2011 ICD-9-CM Diagnostic Code Changes

by Lori Becks, RHIA

There are approximately 129 new valid diagnosis codes that will become effective on October 1, 2010. Many of these new additions are found in Chapter 14 among the codes for congenital anomalies of female genital organs, in Chapter 16 under symptoms involving the respiratory and digestive systems, and in Chapter 17 for injuries and poisoning. Significant changes were made to the supplementary classification chapter. Fifty-five of the new diagnosis codes effective on October 1st are new V codes.

Expanded Avian and H1N1 Codes

Both avian and H1N1 influenza have been expanded into three codes each. They now include codes with pneumonia, with other respiratory manifestations, and with other manifestations.

New Congenital Anomaly Codes

The new codes for congenital anomalies of female genital organs center on unique codes for Müllerian anomalies, which encompass all congenital anomalies of the uterus, cervix, and vagina since they stem from the same embryonic origin. The American Society of Reproductive Medicine recognizes seven types of uterine anomalies. Only two of the seven recognized types currently have specified codes in ICD-9-CM, but it is important to be able to differentiate between the anomalies because of the different gynecologic and obstetric implications they cause. The creation of new codes for these anomalies is meant to enhance communication about these conditions, and thereby improve patient care and management for conception and pregnancy issues.

New Signs and Symptoms Codes

New subcategory additions for symptoms involving the respiratory system expand hemoptysis, which has previously been used to code both an unspecified pulmonary hemorrhage and coughing up blood or bloody sputum. The new codes will now supply separate codes for unspecified hemoptysis (pulmonary hemorrhage NOS) and other hemoptysis (coughing up blood) as well as identify the rare case of acute idiopathic pulmonary hemorrhage in an infant over 28 days old.

Codes for symptoms of the digestive system expand fecal incontinence to distinguish between its different presenting symptoms, particularly incomplete defecation. A new code for fecal impaction was also created in the digestive system chapter, and tabular instructions distinguish between different presenting symptoms of incontinence and the other codes for impaction and constipation, which are not the same.

Also within Chapter 16, a new subcategory was created for signs and symptoms involving cognition that would allow the coding of cognitive symptoms related to other neurologic conditions or traumatic brain injury as supplementary codes that can present a clinical picture when there is no other more specific diagnosis available. These codes include cognitive symptoms such as attention or concentration deficit, visuospatial or psychomotor deficit, and frontal lobe and executive function deficit.

New Injury and Poisoning Codes

Very important changes within the injuries and poisoning chapter include the addition of a code specifically for poisoning by cocaine, or crack, 970.81, since this is a major central nervous system drug responsible for drug abuse and overdose that has not been specifically referenced in ICD-9-CM.

Category 999 Complications of medical care, not elsewhere classified has significant new diagnosis codes added for several conditions specifically related to the transfusion of blood or blood components, such as hemolytic transfusion reaction or HTR, for which no code currently exists in the classification system. Many of these transfusion disorders or reactions are currently under-recognized and under-reported, even though some can become debilitating or cause transfusion-related deaths. It is critical that these conditions are reported when they occur.

HTR is a blood transfusion reaction that causes an increased destruction of red blood cells due to some kind of incompatibility between the donor blood and the recipient. There is currently no provision in the classification system for distinguishing blood group ABO from non-ABO type hemolytic transfusion reactions, nor acute from delayed reactions, so unique codes have been created to help raise increased awareness of the prevalence of these conditions among recipients of blood transfusions and allow tracking for effectiveness of treatment.

New V Codes

V codes were created to report many new personal history conditions, such as a personal history of vaginal and vulvar dysplasia, personal history of combat and operational stress reaction, and personal history of corrected congenital malformations. The codes for insertion, routine checking, removal, and subsequent
reinsertion of IUDs have been modified into more specific codes in order to report these encounters more accurately, specifically, the ability to code removal with immediate reinsertion of IUD.

Body mass index (BMI) codes have also been expanded for reporting adult BMI measurements over 40 to distinguish specific ranges of BMI between 40 and 69.9, and 70 and over. This was necessary to track the population of morbid obesity as Americans are becoming more and more obese.

Two entirely new sections of V codes have been created—V90 Retained Foreign Body and V91 Multiple Gestation Placenta Status. The new category for retained foreign bodies reports cases of fragments or splinters embedded in an injured person that cannot be removed. Because of the potential health risks and hazards of embedded foreign bodies, the Department of Defense requested new codes to report an embedded fragment status that would identify the type of material, such as different types of metal, plastic, or organic matter. Although these codes are useful mainly for military purposes in cases of injuries from explosive devices, they are also applicable to any injury resulting in embedded fragments. The codes for multiple gestation placenta status were instituted to distinguish the number of placentae and amniotic sacs in cases of twin, triplet, quadruplet or other specified multiple gestation pregnancies.