By Melanie Endicott, MBA/HCM, RHIA, CCS, CCS-P
The new ICD-9-CM diagnosis codes go into effect October 1, 2011. This date marks the last regular annual update to the ICD-9-CM code set before the partial code freeze. On October 1, 2012, there will be only limited code updates to ICD-9-CM to capture new technology and new diseases. There will be no updates to ICD-9-CM on October 1, 2013, since ICD-10-CM/PCS will go into effect on that date.
The complete October 1, 2011, addenda with the changes to the ICD-9-CM tabular list and alphabetic index (volumes 1 and 2) are located on the National Center for Health Statistics Web site at www.cdc.gov/nchs/icd.htm. New, deleted, and revised ICD-9-CM diagnosis codes are available in summary tables at www.cms.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp [no longer available at this link]. The files include codes and their associated descriptions.
Shiga Toxin-Producing E. Coli (STEC)
Shiga toxin-producing E. coli is a type of enterohemorrhagic E. coli bacteria that can cause illness ranging from mild intestinal disease to severe kidney complication. Subcategory 041.4, Escherichia coli, was expanded to the fifth-digit level to identify Shiga toxin-producing E. coli (O157 041.41), other specified Shiga toxin-producing E. coli (041.42), Shiga toxin-producing E. coli, unspecified (041.43), and other and unspecified E. coli (041.49).
All of the subcategories under category 173, Other and unspecified malignant neoplasm of skin, were expanded to the fifth-digit level to classify basal cell carcinoma, squamous cell carcinoma, and other specified and unspecified malignant neoplasms.
Subcategory 282.4, Thalassemias, was further expanded to include thalassemia, unspecified (282.40), alpha thalassemia (282.43), beta thalassemia (282.44), delta-beta thalassemia (282.45), thalassemia minor (282.46), and hemoglobin E-beta thalassemia (282.47).
The pancytopenia subcategory was expanded to the fifth-digit level to include antineoplastic chemotherapy-induced pancytopenia (284.11), other drug-induced pancytopenia (284.12), and other pancytopenia (284.19).
Three new codes describing hemorrhagic disorders were also added, including acquired hemophilia (286.52), antiphospholipid antibody with hemorrhagic disorder (286.53), and other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors (286.59).
Mental, Behavioral, and Neurodevelopment Disorders
The title of chapter 5 was revised to "Mental, Behavioral and Neurodevelopmental Disorders." In addition, the section title for categories 317–319 was revised from "Mental Retardation" to "Intellectual Disabilities."
A new subcategory has been created to describe dementia, unspecified (294.2). This subcategory is further expanded to the fifth-digit level to describe with and without behavioral disturbance (294.21, 294.20).
A new code was added for pseudobulbar affect (310.81), which could also be described as an involuntary emotional depressive disorder. A "code first" note follows this code to indicate that the underlying condition, such as amyotrophic lateral sclerosis or late effect of CVA, should be coded first.
A code was added to describe other specified nonpsychotic mental disorders following organic brain damage (310.89). Conditions classified to this code might include mild memory disturbance or postencephalitic syndrome.
Nervous System Disorders
New codes were added for corticobasal degeneration (331.6) and brain death (348.82). A new subcategory also was added for Lambert-Eaton syndrome, which was further subdivided into unspecified (358.30), in neoplastic disease (358.31), and in other diseases classified elsewhere (358.39).
Glaucoma and Other Eye Disorders
Several new codes were added to further describe glaucoma. The borderline glaucoma subcategory was expanded to describe open angle with borderline findings, high-risk (365.05), and primary angle closure without glaucoma damage (365.06).
A new subcategory was added to describe the stage of glaucoma (365.7), which can be classified as mild (365.71), moderate (365.72), severe (365.73), indeterminate (365.74), and unspecified (365.70). These glaucoma stage codes would be assigned in addition to the code for the specific type of glaucoma.
An additional code was added to describe vitreomacular adhesion (379.27).
A new code was added to describe coronary atherosclerosis due to calcified coronary lesion (414.4). This code would be assigned in addition to the code for the specific type of coronary atherosclerosis.
New codes were added to report saddle emboli of the pulmonary artery and abdominal aorta (415.13, 444.01). An additional code was added to classify other arterial embolism and thrombosis of abdominal aorta (444.09).
Two new codes were added to describe hypertrophic cardiomyopathy: 425.11, Hypertrophic obstructive cardiomyopathy, and 425.18, Other hypertrophic cardiomyopathy.
Several new codes were added to describe respiratory disorders. A new subcategory was added for novel Influenza A virus, with fifth-digits describing with pneumonia (488.81), with other respiratory manifestations (488.82), and with other manifestations (488.89).
New codes were added for respiratory conditions due to smoke inhalation (508.2) and postoperative air leak (512.2).
Subcategory 512.8, Other pneumothorax and air leak, was expanded to the fifth-digit level to describe the following:
- Primary spontaneous pneumothorax (512.81)
- Secondary spontaneous pneumothorax (512.82)
- Chronic pneumothorax (512.83)
- Other air leak (512.84)
- Other pneumothorax (512.89)
Numerous codes were added to category 516, Other alveolar and parietoalveolar pneumopathy, to describe interstitial pneumonia (516.30–516.37), lymphangioleiomyomatosis (516.4), adult pulmonary Langerhans cell histiocytosis (516.5), and interstitial lung disorders of childhood (516.61–516.69).
Three new codes have been added to classify acute respiratory failure following trauma and surgery (518.51), other pulmonary insufficiency, NEC, following trauma and surgery (518.52), and acute and chronic respiratory failure following trauma and surgery (518.53).
A new category was added for complications of bariatric procedures (539). The subcategories include 539.0, Complications of gastric band procedure, and 539.8, Complications of other bariatric procedure. These two subcategories are further subdivided to the fifth-digit level to describe the type of complication (i.e., infection or other complications). These codes require additional codes to specify the type of infection (e.g., cellulitis or septicemia), causative organism, or specific complication.
A new code was added for hepatopulmonary syndrome (573.5). When code 573.5 is assigned, the underlying condition should be coded first, such as alcoholic cirrhosis of the liver.
Genitourinary and Pregnancy Disorders
Subcategory 596.8, Other specified disorders of bladder, was expanded to include infection of cystostomy (596.81), mechanical complication of cystostomy (596.82), other complication of cystostomy (596.83), and other specified disorders of bladder (596.89).
Complications of implanted vaginal mesh and other prosthetic materials are classified to subcategory 629.3, which is further subdivided to:
- 629.31, Erosion of implanted vaginal mesh and other prosthetic materials to surrounding organ or tissue
- 629.32, Erosion of implanted vaginal mesh and other prosthetic materials into vagina
Two new subcategories were added to category 631, Other abnormal product of conception, to describe inappropriate change in quantitative hCG in early pregnancy (631.0) and other abnormal products of conception (631.8).
Subcategory 649.8, Onset (spontaneous) of labor after 37 completed weeks of gestation but before 39 weeks gestation, with delivery by (planned) Cesarean section, was also added.
Skin and Musculoskeletal Disorders
New codes were added for pilar cyst (704.41), trichilemmal cyst (704.42), and partial tear of rotator cuff (726.13).
Pulmonary Artery Anomalies
Three new codes were added to describe pulmonary artery anomalies:
- 747.31, Pulmonary artery coarctation and atresia
- 747.32, Pulmonary arteriovenous malformation
- 747.39, Other anomalies of pulmonary artery and pulmonary circulation
Other and Nonspecific (Abnormal) Findings
Code 793.11 was added to describe a solitary pulmonary nodule found on radiological and other examinations. A code for other nonspecific abnormal findings of lung field (793.19) was also added.
Subcategory 795.5, Nonspecific reaction to test for tuberculosis, was expanded to include codes for nonspecific reaction to tuberculin skin test without active tuberculosis (795.51) and nonspecific reaction to cell mediated immunity measurement of gamma interferon antigen response without active tuberculosis (795.52).
New codes were added to describe multiple closed pelvic fractures without disruption of pelvic circle (808.44) and multiple open pelvic fractures without disruption of pelvic circle (808.54).
Complications, Infections, and Reactions
New codes were added to describe various complications, including stem cell transplant complications (996.88), postprocedural aspiration pneumonia (997.32), retained cholelithiasis following cholecystectomy (997.41), other digestive complications (997.49), and postoperative shock (998.00–998.09).
Several new codes were added to category 999, Complications of medical care, NEC, to describe bloodstream infection due to central venous catheter (999.32), local infection due to central venous catheter (999.33), acute infection following transfusion, infusion, or injection of blood and blood products (999.34), and anaphylactic and other serum reactions due to blood and blood products, vaccinations, and other serums (999.41–999.59).
New V Codes
Several new V codes were added to describe personal history of gestational diabetes (V12.21); other endocrine, metabolic, and immunity disorders (V12.29); pulmonary embolism (V12.55); anaphylaxis (V13.81); and other specified diseases (V13.89).
V19.11 was added for family history of glaucoma and V19.19 for family history of other specified eye disorder.
Pregnancy with history of ectopic pregnancy has a new code of V23.42; and code V23.87 describes pregnancy with inconclusive fetal viability.
Two codes were added to subcategory V40.3, Other behavioral problems, to describe wandering in diseases classified elsewhere (V40.31) and other specified behavioral problem (V40.39).
Code V54.82 was added for aftercare following explantation of joint prosthesis.
A new code was added for long-term (current) use of biophosphonates (V58.68).
Code V87.02 describes contact with and (suspected) exposure to uranium.
A new subcategory was added to describe acquired absence of joint (V88.2), which was further expanded to the fifth-digit level to describe the specific joint-hip (V88.21), knee (V88.22), and other joint (V88.29).
More Updates Online
A separate article highlighting the FY 2012 ICD-9-CM procedure codes
is available on the Journal of AHIMA Web site, http://journal.ahima.org.
Melanie Endicott (email@example.com) is a professional practice manager at AHIMA.
"New ICD-9-CM Diagnosis Codes for FY 2012"
Journal of AHIMA