Changes to ICD-9-CM codes that will affect internists

From the October ACP-ASIM Observer, copyright © 2002 by the American College of Physicians-American Society of Internal Medicine.

By Angela Pledger

Q: What changes have been made to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes? When do I need to start using them?

A: The Centers for Medicare and Medicaid Services (CMS), formerly HCFA, and the National Center for Health Statistics released ICD-9-CM code changes that took effect Oct. 1. Medicare and many other payers give physicians a three-month grace period to begin implementing new codes no later than Jan. 1, 2003.

There have not been this many ICD-9 changes affecting internists for eight years, so you'll need some time to become familiar with the new codes. As a result, you should start using the new codes before the three-month grace period expires.

The changes most relevant to internists are noted below and appear in numerical order.

Diseases of the respiratory system

Code 357.8, "Other inflammatory and toxic neuropathy," has been rendered invalid by the introduction of two new five-digit codes:

• 357.82—Critical illness polyneuropathy
• 357.89—Other inflammatory and toxic neuropathy

Code 359.8, "Other myopathies," is invalid, as it is has been expanded to include two new five-digit codes:

• 359.81—Critical illness myopathy
• 359.89—Other myopathies

Diseases of the circulatory system

Code 414.0, "Coronary atherosclerosis," has been expanded to include a new five-digit code:

• 414.06—Coronary atherosclerosis of coronary artery of transplanted heart

Code 454, "Varicose veins of the lower extremities," has been expanded to include two new four-digit codes:

• 454.8—Varicose veins of the lower extremities, with other complications
• 454.9—Asymptomatic varicose veins

Code 459.1, "Postphlebitic syndrome," is now a subcategory with five new five-digit codes:

• 459.10—Postphlebitic syndrome without complications
• 459.11—Postphlebitic syndrome with ulcer
• 459.12—Postphlebitic syndrome with inflammation
• 459.13—Postphlebitic syndrome with ulcer and inflammation
• 459.19—Postphlebitic syndrome with other complication

A new subcategory 459.3, "Chronic venous hypertension," has been added along with five new five-digit codes describing the condition:

• 459.30—Chronic venous hypertension without complications
• 459.31—Chronic venous hypertension with ulcer
• 459.32—Chronic venous hypertension with inflammation
• 459.33—Chronic venous hypertension with ulcer and inflammation
• 459.39—Chronic venous hypertension with other complication

Code 537, "Other disorders of stomach and duodenum," has been expanded to include a new five-digit code:

• 537.84—Dieulafoy lesion (hemorrhagic) of stomach and duodenum

Code 569, "Other disorders of intestine," has been expanded to include:

• 569.86—Dieulafoy lesion (hemorrhagic) of intestine

Genitourinary system

Code 627, "Menopausal and postmenopausal disorders," has been expanded to include two new four-digit codes:

• 627.2—Symptomatic menopause
• 627.4—Symptomatic artificial menopause

Symptoms, signs and ill-defined conditions

Code 795.0, "Nonspecific abnormal Papanicolaou smear of cervix," has been expanded to include two new five-digit codes to identify different types of abnormal findings:

• 795.00—Nonspecific abnormal Papanicolaou smear of cervix, unspecified
• 795.09—Other nonspecific abnormal Papanicolaou smear of cervix

Code 795.3, "Nonspecific positive culture findings," has been expanded to include two new five-digit codes:

• 795.31—Nonspecific positive findings for anthrax
• 795.39—Other nonspecific positive culture findings

Injury/poisoning

Code 995, "Certain adverse effects not elsewhere classified," has been expanded to include two new five-digit codes:

• 995.90—Systemic inflammation response syndrome, unspecified
• 995.91—Systemic inflammation response syndrome, due to infectious process without organ dysfunction

Other factors influencing health

V codes, "Supplementary classification of factors influencing health status and contact with health services," has been expanded to include five new codes and one revision:

• V01.81—Contact with or exposure to communicable diseases, anthrax
• V01.89—Contact with or exposure to communicable diseases, other communicable
• V54.89—Other orthopedic aftercare
• V71.82—Observation and evaluation for suspected exposure to anthrax
• V71.83—Observation and evaluation for suspected exposure to other biological agent

V code V49.81, "Postmenopausal status (age-related) (natural)," has been revised to "Symptom free natural menopause"

Supplemental codes

The E code "Supplementary classification of external causes of injury and poisoning," has been expanded to include twelve new codes:

• E979.0—Terrorism involving the explosion of marine weapons
• E979.1—Terrorism involving destruction of air craft
• E979.2—Terrorism involving other explosions or fragments
• E979.3—Terrorism involving fires, conflagrations, and hot substances
• E979.4—Terrorism involving firearms
• E979.5—Terrorism involving nuclear weapons
• E979.6—Terrorism involving biological weapons
• E979.7—Terrorism involving chemical weapons
• E979.8—Terrorism involving other weapons
• E979.9—Terrorism, secondary affects
• E999.0—Late effects of injury due to war operations
• E999.1—Late effects of injury due to terrorism

If you need a comprehensive list or an updated version of ICD-9-CM, you can purchase it through the AMA ($74.95 for members, $84.95 for non-members) by calling 800-621-8335. ICD-9-CM 2003 is also available through other vendors.

Angela Pledger is Coordinator for Regulatory and Insurer Affairs in the College's Washington office.

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