Come October 1, a multitude of ICD-9 code additions and revisions arrive

795.12  Papanicolaou smear of vagina with atypical squamous cells cannot exclude high grade squamous intraepithelial lesion (ASC-H)

795.13  Papanicolaou smear of vagina with low grade squamous intraepithelial lesion (LGSIL)

795.14  Papanicolaou smear of vagina with high grade squamous intraepithelial lesion (HGSIL)

795.15  Vaginal high risk papillomavirus (HPV) DNA test positive

795.16  Papanicolaou smear of vagina with cytologic evidence of malignancy

795.18  Unsatisfactory cytology smear

795.19  Other abnormal smear of vagina and vaginal HPV

ANUS

796.70  Abnormal glandular Papanicolaou smear of anus

796.71  Papanicolaou smear of anus with atypical squamous cells of undetermined significance (ASC-US)

796.72  Papanicolaou smear of anus with atypical squamous cells cannot exclude high grade squamous intraepithelial lesion (ASC-H)

796.73  Papanicolaou smear of anus with low grade squamous intraepithelial lesion (LGSIL)

796.74  Papanicolaou smear of anus with high grade squamous intraepithelial lesion (HGSIL)

796.75  Anal high risk human papillomavirus (HPV) DNA test positive

796.76  Papanicolaou smear of anus with cytologic evidence of malignancy

796.77  Satisfactory anal smear but lacking transformation zone

796.78  Unsatisfactory anal cytology smear

796.79  Other abnormal Papanicolaou smear of anus and anal HPV

There is also a new code, 569.44 (Dysplasia of anus), to report anal dysplasia. In the past, this condition was reported using 569.49 (Other specified disorders of rectum and anus).

ACQUIRED ABSENCE CODES

Until now, only V45.77 (Acquired absence of genital organs) could be used to report this patient status. As of October 1, you’ll have to be more specific about what is absent, using any of the following three new codes. You might find these codes helpful in supporting the performance of screening Pap smears:

V88.01  Acquired absence of both cervix and uterus

V88.02  Acquired absence of uterus with remaining cervical stump

V88.03  Acquired absence of cervix with remaining uterus

These new codes can be reported in conjunction with V67.01 (Follow-up vaginal Pap smear) and V76.47 (Special screening for malignant neoplasm of vagina).

URINARY PROBLEMS

Use these three new codes to report various presentations of hematuria:

599.70  Hematuria, unspecified

599.71  Gross hematuria

599.72  Microscopic hematuria

Note: The old code for hematuria (599.7) did not require a fifth digit; after October 1, using that old code will trigger a denial of your claim.

In addition, you have two new codes with which to report urinary symptoms:

788.91  Functional urinary incontinence

788.99  Other symptoms involving urinary symptoms

VULVODYNIA AND VULVAR VESTIBULITIS

A single code (625.8) has been available to describe vulvodynia, and it was grouped into a general category that covered symptoms. This condition has been given three new codes.

625.70  Vulvodynia, unspecified

625.71  Vulvar vestibulitis

625.79  Other vulvodynia

BREAST DISORDERS

New codes for breast conditions are about to take effect. These include ptosis (611.81), hypoplasia (611.82), and other disorders of the breast, such as capsular contracture of a breast implant (611.89).

For surgeons who handle follow-up after breast surgery, two new codes describe problems with the reconstructed breast: 612.0 (Deformity of reconstructed breast) and 612.1 (Disproportion of reconstructed breast).

WOUND DISRUPTION

Under current ICD-9-CM guidelines, you must specify “external wound” or “internal wound” to code correctly for dehiscence. On October 1, you have the option to report an unspecified code, 998.30 (Disruption of wound, unspecified) if the record does not specify the type of wound.

PROPHYLACTIC USE OF AGENTS AFFECTING ESTROGEN RECEPTORS AND ESTROGEN LEVELS

ICD-9-CM created a V code to capture data on the many women who receive tamoxifen and raloxifene after treatment of breast cancer. This code has been expanded to include V codes for different classes of drugs used for this type of therapy:

V07.51  Prophylactic use of selective estrogen receptor modulators (SERMs)

V07.52  Prophylactic use of aromatase inhibitors

V07.59  Prophylactic use of agents affecting estrogen receptors and estrogen levels

From a guideline perspective, you can use the cancer code with one of these codes throughout the course of treatment, including during routine chemotherapy and radiation therapy. Long-term use of a drug that falls under the V07.5x category doesn’t require continued use of the cancer code, however.

You can provide additional information on your patient by reporting her estrogen receptor-positive status (V86.0), personal or family history of breast cancer (V10.3/V16.3), genetic susceptibility to cancer (V84.01–V84.09), and postmenopausal status (V49.81).

TAKING A PERSONAL HISTORY

This year, 11 codes make their debut to allow you to report a patient’s personal history. Use them for encounters in which the personal history has a direct impact on the patient’s complaints or status.

V13.51  Personal history of pathologic fracture

V13.52  Personal history of stress fracture

V13.59  Personal history of other musculoskeletal disorders

V15.51  Personal history of traumatic fracture

V15.59  Personal history of other injury

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