The federal government has brought a bumper crop of new diagnosis codes to market this year, and many of them will make coding in radiology easier.

Chief among the improvements is this series of codes, developed to allow for better reporting of medical necessity in obstetrical rule-out diagnoses. Obstetric patients are often referred to specialists for detailed ultrasounds when an initial screening ultrasound in the physician's office indicates a possible abnormality. In many cases the detailed exam shows no abnormality:

·        V89.01: Suspected problem with amniotic cavity and membrane not found

·        V89.02: Suspected placental problem not found

·        V89.03: Suspected fetal anomaly not found

·        V89.04: Suspected problem with fetal growth not found

·        V89.05: Suspected cervical shortening not found

·        V89.09: Other suspected maternal and fetal condition not found

It may take payers some time to get these new codes built into their coverage edits, so coders may want to verify coverage before billing with these codes.

Other encounter codes more thoroughly define the purpose of the testing being performed. For example:

·        V28.81: Encounter for fetal anatomic survey

·        V28.82: Encounter for screening for risk of pre-term labor

·        V28.89: Other specified antenatal screening

In other cases, new codes provide precise coding options when the testing results are positive. Requiring a fifth digit to isolate the episode of care are these obstetric codes:

·        649.7x: Cervical shortening

·        678.0x: Fetal hematologic conditions

·        678.1x: Fetal conjoined twins

·        679.0x: Maternal complications from in utero procedure

·        679.1x: Fetal complications from in utero procedures

To complement the osteoporosis codes that have been expanded in the past few years, a new code for hungry bone syndrome was created for 2009:

·        275.5: Hungry bone syndrome

This syndrome is a common late effect of parathyroidectomy, and for either primary or secondary hyperparathyroidism or thyrotoxicosis. The subsequent change in parathyroid hormone levels then result in rapid removal of serum calcium from the blood and its deposit as remineralized bone. The loss of calcium in circulation can cause tetany and numbness in the extremities, and the deposits in the bone can cause patient cramping, bone pain and tenderness. Hungry bone syndrome was not indexed to any specific code in ICD-9-CM, and coders have been coding manifestations and etiology of the syndrome. The syndrome can now be specifically reported, and would be followed by the code describing its cause.

Personal history can also contribute to the medical necessity of radiological examinations. New personal history codes for 2009 include:

·        V13.51: Personal history of pathologic fracture

·        V13.52: Personal history of stress fracture

·        V13.59: Personal history of other musculoskeletal disorders

·        V15.21: Personal history of undergoing in utero procedure during pregnancy

·        V15.22: Personal history of undergoing in utero procedure while a fetus

·        V15.29: Personal history of surgery to other organs

·        V15.51: Personal history of traumatic fracture

·        V15.59: Personal history of other injury

There are numerous 2009 ICD-9-CM codes that will affect diagnostic coding for radiologists: codes for neonatal necrotizing enterocolitis, malignant pleural effusion, carotid sinus syndrome, and partial or total androgen insensitivity syndrome. Other codes cover methicillin resistant Staphylococcus aureus infection, types of hematuria, carcinoid tumors, secondary diabetes, headaches and migraines, and acquired absence of uterus and/or cervix. To see a complete listing of all new ICD-9-CM diagnostic codes for 2009, visit http://www.aapc.com/new-2009-icd-9-cm-codes.aspx.

Successful implementation of the new codes requires several steps. First, identify all the places that codes are used: Superbills, look-up software, billing software, EMRs, etc. Work with the information technology (IT) and coding departments to ensure that changes are captured in all places where codes are used. Then, create a list of new codes pertinent to radiology and distribute this widely. Ensure that the clinicians understand what new documentation requirements the codes carry, and that the coding and billing staff understand the rules around the new codes. Place orders for your new codebooks or software, remember not to throw away the old books once the new ones arrive. You'd be surprised how the archived books can come in handy in the event of an appeal or a lawsuit sometime in the future.

 Sheri Poe Bernard, CPC, CPC-H, CPC-P, is vice president of clinical content at the American Academy of Professional Coders (AAPC), the nation's largest education and credentialing association for medical coders.