a death in the family member. And then 0.08 is the extended absence of a family member as we all are quite aware with the ongoing problems and troops being elsewhere in the world. This is becoming an ever increasing issue for physicians who are counseling patients who are having these difficulties. So now we do have codes for this owing to the medical coding updates. And then there's a V61.42 code for substance abuse in the family should that be an issue.

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