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Medical Coding News Archives

New ICD-9-CM Codes for Fiscal 2009

June 10, 2008:
So far 2009 looks like a record-breaking year for the number and breadth of changes to the ICD-9-CM code set.

With the release of the proposed rule for the inpatient prospective payment system (IPPS), we have the first look at the list of new codes to be adopted for fiscal 2009. Since new code recommendations presented at the March 2008 ICD-9-CM Coordination & Maintenance meeting have not been finalized, we expect to see more new codes adopted for this year.

For fiscal 2009, there are more than 375 new codes, including:

Diagnosis codes
   New codes: 333
   Revised code titles: 22
   Invalid codes 55

Procedure codes
   New codes: 44
   Revised codes: 26
   Invalid codes 3

Take a look at just some of the areas of change!
  • Secondary diabetes mellitus: Twenty new codes were introduced to code secondary diabetes mellitus with the many associated complications.
  • Poxvirus infections: Increased global travel and imported animals have raised the concern for monkey pox, cowpox, and other poxvirus infections.
  • Leukemia in relapse: Relapse of leukemia after therapy (not remission) requires more aggressive therapy.
  • Migraines and headaches: Fifty-two new codes cover the numerous (and all too common) variations of headaches and migraines.
  • Exposure to hazardous chemicals: Exposure to arsenic, benzene and other chemicals has been linked to bladder and other cancers; new codes have been created to classify common presenting symptoms of bladder cancer associated with hazardous chemical exposure; gross and microscopic hematuria.
  • Decubitus ulcer staging: New codes for the stages of pressure ulcers have been created, and new coding rules will require the use of these in addition to the code for the ulcer by site.
  • Ventilator-associated pneumonia: A new code was created specifically to identify this hospital acquired condition (HAC).
  • Retinopathy of prematurity (ROP): ROP is the leading cause of blindness in children.
  • Malignant and benign neuroendocrine tumors: Forty-three new codes cover malignant and benign neuroendocrine tumors of common sites.
  • Heparin-induced thrombocytopenia (HIT): This is an adverse reaction to heparin, one of the most widely prescribed medications.
  • Chronic and acute graft versus host disease, malignant neoplasm associated with transplant, and post-transplant lymphoproliferative disorder (PTLD): Common complications seen with immunosuppressive drug therapy used to prevent organ transplant rejection.
  • Malignant pleural effusion: New coding instructions and expanded use accompanies this new code for pleural effusion that may be assigned for a secondary neoplasm of the pleura, a thoracic lymphoma, and also as a condition used in staging for lung cancer.
  • Maternal and newborn complications of in utero procedures: Both mother and child may have complications due to in utero procedures performed on the mother.
  • Erythema multiforme and erythematous conditions: New codes and coding rules were created to require additional codes describing the percentage of skin exfoliation associated with these conditions characterized by extreme skin eruptions and exfoliation of the skin.
  • Prion disease: Recent recognition that certain diseases are caused by proteinaceous infectious particles (prions) rather than a virus have lead to the need to reclassify certain diseases such as Creutzfeldt-Jakob disease, Gerstmann-Sträussler-Scheinker syndrome, and fatal familial insomnia.
  • Genital and other warts: CDC requested greater specificity for monitoring and coding human papillomavirus (HPV)-related conditions, specifically anogenital warts. This required restructuring the classification of viral warts, including plantar warts and genital warts.
  • Eye infection associated with contact lens wearing: Contact lens wearers are at increased risk for Acanthamoeba keratitis and Fusarium keratitis; new codes and coding instructions have been created.
  • Carotid sinus syndrome: A new code was created for this disorder characterized by slow heart beat (bradycardia), low blood pressure (hypotension), and fainting (syncope).
Other topics addressed by new codes:
  • Coronary atherosclerosis due to lipid rich plaque
  • Staged breast reconstruction encounter codes and disorders of reconstructed breast
  • Specificity added for disruption of operative versus traumatic wound codes
  • Newborn necrotizing enterocolitis (NEC) staging codes reflecting the for this serious gastrointestinal illness in premature infants
  • Post-traumatic seroma and nontraumatic hematoma
  • Plateau iris syndrome
  • Autoimmune hepatitis reclassified to separate chronic from viral hepatitis
  • Abnormal Pap smear of anus and vagina
  • Specificity added for extravasation of vesicants and other infusion and transfusion reactions
  • Personal history and status V codes:
    • traumatic, pathological, and stress fractures
    • noncompliance with renal dialysis
    • wheelchair dependence
    • specific therapies such as antineoplastic chemotherapy, and monoclonal drug therapy—use of these powerful drugs can increase the risk of developing serious conditions later in life
    • in utero surgery
    • prophylactic use of estrogen receptor modulators
Every specialty will encounter coding practice changes due to the sweeping code changes.

Following are just some of the areas of change in volume 3 procedures.

New procedures for fiscal 2009:
  • Super saturated oxygen therapy (SSO2): Therapy associated with acute myocardial infarctions.
  • Intravascular pressure monitoring for coronary, intrathoracic, and peripheral arteries: Improved and accurate measuring of arterial stenoses.
  • Intravascular spectroscopy. Fiberoptic, catheter-based spectroscopy system designed to characterize the composition of coronary artery plaques for improved determination of the appropriate stent utilization.
  • Laparoscopic repair of hernias.
  • Laparoscopic colectomy: New code differentiation between open and laparoscopic colorectal surgeries.
  • Excision or destruction of left atrial appendage (LAA): Removal or destruction of the LAA reduces the risk of thromboembolic strokes and AMI due to clots released by the LAA in patients with atrial fibrillation.
  • Biventricular heart replacement systems: Clarification of the coding for implantation and removal of biventricular mechanical heart assist devices.
  • Repair of anulus fibrosus. Repair of a residual open defect of the vertebra that is a complication following spinal surgery (lumbar discectomy).
Deborah C. Hall
Clinical/Technical Editor


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