ICD-9-Codes and DRG Updates FY 2005
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Transcript of ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
Barry Libman, RHIA, CCS, CCS-P
President, Barry Libman Inc
Federal Register, August 11, 2004Volume 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
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
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
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/o
hepatic coma, CC 070.71 …w/ hepatic coma, CC
Endocrine Disorders
Disorders of Parathyroid Gland 252.00 Hyperparathyroidism, unspecified 252.01 Primary hyperparathyroidism 252.02 Secondary hyperparathyroidism,
non-renal 252.08 Other hyperparathyroidism
Endocrine Disorders
Other Metabolic and Immunity Disorders
273.4Alpha-1-antitrypsin deficiency
277.85 Disorders of fatty acid oxidation 277.86 Peroxisomal disorders 277.87 Disorders of mitochondrial
metabolism
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
Circulatory System
Diseases of Veins and Lymphatics, and Other Diseases of Circulatory System
453.40 Venous embolism and thrombosis of unspecified deep vessels
of lower extremity, CC 453.41 … of deep vessels of proximal
lower extremity, CC 453.42 … of deep vessels of distal lower
extremity, CC
Respiratory System
Other Diseases of the Upper Respiratory Tract 477.2Allergic 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
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
Digestive System
Diseases of Oral Cavity, Salivary Glands, and Jaws (cont.) 524.07 Excessive tuberosity of jaw 524.20 Unspecified anomaly of dental arch
relationship 524.21-23 Angle’s 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 arch
relationship 524.30-37, 39 Anomaly of tooth position
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 the
mandible 524.54 Insufficient anterior guidance 524.55 Centric occlusion maximum
intercuspation discrepancy 524.56 Non-working side interference 524.57 Lack of posterior occlusal support 524.59 Other dentofacial functional
abnormalities
Digestive System
Diseases of Oral Cavity, Salivary Glands, and Jaws (cont.) 524.64 Temporomandibular joint sounds on
opening and/or closing the jaw 524.75 Vertical displacement of alveolus and
teeth 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 ridge
mucosa 528.79 Other disturbances of oral epithelium,
including tongue
Digestive System
Diseases of Esophagus, Stomach and Duodenum
530.86 Infection of esophagostomy, CC 530.87 Mechanical complication of
esophagostomy, CC
Genitourinary System
Nephritis, Nephrotic Syndrome, and Nephrosis 588.81 Secondary hyperparathyroidism
(of renal origin) 588.89 Other specified disorders resulting
from impaired renal function
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/o
mention of uterine prolapse
Genitourinary System
Other Disorders of Female Genital Tract (continued) 618.81 Incompetence or weakening of
pubocervical tissue 618.82 Incompetence or weakening of
rectovaginal 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/o
atypia 621.33 Endometrial hyperplasia w/ atypia
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
Skin and Subcutaneous Tissue
Other Inflammatory Conditions of Skin and Subcutaneous Tissue
692.84 Contact dermatitis and other eczema due to animal (cat)
(dog) dander
Other Diseases of Skin and Subcutaneous Tissue
705.21 Primary focal hyperhidrosis 705.22 Secondary focal hyperhidrosis
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
Congenital Anomalies
758.31 Cri-du-chat syndrome 758.32 Velo-cardio-facial syndrome 758.33 Other microdeletions 758.39 Other autosomal deletions
Symptoms, Signs, and Ill-Defined Conditions 780.58 Sleep related movement disorder
788.38 Overflow incontinence
790.95 Elevated C-reactive protein (CRP)
Symptoms, Signs, and Ill-Defined Conditions 795.03 Papanicolaou smear of cervix w/ low
grade squamous intraepithelial lesion (LGSIL)
795.04 …w/ high grade squamous intraepithelial lesion (HGSIL)
795.05 Cervical high risk human papillomavirus (HPV) DNA test positive
795.08 Nonspecific abnormal papanicolaou smear of cervix, unsatisfactory smear
796.6 Nonspecific abnormal findings on neonatal screening
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
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
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
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
New V Codes
Genetic Susceptibility V84.01 Genetic susceptibility to malignant
neoplasm of breast V84.02 … malignant neoplasm of ovary V84.03 … malignant neoplasm of prostate V84.04 … malignant neoplasm of
endometrium V84.09 … other malignant neoplasm V84.8 … other disease
New Procedure Codes
00.16Pressurized treatment of venous bypass graft [conduit] w/
pharmaceutical substance E2F Decoy (edifoligide) procedure
00.17Infusion of vasopressor agent Intended for use w/ severe sepsis
codes
New Procedure Codes
00.21Intravascular imaging of extracranial cerebral 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)
New Procedure Codes
00.31Computer assisted surgery w/ CT/CTA
00.32… w/ MR/MRA 00.33… w/ fluoroscopy 00.34Imageless computer assisted
surgery 00.35Computer assisted surgery w/
multiple datasets 00.39Other computer assisted surgery
New Procedure Codes
00.61Percutaneous angioplasty or atherectomy of precerebral
(extracranial) vessel(s)
00.62…of intracranial vessel(s)
DRG 533, 534
Extracranial Procedures w/ and w/o CC
New Procedure Codes
00.63Percutaneous insertion of carotid artery stent(s)
00.64… other precerebral (extracranial) artery stent(s)
00.65… intracranial vascular stent(s)
New Procedure Codes
00.91Transplant from live related donor 00.92…live non-related donor 00.93…cadaver
27.64Insertion of palatal implant
New Procedure Codes
37.68 Insertion of percutaneous external heart assist device
DRG 104, 105
Cardiac Valve and Other Major Cardiothoracic Procedure w/ and w/o Cardiac Catheterization
37.90 Insertion of left atrial appendage device
DRG 518
Percutaneous Cardiovascular Procedure w/o Coronary Artery Stent or AMI
New Procedure Codes
Laparoscopic 44.38gastroenterostomy 44.67procedures for creation of
esophagogastric sphincteric competence
44.68gastroplasty
DRG 154, 155, 156Stomach, Esophageal and Duodenal
Procedures, w/ and w/o CC, and age 0-17
New Procedure Codes
Laparoscopic 44.95gastric restrictive procedure 44.96revision of gastric restrictive
procedure 44.97removal of gastric restrictive
device(s) 44.98adjustment of size of adjustable
gastric restrictive device
DRG 288
OR Procedures for Obesity
New Procedure Codes
81.65Vertebroplasty 81.66Kyphoplasty
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
New Procedure Codes
84.53Implantation of internal limb lengthening device w/ kinetic
distraction 84.54Implantation of other internal limb
lengthening device 84.55Insertion of bone void filler
New Procedure Codes
84.59 Insertion of other spinal devices 84.60 … spinal disc prosthesis, not otherwise
specified 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,
lumbosacralDRG 531, 532 Spinal Procedures, w/ and w/o CC
DRG 499, 500 Back and Neck Procedures Except Spinal Fusion, w/ and w/o CC
New Procedure Codes
84.66Revision or replacement of artificial spinal 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
New Procedure Codes
86.94Insertion or replacement of single array neurostimulator pulse
generator 86.95…dual array neurostimulator pulse
generator 86.96…other neurostimulator pulse
generator
DRG 7, 8 Peripheral and Cranial Nerve and other
Nervous System Procedure, w/ and w/o CC
New Procedure Codes
89.49Automatic implantable cardioverter/ defibrillator (AICD) check
99.78Aquapheresis
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
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
Changes in Grouper LogicSpinal FusionProcedure Code 81.61 360º 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
Changes in Grouper LogicNewborn DRGs
New codes added to major problem list for
DRG 387 Prematurity with Major Problems DRG 389 Full-term Neonate with Major
Problems
Changes in Grouper LogicNewborn 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
Changes in Grouper Logic Newborn 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
Changes in Grouper LogicCRT-P Implantation or ReplacementPacemaker 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
Changes in Grouper LogicCRT-P -- DRGs 115 and 116Pacemaker 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
Changes in Grouper LogicIntestinal 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”
Changes in Grouper Logic Pancreatic 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
Changes in Grouper LogicBurns 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
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
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
(Italics indicates text no longer in title)
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”
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