Updating Superbills for the New Year

Coding Corner - Updating Superbills for the New Year

Summer is ending and fall is just around the corner. Kids are going back to school, football season has begun, and for coders, it is the time of year when the first set of major encounter form revisions takes place. Form updates and revisions are an important part in maintaining the accuracy and correct coding of claims. The more up-to-date and relevant your encounter forms are, the less risk you will have for denials and decreased reimbursement.

Those tasked with the responsibility of revising or creating new encounter forms must review any code changes to see if they affect their practice. In addition, employees must navigate major holiday and vacation schedules by physicians and staff in order to generate viable encounter forms by the October and January implementation dates.

In short, life is busy and there is much to do over the next three months to prepare for the new year.

Code Changes

This year’s diagnosis changes include 122 new, 11 deleted and 10 revised codes (Continue reading below for more information on diagnosis code updates). In addition, several new immunizations became active as of July 1, 2010. The new immunizations include:

• 90664 – Influenza Virus Vaccine, pandemic formulation, live, intransal
• 90666 – Influenza Virus Vaccine, pandemic formulation, split virus, preservative free,                  intramuscular
• 90667 – Influenza Virus Vaccine, pandemic formulation, split virus, adjuvanted,                          intramuscular
• 90668 – Influenza Virus Vaccine, pandemic formulation, split virus, intramuscular

Note: CPT® 90654 (Influenza Virus Vaccine, split virus, preservative free, intradermal use) is also a new code, but its implementation date is not until January 1, 2011.

Flu and Pneumonia Shot Clinics

During the fall, it is very common for medical practices to hold a flu clinic for their patients. If you have many patients that schedule a visit for flu or pneumonia shots alone, it might be valuable to create an encounter form just for flu and pneumonia shots. Often, a flu shot form can be created in a relatively short amount of time and at a lower cost than standard encounter forms.

New Diagnosis Codes Related to Transfusions

Hemolytic Transfusion Reaction (999.60-999.6, 999.70-999.80, and 999.83-999.85) 

This year, the diagnoses related to a hemolytic transfusion reaction (due to either ABO/non-ABO or Rh/non-Rh Incompatibility) have been expanded. Hemolytic Transfusion Reactions (HTRs) are defined based on the timing of the reaction. Patients can suffer from a(n):                 

1. Acute Hemolytic Transfusion Reaction (AHTR) – Occurs within 24 hours of a transfusion
2. Delayed Hemolytic Transfusion Reaction (DHTR) – Occurs between 24 hours and 28 days of a transfusion 

These conditions were previously reported as 999.6, ABO incompatibility reaction, or as 999.7, Rh incompatibility reaction. Codes 999.6 and 999.7 will no longer be valid as of October 1, 2010. 

Hemochromatosis (275.01 thru 275.09)

Hemochromatosis is an iron metabolic disorder, and the new codes establish why the iron is not metabolizing. Hemochromatosis may be hereditary, due to a repeated red blood cell transfusion, or caused by other iron metabolic disorders. These conditions were previously reported as 275.0, disorders of iron metabolism. Code 275.0 has been deleted. 

Other Transfusion-Related Diagnoses (Fluid Overload and Secondary Thrombocytopenia)

Code 276.6, fluid overload, has been deleted this year. Providers must now distinguish between fluid overload caused by a transfusion of blood or blood components, and a fluid overload caused by other reasons. The new diagnosis codes are as follows:

• 276.61, Transfusion Associated Circulatory Disorder (TACO) - Occurs during or within 6 hours of a transfusion
• 276.69, Other fluid overload 

Code 287.4, secondary thrombocytopenia, has been deleted this year. Posttransfusion purpura (PTP), a condition characterized by a sudden severe thrombocytopenia (platelet count < 10,000), can occur 5 to 12 days after a transfusion. For secondary thrombocytopenia that develops as a result of a transfusion, report code 287.41, posttransfusion purpura. For secondary thrombocytopenia that develops for reasons other than a transfusion, report code 287.49, other secondary thrombocytopenia. 

Nonhemolytic Transfusion Reaction

Patients can develop a post transfusion fever when passively transfused cytokines react with recipient antibodies and transfused leukocytes. In this situation, there is no destruction of red blood cells, but the patient experiences fever and chills within 4 hours of the transfusion. To report this condition, use code 780.66, febrile nonhemolytic transfusion reaction (FNHTR). 

New Neoplasm Diagnosis Codes

The American Medical Association (AMA) added two new diagnosis codes to document neurofibromatosis (NF), a genetic disorder that causes tumors to grow primarily on nerve tissues, as well as, on bone and skin. There are now three specific types of neurofibromatosis: 

1.  von Recklinghausen’s Disease (237.71) – The most common type of NF

2.  Acoustic (237.72) - Patients lose hearing

3. *New Schwannomatosis (237.73) - Patients have multiple Schwannoma-type tumors on the cranial, spinal and peripheral nerves, but do not lose hearing 

Note: If the patient is diagnosed with NF, but it is not specific to these three types, use 237.79, Other Neurofibromatosis.

Body Mass Index

The diagnosis codes for reporting Body Mass Index (BMI) have been

expanded, and code V85.4, body mass index 40.0 and over, was deleted.

Providers now have the ability to document a BMI that is greater than 40.0. The new

BMI codes include the following: 

• V85.41 – Body Mass Index 40.0-44.9, adult
• V85.42 – Body Mass Index 45.0-49.9, adult
• V85.43 – Body Mass Index 50.0-59.9, adult
• V85.44 – Body Mass Index 60.0-69.9, adult
• V85.45 – Body Mass Index 70 and over, adult

Aortic Ectasia

Four new diagnosis codes were created to describe aortic ectasia (the swelling and weakening

of the wall of the aorta). Providers must select the appropriate diagnosis code based on where the swelling or weakening of the aortic wall has occurred: unspecified (447.70), thoracic (447.71), abdominal (447.72), or thoracoabdominal (447.73). 

Previously, the only diagnosis providers had to document these conditions was code 441.9, aortic aneurysm, unspecified. Unfortunately, these conditions are not really aneurysms, but conditions that may lead to an aneurysm over time. As of October 1, code 441.9 should only be used for documented aneurysms, not potential aneurysms. 

Digestive System

A new diagnosis code, 560.32, Fecal Impaction, was created to document patients that require manual or surgical intervention due to fecal impaction. Previously, this condition would have been reported as 560.39, other impaction of intestine. 

Code 787.6, incontinent feces, was deleted for this year, and replaced with the following four diagnosis codes: 

• 787.60 – Full incontinence of feces
• 787.61 – Incomplete defecation
• 787.62 – Fecal smearing
• 787.63 – Fecal urgency 

OB/GYN

Several new codes have been added that are related to obstetrics and gynecological services (OB/GYN). See the 2011 ICD-9-CM manual for additional information on the following additions: 

• Congenital Anomalies of the Uterus (752.31 thru 752.39)
• Congenital Anomalies of Genital Organs (752.43 thru 752.47)
• Personal History of Vaginal or Vulvar Disease (V13.23 or V13.24)
• Intrauterine Contraceptive Device Management (V25.11 thru V25.13)
• Multiple Gestation Placenta Status (V91.00 thru V91.99) 

Neurology

Seven new Symptoms, Signs and Ill-Defined Conditions diagnoses were added in order to describe cognitive deficits in patients who have suffered a traumatic brain injury (TBI). The new codes include the following:

• 799.50 – Unspecified signs and symptoms involving cognition
• 799.51 – Attention or concentration deficit
• 799.52 – Cognitive communication deficit
• 799.53 – Visuospatial deficit
• 799.54 – Psychomotor deficit
• 799.55 – Frontal lobe and executive function deficit
• 799.59 – Other signs and symptoms involving cognition 

Personal History

Eight new personal history codes (V13.62 thru V13.69) were added this year to document corrected congenital conditions (See the ICD-9 manual for more detailed definitions). These codes ought to be used in addition to the diagnosis for the condition itself. For example, a child with a surgically repaired cleft would be documented as 749.00, cleft palate, and V13.64,

personal history of corrected congenital malformations of eye, ear, face and neck. 

Foreign Body

Several new codes were added this year in regards to foreign bodies. Providers must distinguish between foreign bodies that have been fully removed, as opposed to foreign bodies that remain in the body. With retained foreign bodies, code selection is based on the type of foreign body present. The new codes are listed as: personal history of retained foreign body fully removed (V15.53), and retained foreign body status (V90.01 thru V90.89). 

Miscellaneous

Several other diagnosis code changes were included in this year’s updates, but they do not fit into any of the previously mentioned groups. A brief description of these additional codes is listed below: 

• 278.03 – Obesity hypoventilation syndrome
• 724.02 – Spinal stenosis, lumbar region, without neurogenic claudication (Providers                    must specify with/without claudication)
• 724.03 – Spinal stenosis, lumbar region, with neurogenic claudication (Providers must                 specify with/without claudication)
• 780.33 – Post traumatic seizures
• 784.92 – Jaw pain (Previously reported as 526.9, unspecified disease of jaws)
• 970.81 – Poisoning by cocaine
• 970.89 – Poisoning by other central nervous system stimulants
• E000.2 – Volunteer activity
• V11.4   – Personal history of combat and operational stress reaction
• V49.86 – Do not resuscitate status
• V49.87 – Physical restraints status
• V62.85 – Homicidal Ideation
• V88.11 – Acquired total absence of pancreas (Previously reported as V45.79, other                     acquired absence of organ)
• V88.12 – Acquired partial absence of pancreas (Previously reported as V45.79, other acquired absence of organ) 

Coding Books

As responsible coders, it is always a good idea to purchase new ICD-9, CPT® and HCPCS manuals every year. Coding manuals can be purchased easily from a variety of sources, such as the AAPC or AHIMA websites. Furthermore, if you are planning to take a certification class this year, you will need updated manuals for any test that you take (Note: Make sure any books you purchase are approved by the testing organization). 

Resources

AMA CPT® Category I Vaccine Codes Update June 21, 2010

http://www.ama-assn.org/ama1/pub/upload/mm/362/vaccine-codes.pdf

Medicare Annual Update of ICD-9-CM

http://www.cms.gov/transmittals/downloads/R1996CP.pdf

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