If you’re like most family physicians, you’re probably interested in reducing the number of your claims that are rejected or denied, and using the right diagnosis codes certainly helps. Here are highlights of the ICD-9 code changes that took effect Oct. 1. A complete list of the changes is available at www.aafp.org/fpm/icd9.html.

Circulatory problems

For patients with hypertensive heart disease and heart failure, ICD-9 now advises that you code hypertensive heart disease as the primary diagnosis (using a code in the 402 or 404 series) and use an additional code to specify the type of heart failure (i.e., a code in the 428 series).

Also under the category of heart failure, ICD-9 has revised the descriptor for 428.0 to read, “Congestive heart failure, unspecified.” This code should not be used to describe fluid overload not otherwise specified (NOS) (i.e., 276.6). And, there are three new subcategories of heart failure:

• 428.2 Systolic heart failure,

• 428.3 Diastolic heart failure,

• 428.4 Combined systolic and diastolic heart failure.

Each of the codes in these new subcategories will require one of the following fifth digits: 0 Unspecified; 1 Acute; 2 Chronic; 3 Acute on chronic.

There are also new codes under the 438 series, which concerns late effects of cerebrovascular disease, e.g., 438.6, “Alterations of sensations,” and 438.7, “Disturbances of vision.” You will need to use an additional code to identify the altered sensation or visual disturbance. Also, under 438.8, “Other late effects of cerebrovascular disease,” three new codes describe facial weakness (438.83), ataxia (438.84) and vertigo (438.85).

A new code, 454.8, “Varicose veins of the lower extremities with other complications” (e.g., edema, pain or swelling), has been added, and 454.9 has been revised to read, “Asymptomatic varicose veins,” which will include varicose veins NOS.

Finally, there is a new subcategory, 459.3, for “Chronic venous hypertension (idiopathic)” that includes the following five new codes:

• 459.30 Chronic venous hypertension without complications,

• 459.31 Chronic venous hypertension with ulcer,

• 459.32 Chronic venous hypertension with inflammation,

• 459.33 Chronic venous hypertension with ulcer and inflammation,

• 459.39 Chronic venous hypertension with other complication.

Maternity care

A fifth digit will now be required with each of the ectopic pregnancy codes (633.0–633.9). Specifically, a fifth digit of “0” will denote “without intrauterine pregnancy,” while a fifth digit of “1” will denote “with intrauterine pregnancy.”

Also, there is a new subcategory, 765.2, “Weeks of gestation,” under category 765, “Disorders relating to short gestation and unspecified low birthweight.” The new codes in this subcategory include the following:

• 765.20 Unspecified weeks of gestation,

• 765.21 Less than 24 completed weeks of gestation,

• 765.22 24 completed weeks of gestation,

• 765.23 25–26 completed weeks of gestation,

• 765.24 27–28 completed weeks of gestation,

• 765.25 29–30 completed weeks of gestation,

• 765.26 31–32 completed weeks of gestation,

• 765.27 33–34 completed weeks of gestation,

• 765.28 35–36 completed weeks of gestation,

• 765.29 37 or more completed weeks of gestation.

The codes for other respiratory problems after birth (770.8), other infections specific to the perinatal period (771.8), and other specified conditions originating in the perinatal period (779.8) have been made more specific:

• 770.81 Primary apnea of newborn,

• 770.82 Other apnea of newborn,

• 770.83 Cyanotic attacks of newborn,

• 770.84 Respiratory failure of newborn,

• 770.89 Other respiratory problems after birth,

• 771.81 Septicemia [sepsis] of newborn,

• 771.82 Urinary tract infection of newborn,

• 771.83 Bacteremia of newborn,

• 771.89 Other infections specific to the perinatal period,

• 779.81 Neonatal bradycardia,

• 779.82 Neonatal tachycardia,

• 779.89 Other specified conditions originating in the perinatal period.

Also note that under the category of personal history of other diseases (V13), several new codes relate to maternity care, including the following:

• V13.21 Personal history of pre-term labor [which excludes current pregnancy with history of pre-term labor (V23.41)],

• V23.41 Pregnancy with history of pre-term labor,

• V23.49 Pregnancy with other poor obstetric history.

Signs and symptoms

The code for other general symptoms (780.9) has been subdivided into three new codes:

• 780.91 Fussy infant (baby),

• 780.92 Excessive crying of infant (baby),

• 780.99 Other general symptoms.

Similarly, the code for nonspecific abnormal Pap smear of cervix (795.0) has been subdivided into four new codes:

• 795.00 Nonspecific abnormal Pap smear of cervix, unspecified,

• 795.01 Atypical squamous cell changes of undetermined significance favor benign (ASCUS favor benign),

• 795.02 Atypical squamous cell changes of undetermined significance favor dysplasia (ASCUS favor dysplasia),

• 795.09 Other nonspecific abnormal Pap smear of cervix.

V codes

There are a significant number of new V codes for various types of aftercare. For instance, there are new subcategories for aftercare for healing traumatic fracture (V54.1), aftercare for healing pathologic fracture (V54.2), and aftercare following surgery to specified body systems, not elsewhere classified (V58.7). For aftercare for a healing fracture NOS, you will need to use the new code V54.89, “Other orthopedic after-care.” Note that there is also a new code, V54.81, for aftercare following joint replacement; with this code, you will need to use an additional code (i.e., V43.60–V43.69) to identify the joint replacement site. There are also new codes for aftercare following surgery for neoplasm (V58.42) and aftercare following surgery for injury and trauma (V58.43).

There is also a new code, V46.2, for “Other dependence on machines, supplemental oxygen,” which includes long-term oxygen therapy.

Other codes

Among the other new codes of potential interest, there is one for “Fall from (nonmotorized) scooter” (E885.0), which you can use as a supplementary code when treating injuries resulting from such falls.

There is also a new code, 040.82, for “Toxic shock syndrome.” You will need to use an additional code to identify the organism causing the toxic shock.

A new code, 066.4, for West Nile fever has been created. This includes West Nile encephalitis, West Nile encephalomyelitis and West Nile virus. Previously, viral West Nile fever had been coded using 066.3.

Finally, in a nod to recent events, there is a new code, 795.31, for “Nonspecific positive findings for anthrax,” which includes positive findings by nasal swab. There are also new codes for contact with or exposure to anthrax (V01.81), observation and evaluation for suspected exposure to anthrax (V71.82) and observation and evaluation for suspected exposure to other biological agent (V71.83).

Sadly, the events of Sept. 11 have even affected diagnosis coding. There is a whole new category of E-codes labeled “Terrorism” (E979). This category includes E979.1, “Terrorism involving destruction of aircraft,” which lists “Aircraft used as a weapon” under it, and E979.6, “Terrorism involving biological weapons (e.g., anthrax and smallpox).”

As always, these represent just some of the changes in ICD-9. Be sure to consult your new ICD-9 manual for all the changes that may be relevant to your practice.