Diagnosis codes have transitioned through many stages to this point. Since 1988 with the passage of the Medicare Catastrophic Coverage Act, physicians have been required by law to submit diagnosis codes for every Medicare reimbursable service and procedure.

Deleted Codes

There are 29 currently utilized codes that have been deleted effective October 1, 2006.

A sampling of these codes include code 277.3 for Constitutional aplastic anemia, code 323.0 for Encephalitis in viral diseases classified elsewhere, code 478.1 for Other diseases of nasal cavity and sinuses, 523.0 for Acute gingivitis, code 523.3 for Chronic gingivitis, code 608.2 for Torsion of the testis, code 793.9, for Other nonspecific

abnormal findings on radiological and other examinations of body structure, code 995.2, for Unspecified adverse effect of drug, medicinal and biological substance, code V18.5 for Family history, digestive disorders, code V58.3 for Attention to surgical dressings and sutures, and code V72.1 for Examination of ears and hearing.

New Diagnosis Codes

There are 211 new diagnosis codes that will become effective as of October 1, 2006. A sampling of these codes are code 331.83 for Mild cognitive impairment, code 333.94 for Restless legs syndrome, code 389.16 for Sensorineural hearing loss, asymmetrical, code 478.11 for Nasal mucositis (ulcerative), code 521.81 for a Cracked tooth, code 616.89 for Other inflammatory disease of cervix, vagina and vulva, code 780.97 for Altered mental status, code 784.91 for Postnasal drip, code 788.64 for Urinary hesitancy, code 795.06 for Papanicolaou smear of cervix with cytologic evidence of malignancy, code 795.81 for Elevated carcinoembryonic antigen, code 995.27 for Other drug allergy, code V18.59 for Family hx, digestive disorders code V45.86for Bariatric surgery status, code V58.30 for Encounter for change or removal of non-surgical wound dressing, code V58.31 for Encounter for change or removal of surgical wound dressing, and code V58.32 for Encounter for removal of sutures.

Some new codes for pain management include code 338.0 for Central pain syndrome, code 338.11 for Acute pain due to trauma, code 338.19 for Other acute pain, code 338.28 for Other chronic postoperative pain, code 780.96 for Generalized pain and code 338.29 for Other chronic pain.

Revised Codes

There are 55 revised codes that will become effective October 1, 2006. Of these 55 codes, 18 involve changes to the hypertension codes. There are six codes related to Epilepsy, ten codes related to ENT, nine related to the genitourinary system, and the remaining codes entail various other systems.

Three of the ENT codes that have been revised are 389.11 for Sensory hearing loss, unilateral, code 389.12 for Neural hearing loss, bilateral, and code 389.14 Central hearing loss, bilateral. An example of one of the hypertensive codes is code 403.00 for Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage I through stag IV, or unspecified, and two of the nine genitourinary codes is code 600.01 for Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract (LUTS) and 790.93 for Elevated prostate specific antigen.

Other revised diagnosis codes include code 780.31 for Febrile convulsions (simple), unspecified, code 780.95 for Excessive crying of child, adolescent, or adult, code 995.91 for Sepsis, and code 995.92 for Sepsis, severe.

It is important to review the codes related to your specialty and then to make the appropriate changes to your patient encounter form and diagnosis master file in your computer. A joint effort between the coder and the physician is essential to assure correct code assignment and diagnosis reporting. Diagnosis coding accuracy is essential for physicians and hospitals to receive proper reimbursement. In a nutshell, it affects the bottom line. We will be making these changes twice a year to our diagnosis codes until the impending ICD-10.

ICD-10

The ICD-9 is obsolete and cannot meet the necessary requirements of health care today. Yet, we continue to promote its use in this country. We all understand that the adoption of this new system will impact all of us in health care in a big way.

The new coding system will have an entirely different appearance, as the format of the current codes will change. All diagnosis codes for ICD-10 will be in alphanumeric format, for example gastroenteritis will be reported using code K52.0. Essential hypertension becomes I10, which is confusing using the letter "I" and the number "1" together. Abnormal blood pressure reading, without the diagnosis of hypertension becomes R03.0. The number of diagnosis codes will double, allowing for more specific diagnosis coding. There will be the addition of a sixth digit to certain codes. There is a restructuring of chapters with the addition of laterality.

Those who are forward looking will have an easier transition into the new system. The following recommendations should be considered. The first of these recommendations is to start now. Although it is anticipated that these new codes will be implemented in January of 2008, some expect to see them in October of 2007. Appoint someone in your office to spearhead this transition, purchase one of the many books on understanding the ICD-10 coding system and begin reading. Individuals may also use the Internet at to gain information.

The next recommendation is to develop a plan for implementation. There is no crosswalk from ICD-9 to ICD-10. Develop a written plan on how the practice is going to proceed with this transition. Include timelines, tasks to be performed and individuals that will be responsible for those tasks. Prepare a listing of the diagnosis codes currently utilized by the practice. This can be accomplished by generating a report from the computer which identifies the ICD-9 codes in order of the most commonly used code being first. The ICD-10 codes can be obtained either from the purchase of a book, or from the Internet site listed previously. These ICD-10 codes can then be compared to the ICD-9 descriptions listed on the computer generated report. Contact your computer company to arrange a meeting to discuss the changes that will be necessary on the computer side.

Through this entire process, there should be continual meetings with physicians or one physician representative for the group. Physicians need to be aware that documentation is critical in ICD-10.

So what will all this cost? There will be training costs for the physicians and their personnel, the cost of lost productivity during the implementation and training phase, and the cost of all computer system changes and upgrades. We are told that this will provide a future benefit of more accurate payments for services and procedures and fewer rejected claims.