S e c t i o n s

MPM Publications

To: All Physicians
From: Bridget Ash, CPC
Date: September 13, 2004
Re: ICD-9-CM changes for 2005
Cc: Office Managers, Coders

Effective with Dates of service October 1, 2004 through September 30, 2005, we have a lot of changes with our ICD-9-CM codes. This year we have 171 new diagnosis codes to use.

One of the changes I would like to highlight effects the way we assign a diagnosis code to decubitus ulcers. Regardless of the different names that may be used, decubitus ulcers, pressure ulcers or bed sores, we can no longer use the generic diagnosis code of 707.0 (on or after Oct. 1, 2004) because a fifth digit is now required. We will use 707.0x. For example, if the ulcer is on the hip we would report 707.04 (decubitus ulcer, hip). For less commonly involved areas such as nose, chin, forehead or chest, we would use 707.09 (decubitus ulcer, other site). Code 707.00 (decubitus ulcer, unspecified site) can be used when we receive non-specific documentation, but as an unspecified code, it may not be covered by some carriers or others may delay payment of claim and request additional documentation.

These new codes mean that we, as coders, will need more detailed information on than you may have been providing in the past. We will need to be much more careful to link the appropriate code that accurately reflects the specific area involved or we may begin to see claim denials due to CPT/ICD-9-CM incompatibility. If given the complete specific information on each patient, we can use these new codes to support medical necessity for many CPT codes, including E/M services, excisions, reconstructions, Radiological procedures and I/D from the Integumentary and Musculoskeletal sections of CPT.

New ICD-9-CM codes to know:

• 707.00 Decubitus ulcer, unspecified area
• 707.01 Decubitus ulcer, elbow
• 707.02 Decubitus ulcer, upper back
• 707.03 Decubitus ulcer, lower back
• 707.04 Decubitus ulcer, hip
• 707.05 Decubitus ulcer, buttock
• 707.06 Decubitus ulcer, ankle
• 707.07 Decubitus ulcer, heel
• 707.09 Decubitus ulcer, other site
   
• Deleted Code: 707.0 Decubitus ulcer

Remember, there is no grace period starting this year for the use of the new codes. We must begin using the codes starting with dates of service Oct. 1, 2004. CMS has eliminated the 90-day grace period, previously Oct. 1 to Dec. 31, during which you could still bill using discontinued ICD-9 codes. The grace period was cut in order for CMS to comply with provisions in the Health Insurance Portability and Accountability Act (HIPAA).

Although this is only a small sampling of the 171 new codes, please be mindful of the type of detailed information coders need in order to code to the highest specificity to allow for the most appropriate reimbursement due to you. Never hesitate to provide more information than you may think in necessary, as every coder would prefer to have too much information rather than not enough.