1. ICD-9 Changes for 2006 Julie A. Leu, CPC Billing Compliance Coordinator September 27, 2005

2. Changes to ICD-9 for 2006 Effective October 1, 2005 Effective October 1, 2005 ICD-10 still “in the wings” ICD-10 still “in the wings” Updates are available at: Updates are available at: http://www.IngenixOnline.comhttp://www.IngenixOnline.comhttp://www.IngenixOnline.com http://www.cdc.gov/nchs/datawh/ftp serv/ftpicd9/ftpicd9.htmhttp://www.cdc.gov/nchs/datawh/ftp serv/ftpicd9/ftpicd9.htmhttp://www.cdc.gov/nchs/datawh/ftp serv/ftpicd9/ftpicd9.htmhttp://www.cdc.gov/nchs/datawh/ftp serv/ftpicd9/ftpicd9.htm

3. Summary of Changes for 2006 173 New diagnosis codes 173 New diagnosis codes 14 New category or subcategory titles 14 New category or subcategory titles 28 Revised diagnosis code titles 28 Revised diagnosis code titles April 2005 revisions to Guidelines have been incorporated. April 2005 revisions to Guidelines have been incorporated.

4. Summary of Changes to the Coding Guidelines  Conventions, general coding guidelines and chapter-specific guidelines  Addition of V Code Table Principal or first listedPrincipal or first listed First or additionalFirst or additional Additional onlyAdditional only

5. Changes to ICD-9 for 2006  New Code 259.5 Androgen insensitivity syndrome259.5 Androgen insensitivity syndrome  276.5 (Volume depletion) has been expanded to require a 5 th digit: 276.50 Volume depletion, unspecified276.50 Volume depletion, unspecified 276.51 Dehydration276.51 Dehydration 276.52 Hypovolemia276.52 Hypovolemia

6. Changes to ICD-9 for 2006  New Code 278.02 Overweight278.02 Overweight  287.3 has been expanded to 5 th digit 287.30 Primary thrombocytopenia, unspecified287.30 Primary thrombocytopenia, unspecified 287.31 Immune thrombocytopenic purpura287.31 Immune thrombocytopenic purpura 287.32 Evans’ syndrome287.32 Evans’ syndrome 287.33 Congenital and hereditary thrombocytopenic purpura287.33 Congenital and hereditary thrombocytopenic purpura 287.39 Other primary thrombocytopenia287.39 Other primary thrombocytopenia

7. Changes to ICD-9 for 2006 New Codes New Codes 291.82 Alcohol induced sleep disorders291.82 Alcohol induced sleep disorders 292.85 Drug induced sleep disorders292.85 Drug induced sleep disorders New Category, subcategories, and codes for Organic sleep disorder New Category, subcategories, and codes for Organic sleep disorder

8. New Category: Organic Sleep Disorders 327.0 Organic disorders of initiating and maintaining sleep (Organic insomnia)327.0 Organic disorders of initiating and maintaining sleep (Organic insomnia) 327.00 Organic insomnia, unspecified327.00 Organic insomnia, unspecified 327.01 Insomnia due to medical condition classified elsewhere327.01 Insomnia due to medical condition classified elsewhere 327.02 Insomnia due to mental disorder327.02 Insomnia due to mental disorder 327.09 Other organic insomnia327.09 Other organic insomnia

9. New Subcategory Under Organic Sleep Disorders 327.1 Organic disorders of excessive somnolence327.1 Organic disorders of excessive somnolence 327.10 Organic hypersomnia, unspecified327.10 Organic hypersomnia, unspecified 327.11 Idiopathic hypersomnia with long sleep time327.11 Idiopathic hypersomnia with long sleep time 327.12 Idiopathic hypersomnia without long sleep time327.12 Idiopathic hypersomnia without long sleep time 327.14 Hypersomnia due to medical condition classified elsewhere327.14 Hypersomnia due to medical condition classified elsewhere 327.15 Hypersomnia due to mental disorder327.15 Hypersomnia due to mental disorder 327.19 Other organic hypersomnia327.19 Other organic hypersomnia

10. New Subcategory Under Organic Sleep Disorders 327.2 Organic sleep apnea327.2 Organic sleep apnea 327.20 Organic sleep apnea, unspecified327.20 Organic sleep apnea, unspecified 327.21 Primary central sleep apnea327.21 Primary central sleep apnea 327.22 High altitude periodic breathing327.22 High altitude periodic breathing 327.23 Obstructive sleep apnea (adult) (pediatric)327.23 Obstructive sleep apnea (adult) (pediatric) 327.24 Idiopathic sleep related nonobstructive alveolar hypoventilation327.24 Idiopathic sleep related nonobstructive alveolar hypoventilation

11. New Subcategory Under Organic Sleep Disorders 327.2 Organic sleep apnea, con’t.327.2 Organic sleep apnea, con’t. 327.25 Congenital central alveolar hypoventilation syndrome327.25 Congenital central alveolar hypoventilation syndrome 327.26 Sleep related hypoventilation/ hypoxemia in conditions classified elsewhere327.26 Sleep related hypoventilation/ hypoxemia in conditions classified elsewhere 327.27 Central sleep apnea in conditions classified elsewhere327.27 Central sleep apnea in conditions classified elsewhere 327.29 Other organic sleep apnea327.29 Other organic sleep apnea

12. New Subcategory Under Organic Sleep Disorders 327.3 Circadian rhythm sleep disorder327.3 Circadian rhythm sleep disorder 327.30 Circadian rhythm sleep disorder, unspecified327.30 Circadian rhythm sleep disorder, unspecified 327.31 Circadian rhythm sleep disorder, delayed sleep phase type327.31 Circadian rhythm sleep disorder, delayed sleep phase type 327.32 Circadian rhythm sleep disorder, advanced sleep phase type327.32 Circadian rhythm sleep disorder, advanced sleep phase type 327.33 Circadian rhythm sleep disorder, irregular sleep-wake type327.33 Circadian rhythm sleep disorder, irregular sleep-wake type

13. New Subcategory Under Organic Sleep Disorders 327.3 Circadian rhythm sleep disorder,con’t327.3 Circadian rhythm sleep disorder,con’t 327.34 Circadian rhythm sleep disorder, free-running type 327.34 Circadian rhythm sleep disorder, free-running type 327.35 Circadian rhythm sleep disorder, jet lag type 327.35 Circadian rhythm sleep disorder, jet lag type 327.36 Circadian rhythm sleep disorder, shift work type 327.36 Circadian rhythm sleep disorder, shift work type 327.37 Circadian rhythm sleep disorder in conditions classified elsewhere 327.37 Circadian rhythm sleep disorder in conditions classified elsewhere 327.39 Other circadian rhythm sleep disorder 327.39 Other circadian rhythm sleep disorder

14. New Subcategory Under Organic Sleep Disorders 327.4Organic parasomnia327.4Organic parasomnia 327.40 Organic parasomnia, unspecified 327.40 Organic parasomnia, unspecified 327.41 Confusional arousals 327.41 Confusional arousals 327.42 REM sleep behavior disorder 327.42 REM sleep behavior disorder 327.43 Recurrent isolated sleep paralysis 327.43 Recurrent isolated sleep paralysis 327.44 Parasomnia in conditions classified elsewhere 327.44 Parasomnia in conditions classified elsewhere 327.49 Other organic parasomnia 327.49 Other organic parasomnia

15. New Subcategory Under Organic Sleep Disorders 327.5 Organic sleep related movement disorders327.5 Organic sleep related movement disorders 327.51 Periodic limb movement disorder 327.51 Periodic limb movement disorder 327.52 Sleep related leg cramps 327.52 Sleep related leg cramps 327.53 Sleep related bruxism 327.53 Sleep related bruxism 327.59 Other organic sleep related movement disorders 327.59 Other organic sleep related movement disorders 327.8 Other organic sleep disorders 327.8 Other organic sleep disorders

16. New Codes in Diabetic Retinopathy Subcategory 362.03 Nonproliferative diabetic retinopathy NOS362.03 Nonproliferative diabetic retinopathy NOS 362.04 Mild nonproliferative diabetic retinopathy362.04 Mild nonproliferative diabetic retinopathy 362.05 Moderate nonproliferative diabetic retinopathy362.05 Moderate nonproliferative diabetic retinopathy 362.06 Severe nonproliferative diabetic retinopathy362.06 Severe nonproliferative diabetic retinopathy 362.07 Diabetic macular edema362.07 Diabetic macular edema Instructional note added Instructional note added

17. Changes to ICD-9 for 2006 ▲ Change in nomenclature throughout the 403 and 404 sections. ▲ “renal” disease changed to “kidney” disease” ▲ “renal failure” changed to “chronic kidney disease”

18. Changes to ICD-9 for 2006 New Codes:New Codes: 426.82 Long QT syndrome426.82 Long QT syndrome 443.82 Erythromelalgia443.82 Erythromelalgia

19. Changes to ICD-9 for 2006 New Subcategory: 525.4 Complete edentulismNew Subcategory: 525.4 Complete edentulism 525.40 Complete edentulism, unspecified525.40 Complete edentulism, unspecified 525.41 Complete edentulism, class I525.41 Complete edentulism, class I 525.42 Complete edentulism, class II525.42 Complete edentulism, class II 525.43 Complete edentulism, class III525.43 Complete edentulism, class III 525.44 Complete edentulism, class IV525.44 Complete edentulism, class IV

20. Changes to ICD-9 for 2006 New Subcategory: 525.5 Partial edentulismNew Subcategory: 525.5 Partial edentulism 525.50 Partial edentulism, unspecified525.50 Partial edentulism, unspecified 525.51 Partial edentulism, class I525.51 Partial edentulism, class I 525.52 Partial edentulism, class II525.52 Partial edentulism, class II 525.53 Partial edentulism, class III525.53 Partial edentulism, class III 525.54 Partial edentulism, class IV525.54 Partial edentulism, class IV

21. Changes to ICD-9 for 2006 ▲ 567.2 Other suppurative peritonitis, has been expanded to require a fifth digit: 567.21 Peritonitis (acute) generalized567.21 Peritonitis (acute) generalized 567.22 Peritoneal abscess567.22 Peritoneal abscess 567.23 Spontaneous bacterial peritonitis567.23 Spontaneous bacterial peritonitis 567.29 Other suppurative peritonitis567.29 Other suppurative peritonitis

22. Changes to ICD-9 for 2006 ▲ 567.3 Retroperitoneal infections, has been expanded to require a fifth digit: 567.31 Psoas muscle abscess567.31 Psoas muscle abscess 567.38 Other retroperitoneal abscess567.38 Other retroperitoneal abscess 567.39 Other retroperitoneal infections567.39 Other retroperitoneal infections

23. Changes to ICD-9 for 2006 ▲ 567.8 Other specified retroperitonitis, has been expanded to require a fifth digit: 567.81 Choleperitonitis 567.81 Choleperitonitis 567.82 Sclerosing mesenteritis 567.82 Sclerosing mesenteritis 567.89 Other specified peritonitis 567.89 Other specified peritonitis

24. Changes to ICD-9 for 2006 ▲ 585 Revised from “Chronic renal failure” to “Chronic kidney disease” and has been expanded to require a forth digit: 585.1 Chronic kidney disease, Stage I 585.1 Chronic kidney disease, Stage I 585.2 Chronic kidney disease, Stage II (mild) 585.2 Chronic kidney disease, Stage II (mild) 585.3 Chronic kidney disease, Stage III (moderate) 585.3 Chronic kidney disease, Stage III (moderate)

25. Changes to ICD-9 for 2006 ▲ 585 Revised from “Chronic renal failure” to “Chronic kidney disease” and has been expanded to require a fourth digit: 585.4 Chronic kidney disease, Stage IV (severe) 585.4 Chronic kidney disease, Stage IV (severe) 585.5 Chronic kidney disease, Stage V 585.5 Chronic kidney disease, Stage V 585.6 End stage renal disease 585.6 End stage renal disease 585.9 Chronic kidney disease, unspecified 585.9 Chronic kidney disease, unspecified

26. Changes to ICD-9 for 2006 ▲ 599.6“Urinary obstruction” has been expanded to require a fifth digit: 599.60 Urinary obstruction, unspecified 599.60 Urinary obstruction, unspecified 599.69 Urinary obstruction, not otherwise specified 599.69 Urinary obstruction, not otherwise specified

27. Changes to ICD-9 for 2006 ▲ 651.7 “Multiple gestation following (elective) fetal reduction” has been expanded to require a fifth digit: 651.70 Multiple gestation... unspecified as to episode of care or not applicable 651.70 Multiple gestation... unspecified as to episode of care or not applicable 651.71 Multiple gestation... delivered, with or without mention of antepartum condition 651.71 Multiple gestation... delivered, with or without mention of antepartum condition 651.73 Multiple gestation... antepartum condition or complication 651.73 Multiple gestation... antepartum condition or complication

28. Changes to ICD-9 for 2006 New Codes: 760.77 Noxious influences affecting fetus or newborn via placenta or breast milk, Anticonvulsants760.77 Noxious influences affecting fetus or newborn via placenta or breast milk, Anticonvulsants 760.78 Noxious influences affecting fetus or newborn via placenta or breast milk, Antimetabolic agents760.78 Noxious influences affecting fetus or newborn via placenta or breast milk, Antimetabolic agents 763.84 Meconium passage during delivery763.84 Meconium passage during delivery

29. Changes to ICD-9 for 2006 ▲ 770.1 Revised from “Meconium aspiration syndrome” to “Fetal and newborn aspiration” and has been expanded to require a fifth digit: 770.10 Fetal and newborn aspiration, unspecified770.10 Fetal and newborn aspiration, unspecified 770.11 Meconium aspiration without respiratory symptoms770.11 Meconium aspiration without respiratory symptoms 770.12 Meconium aspiration with respiratory symptoms770.12 Meconium aspiration with respiratory symptoms 770.13 Aspiration of clear amniotic fluid without respiratory symptoms770.13 Aspiration of clear amniotic fluid without respiratory symptoms

30. Changes to ICD-9 for 2006 770.14 Aspiration of clear amniotic fluid with respiratory symptoms770.14 Aspiration of clear amniotic fluid with respiratory symptoms 770.15 Aspiration of blood without respiratory symptoms770.15 Aspiration of blood without respiratory symptoms 770.16 Aspiration of blood with respiratory symptoms770.16 Aspiration of blood with respiratory symptoms 770.17 Other fetal and newborn aspiration without respiratory symptoms770.17 Other fetal and newborn aspiration without respiratory symptoms

31. Changes to ICD-9 for 2006 770.18 Other fetal and newborn aspiration with respiratory symptoms770.18 Other fetal and newborn aspiration with respiratory symptoms 770.85 Aspiration of postnatal stomach contents without respiratory symptoms770.85 Aspiration of postnatal stomach contents without respiratory symptoms 770.86 Aspiration of postnatal stomach contents with respiratory symptoms770.86 Aspiration of postnatal stomach contents with respiratory symptoms 779.84 Meconium staining779.84 Meconium staining

32. Changes to ICD-9 for 2006 ▲ In addition to codes in the 327.XX classification, codes in the 780.5 subclassification for signs and symptoms of insomnia have been changed in their description. ! Correction: Code 780.50 was mistakenly omitted from ICD-9 for 2006. It is a valid code and reports: “Sleep disturbance, unspecified” 780.95 Other excessive crying780.95 Other excessive crying

33. Changes to ICD-9 for 2006 ▲ 799.0 Subcategory descriptor revised to “Asphyxia and hypoxemia” and has been expanded to require a fifth digit: 799.01 Asphyxia799.01 Asphyxia 799.02 Hypoxemia799.02 Hypoxemia

34. Changes to ICD-9 for 2006 ▲ 996.4 “Mechanical complication of internal orthopedic device, implant, and graft” has been expanded to require a fifth digit: 996.40 Unspecified complication... 996.40 Unspecified complication... 996.41 Mechanical loosening of prosthetic joint 996.41 Mechanical loosening of prosthetic joint 996.42 Dislocation of prosthetic joint 996.42 Dislocation of prosthetic joint 996.43 Prosthetic joint implant failure 996.43 Prosthetic joint implant failure

35. Changes to ICD-9 for 2006 996.44 Peri-prosthetic fracture around prosthetic joint996.44 Peri-prosthetic fracture around prosthetic joint 996.45 Peri-prosthetic osteolysis996.45 Peri-prosthetic osteolysis 996.46 Articular bearing surface wear of prosthetic joint996.46 Articular bearing surface wear of prosthetic joint 996.47 Other mechanical complication of prosthetic joint implant996.47 Other mechanical complication of prosthetic joint implant 996.49 Other mechanical complication of other internal orthopedic device, implant, and graft996.49 Other mechanical complication of other internal orthopedic device, implant, and graft

36. Changes to ICD-9 for 2006 V Code Changes V12.42 Personal history of Infections of the central nervous system V12.42 Personal history of Infections of the central nervous system V12.60 Personal history of Unspecified disease of respiratory system V12.60 Personal history of Unspecified disease of respiratory system V12.61 Personal history of Pneumonia (recurrent) V12.61 Personal history of Pneumonia (recurrent) V12.69 Personal history of Other diseases of respiratory system V12.69 Personal history of Other diseases of respiratory system

37. Changes to ICD-9 for 2006 V Code Changes V13.02 Personal history of Urinary (tract) infectionV13.02 Personal history of Urinary (tract) infection V13.03 Personal history of nephrotic syndromeV13.03 Personal history of nephrotic syndrome V15.88 Personal history of, History of fallV15.88 Personal history of, History of fall V17.81 Family history of, OsteoporosisV17.81 Family history of, Osteoporosis V17.89 Family history of, Other musculoskeletal diseasesV17.89 Family history of, Other musculoskeletal diseases V18.9 Family history of, Genetic disease carrierV18.9 Family history of, Genetic disease carrier

38. Changes to ICD-9 for 2006 V Code Changes V26.31 Testing for genetic disease carrier statusV26.31 Testing for genetic disease carrier status V26.32 Other genetic testingV26.32 Other genetic testing V26.33 Genetic counselingV26.33 Genetic counseling V46.13 Encounter for weaning from respirator [ventilator]V46.13 Encounter for weaning from respirator [ventilator] V46.14 Mechanical complication of respirator [ventilator]V46.14 Mechanical complication of respirator [ventilator]

39. Changes to ICD-9 for 2006 V Code Changes V49.84 Bed confinement statusV49.84 Bed confinement status ▲ V58.1 subcategory descriptor revised and expanded to require a fifth digit: V58.11 Encounter for antineoplastic chemotherapyV58.11 Encounter for antineoplastic chemotherapy V58.12 Encounter for antineoplastic immunotherapyV58.12 Encounter for antineoplastic immunotherapy

40. Changes to ICD-9 for 2006 V Code Changes New subcategory requiring fifth digit, V59.7 Donors, Egg (oocyte) (ovum)New subcategory requiring fifth digit, V59.7 Donors, Egg (oocyte) (ovum) V59.70 Egg... Donor, unspecified V59.70 Egg... Donor, unspecified V59.71 Egg... Donor, under age 35, anonymous recipient V59.71 Egg... Donor, under age 35, anonymous recipient V59.72 Egg... Donor, under age 35, designated recipient V59.72 Egg... Donor, under age 35, designated recipient V59.73 Egg... Donor, age 35 and over, anonymous recipient V59.73 Egg... Donor, age 35 and over, anonymous recipient V59.74 Egg... Donor, age 35 and over, designated recipient V59.74 Egg... Donor, age 35 and over, designated recipient

41. Changes to ICD-9 for 2006 V Code Changes V62.84 Suicidal ideation V62.84 Suicidal ideation V64.0 subcategory descriptor revised and expanded to require a fifth digit, Vaccination not carried out... V64.0 subcategory descriptor revised and expanded to require a fifth digit, Vaccination not carried out... V64.00... unspecified reason” V64.00... unspecified reason” V64.01... because of acute illness” V64.01... because of acute illness” V64.02... because of chronic illness or condition” V64.02... because of chronic illness or condition” V64.03... because of immune compromised state” V64.03... because of immune compromised state”

42. Changes to ICD-9 for 2006 V Code Changes ▲ V64.0 subcategory descriptor revised and expanded to require a fifth digit, “Vaccination not carried out... V64.04... because of allergy to vaccine or component” V64.04... because of allergy to vaccine or component” V64.05... because of caregiver refusal” V64.05... because of caregiver refusal” V64.06... because of patient refusal” V64.06... because of patient refusal” V64.07... for religious reasons” V64.07... for religious reasons” V64.08... because patient had disease being vaccinated against” V64.08... because patient had disease being vaccinated against” V64.09... for other reason” V64.09... for other reason”

43. Changes to ICD-9 for 2006 V Code Changes V69.5 Behavioral insomnia of childhood V69.5 Behavioral insomnia of childhood V72.4 Pregnancy examination or test, positive result V72.4 Pregnancy examination or test, positive result V72.86 Encounter for blood typing V72.86 Encounter for blood typing

44. Changes to ICD-9 for 2006 V Code Changes New V Code category to report Body Mass Index New V Code category to report Body Mass Index V85.0 Body Mass IndexV85.0 Body Mass Index V85.0 through V85.4 vary from four digit to five digit codes and report BMI from 19 to 40 and over, adultV85.0 through V85.4 vary from four digit to five digit codes and report BMI from 19 to 40 and over, adult

45. Thank you!