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Decoding the codes: How to apply the new ICD-9

OBG Management. 2003 November;15(11):42-49
November 1, 2003|OBG Management
Melanie Witt, RN, CPC, MA
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MELANIE WITT, RN, CPC, MA
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant.

At last—specific codes for diminished libido, emergency contraception, and premenstrual dysphoric disorder. Also notable are new codes for urinary urgency, long-term drug therapy, glucose levels, peripartum cardiomyopathy—and 3 SARS codes.

Factor V Leiden mutation. This condition can now be reported using the new code 289.81 (primary hypercoagulable state). The old code 289.8 was expanded to differentiate between inherited conditions (289.81) and predominately acquired conditions (289.82).

Urgency of urination. This common symptom is not the same as urge incontinence. Urgency is the intense feeling of having to urinate; urge incontinence, on the other hand, is the intense feeling of having to urinate but being unable to make it to the bathroom. Because of this difference, the American Urological Association requested and was granted the new code 788.63 (urgency of urination).

Abnormal glucose. In 1997, the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus recommended designation of a new stage of impaired glucose condition, impaired fasting glucose.1

A new code was requested to help identify patients with this disorder. Thus, the old code (790.2) has been expanded to 3 codes:

  • 790.21, impaired fasting glucose
  • 790.22, impaired glucose tolerance test
  • 790.29, other abnormal glucose
The latter code includes an abnormal nonfasting glucose result.

Billing staff should make special note of this change since the old 3-digit code, frequently found on practice encounter forms, is invalid as of October 1, 2003.

Injury. Code 959.1 has been expanded to several 5-digit codes, to capture specific sites of trunk injury.

Use:

  • 959.11 for injuries to the breast
  • 959.12 for injuries to the abdomen
  • 959.14 for injuries to the external genitalia (also referred to as the vulva, which includes the mons pubis, the labia majora and minora, the clitoris, the vestibule of the vagina and its glands, and the opening of the urethra and vagina)
  • 959.19 (other injury of other sites of trunk, not otherwise specified) for injuries to the groin, buttock, or perineum.
Need for prophylactic vaccination. The code V04.8 (need for prophylactic vaccination and inoculation against influenza) has been expanded to 3 new codes. Report:
  • V04.81 for patients receiving the influenza vaccine
  • V04.82 for children receiving vaccination against respiratory syncytial virus
  • V04.89 for patients receiving vaccination for other viral diseases
The code for a laparoscopic surgical procedure converted to an open procedure has been expanded to include other surgical procedures converted to open.

Long-term current drug use. Several new codes were added to this V58.6 code category. Assign:

  • V58.63 for use of antiplatelets or antithrombotics
  • V58.64 for the use of nonsteroidal antiinflammatories
  • V58.65 for the long-term use of steroids
Converted procedures. The old code V64.4 (laparoscopic surgical procedure converted to open procedure) has been expanded to include other closed surgical procedures converted to open procedures. You must now use V64.41 to report the converted laparoscopy.

Other persons seeking consultation. V65.1 (person consulting on behalf of another person) has been expanded to 2 codes:

  • V65.11 denotes a visit to the pediatrician made by the pregnant mother
  • V65.19 covers all other situations in which the person consulting with the physician is not the patient and the patient is not present.

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