Home Health Coding Education: ICD-9 2010 Made Simple

Posted on 30. Sep, 2009 by Editor in Hot Topics

Photo: Wikipedia, KMJ

Learn how to use the new codes for carcinomas, secondary neuroendocrine tumors, gouty arthropathy, brain injuries & more.

It’s that time of year again — are you ready for the new and revised 2010 ICD-9 codes? Make sure you know which changes are most likely to impact your home health agency.

The changes, announced by the Centers for Medicare & Medicaid Services (CMS) are effective Oct. 1 with no grace period. The good news: You’ll have fewer changes to master this year than you did last year, said Judy Adams, RN, BSN, HCS-D, COS-C, president and CEO of Adams Home Care Consulting in Chapel Hill, N.C. during a recent Eli-sponsored audioconference. This reduction in changes may be a trend we’ll continue to see as we ramp up for ICD-10, she says.

Welcome More Specific Neuroendocrine Tumors Codes

Look for six new codes for Merkel cell carcinoma at 209.3x (Malignant poorly differentiated neuroendocrine tumors). These additions expand on the 209.3x subcategory that was added last year, along with the 209.xx (Neuroendocrine tumor) category. These neoplasm case mix category welcomes the six new codes:

• 209.31 — Merkel cell carcinoma of the face

• 209.32 — Merkel cell carcinoma of the scalp and neck

• 209.33 — Merkel cell carcinoma of the upper limb

• 209.34 — Merkel cell carcinoma of the lower limb

• 209.35 — Merkel cell carcinoma of the trunk

• 209.36 — Merkel cell carcinoma of other sites.

The Merkel cell carcinomas are aggressive skin cancers and are actually more prevalent and more aggressive than melanomas. Until Oct. 1, you would code these skin cancers in the 173 category along with other skin cancers, such as basal cell carcinomas. These new codes help differentiate Merkel cell carcinomas from other skin cancers to better track treatment and prevalence.

Additions for secondary neuroendocrine tumors at 209.7x provide seven new case mix codes:

• 209.70 — Secondary neuroendocrine tumor, unspecified site

• 209.71 — Secondary neuroendocrine tumor of distant lymph nodes

• 209.72 — Secondary neuroendocrine tumor of liver

• 209.73 — Secondary neuroendocrine tumor of bone

• 209.74 — Secondary neuroendocrine tumor of peritoneum

• 209.75 — Secondary Merkel cell carcinoma

• 209.79 — Secondary neuroendocrine tumor of other sites.

Some skin cancers will no longer earn NRS points: The new skin cancer codes don’t earn non-routine supply points, says Trish Twombly, RN, BSN, HCS-D, CHCE, director of coding with Foundation Management Services in Denton, Texas. Up until Oct. 1 the codes for this type cancer earned NRS supply points. After Oct. 1, the new codes will be more specific, but they aren’t on the NRS list, she says.

However, both the 209.3x codes and the 209.7x codes are case mix so they add points to the home health resource group calculation, says Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principle of Selman-Holman & Associates in Denton, Texas.

Add Detail to Gouty Arthropathy

Four new codes for gouty arthropathy will come in handy when providing pain and medication management for patients with this condition, Adams says. New levels of detail allow you to indicate whether the patient has tophi — crystallized deposits of uric acid in the soft tissue under his skin. Codes include:

• 274.00 — Gouty arthropathy, unspecified

• 274.01 — Acute gouty arthropathy

• 274.02 — Chronic gouty arthropathy without mention of tophus [tophi]

• 274.03 — Chronic gouty…

Related posts:

1. Home Health ICD-9 2010 Quick Start Guide
2. Home Health Coding: Gather Details for COPD Case Mix Points
3. Home Health Coding Coach: Late Effects ICD-9 Tips
4. Home Health Coding Challenge: Double Diabetes, Hybrid Diabetes
5. 2010 ICD-9 Checklist for Home Health Coders & Billers

Tags: gouty arthropathy, ICD-9 2010, Merkel cell carcinoma, secondary neuroendocrine tumor, speech, thrombosis, venous embolism