IHEU unique 7/13/06 12:03 PM Page i

2007

ICD-9-CM Expert

for Hospitals Volumes 1, 2 & 3

International Classification of Diseases 9th Revision Clinical Modification Sixth Edition

Edited by: Anita C. Hart, RHIA, CCS, CCS-P Beth Ford, RHIT, CCS

Ingenix is committed to providing you with the ICD-9-CM code update information you need to code accurately and to be in compliance with HIPAA regulations. In the case of adoption of additional ICD-9-CM code changes effective April 1, 2007, Ingenix will provide these code changes to you at no additional cost! Just check back at http://www.IngenixOnline.com and look for the ICD-9, CPT® and HCPCS Alerts link under the Quick Access Resources menu to review the latest information concerning any new code changes.

Codes Valid October 1, 2006, through September 30, 2007 October 2006 Update 3539/IHEU/U0515 07 ICD9 v1 H 7/11/06 2:24 PM Page 127

Tabular List 425.8–426.89 425.8–426.89 Circulatory System Nerve Conduction of the Normal and Long QT Electrocardiogram

QRS Interval ST Interval Normal Long QT R Syndrome R PR Segment QT Interval QT Interval (pacemaker) Bachmannʼs bundle PR ST Interval Segment Internodal tracts: Anterior T Middle P T P Posterior Left Left bundle branch: Atrioventricular Q node Anterior fascicle Q Common bundle Posterior fascicle S (of His) S Left bundle branch hemiblock 0.2.4.6 0.2.4.6 Accessory bundle MC (of Kent) 426.3 ¥Other> Right bundle branch Left bundle branch block: Right bundle branch block NOS anterior fascicular with posterior fascicular complete 425.8 <¥Cardiomyopathy> in other diseases classified CC CD main stem ¥elsewhere> Code first underlying disease, as: 426.4 ¥Right> bundle branch block Friedreich’s ataxia (334.0) AHA: 3Q, ‘00, 3 myotonia atrophica (359.2) k 426.5 Bundle branch block, other and unspecified progressive muscular dystrophy (359.1) 426.50 Bundle branch block, unspecified sarcoidosis (135) <¥> 426.51 Right bundle branch block and left MC EXCLUDES in Chagas’ disease posterior fascicular block (086.0) 426.52 Right bundle branch block and left MC CC Excl: See code 425.0 anterior fascicular block AHA: 2Q, ‘93, 9 11 426.53 Other bilateral bundle branch CC MC MCV 425.9 Secondary cardiomyopathy, unspecified CC CD block CC Excl: See code 425.0 NOS Bilateral bundle branch block NOS ' 426 Conduction disorders Right bundle branch with left bundle DEF: Disruption or disturbance in the electrical impulses that regulate branch block (incomplete) (main stem) heartbeats. CC Excl: See code 426.0 11 CC MC MCV 426.0 Atrioventricular block, complete 11 426.54 CC MC MCV Third degree atrioventricular block CC Excl: See code 426.0 CC Excl: 426.0-427.5, 427.89, 459.89, 459.9 CC k 426.6 Other 426.1 Atrioventricular block, other and unspecified : 426.10 Atrioventricular block, unspecified MC NOS Sinoauricular block Atrioventricular [AV] block (incomplete) diffuse (partial) myofibrillar 426.11 First degree atrioventricular block CC Excl: See code 426.0 Incomplete atrioventricular block, first degree Prolonged P-R interval NOS 426.7 Anomalous atrioventricular excitation CC 426.12 Mobitz (type) II atrioventricular CC MC Atrioventricular conduction: block accelerated Incomplete atrioventricular block: accessory Mobitz (type) II pre-excitation second degree, Mobitz (type) II Ventricular pre-excitation CC Excl: See code 426.0 Wolff-Parkinson-White syndrome CC Excl: See code 426.0 DEF: Impaired conduction of excitatory impulse from cardiac to through AV node. DEF: Wolff-Parkinson-White: normal conduction pathway is 426.13 Other second degree atrioventricular CC MC bypassed; results in short P-R interval on EKG; tendency to block supraventricular . Incomplete atrioventricular block: k 426.8 Other specified conduction disorders Mobitz (type) I [Wenckebach’s] 426.81 Lown-Ganong-Levine syndrome CC second degree: Syndrome of short P-R interval, normal QRS NOS complexes, and supraventricular Mobitz (type) I with 2:1 atrioventricular response [block] CC Excl: See code 426.0 Wenckebach’s phenomenon 426.82 Long QT syndrome CC Excl: See code 426.0 AHA: 4Q, ’05, 72 DEF: Wenckebach’s phenomenon: impulses generated at constant rate to sinus node, P-R interval lengthens; DEF: Condition characterized by recurrent , results in cycle of ventricular inadequacy and shortened malignant , and sudden death; characteristic P-R interval; second-degree A-V block commonly called prolonged Q-T interval on electrocardiogram. "Mobitz type 1.” 426.89 Other CC 426.2 <¥Left> bundle branch hemiblock Dissociation: Block: atrioventricular [AV] left anterior fascicular interference left posterior fascicular isorhythmic Nonparoxysmal AV nodal tachycardia CC Excl: See code 426.0

11 MCV for DRGs 547, 549, 553, 555, and 557 only. ' MCV wx l s k Additional Digit Required Nonspecific PDx Unacceptable PDx Manifestation Code Major Cardiovascular Condition Revised Text New Code Revised Code Title 2007 ICD•9•CM October 2006 • Volume 1 — 127 07 ICDv3 H 7/11/06 3:50 PM Page 112

37.83–37.98 OPERATIONS ON THE CARDIOVASCULAR SYSTEM Tabular List

Insertion of Pacemaker Automatic Implantable Cardioverter/Defibrillator

Subclavian Intravascular Lead vein electrode leads in Pulse subclavian vein generator (pacemaker) in subcutaneous pocket

Pulse generator Pacing electrode lead

Electrode Defibrillation electrode lead 17 37.83 <¥Initial> insertion of dual-chamber device 37.92 Injection of therapeutic substance into heart Atrial ventricular sequential device 37.93 Injection of therapeutic substance into EXCLUDES replacement of existing pacemaker device 37.94 Implantation or replacement of automatic (37.85-37.87) ¥> AHA: 2Q, ‘97, 4 ¥cardioverter/defibrillator,> total system ¥[AICD]> 37.85 ¥Replacement> of any type pacemaker device wNote: Device testing during procedure— ¥with> single-chamber device, not specified as omit codex ¥rate> responsive Implantation of defibrillator with leads 37.86 ¥Replacement> of any type pacemaker device (epicardial patches), formation of pocket (abdominal fascia) (subcutan- ¥with> single-chamber device, rate responsive Rate responsive to physiologic stimuli other eous), any transvenous leads, intra- than atrial rate operative procedures for evaluation of lead signals, and obtaining 37.87 ¥Replacement> of any type pacemaker device defibrillator threshold measurements ¥with> dual-chamber device Techniques: Atrial ventricular sequential device lateral thoracotomy 37.89 ¥Revision> or removal of pacemaker device medial sternotomy Removal without replacement of cardiac re- subxiphoid procedure synchronization pacemaker device Code also extracorporeal circulation, if [CRT-P] performed (39.61) Repair of pacemaker device Code also any concomitant procedure [e.g., EXCLUDES removal of temporary trans- coronary bypass] (36.01-36.19) venous pacemaker EXCLUDES implantation of cardiac resyn- system — omit code chronization defibrillator, replacement of existing pacema- total system [CRT-D] ker device (37.85-37.87) (00.51) replacement of existing pace- AHA: 2Q, ‘03, 19; 3Q, ‘01, 5-7; 3Q, ‘99, 12; 1Q, ‘99, 3; maker device with CRT-P 3Q, ‘90, 11; S-O, ‘87, 5 37.83–37.98 Operations on the Cardiovascular System pacemaker device (00.53) DEF: Direct insertion, of defibrillator/cardioverter system AHA: N-D, ‘86, 1 to deliver shock and restore heart rhythm. ' 37.9 Other operations on heart and pericardium 37.95 ¥Implantation> of automatic AHA: 3Q, ‘90, 11 ¥cardioverter/defibrillator> lead(s) only AHA: 3Q, ‘90, 11 37.90 <¥Insertion> of left atrial appendage device Left atrial filter Transseptal catheter 37.96 ¥Implantation> of automatic cardioverter/ Left atrial occluder technique ¥defibrillator> pulse generator only AHA: 4Q, ’04, 121 wNote: Device testing during procedure— DEF: Implantation of a filtering device within the left omit codex atrial appendage (LAA) to block emboli from exiting the EXCLUDES implantation or replacement of LAA causing stroke or systemic thromboembolism. cardiac resynchron- ization defibrillator, pulse 37.91 ¥Open> chest cardiac massage generator device only EXCLUDES closed chest cardiac massage [CRT-D] (00.54) (99.63) AHA: 3Q, ‘90, 11 AHA: 4Q, ‘88, 12 DEF: Massage of heart through opening in chest wall to 37.97 ¥Replacement> of automatic reinstate or maintain circulation. ¥cardioverter/defibrillator> lead(s) only EXCLUDES w replacement of epicardial lead Left Atrial Appendage Device Insertion [electrode] into Left atrial Left epicardium (37.74) appendage atrium replacement of transvenous lead [electrode] into left ventricular coronary venous system (00.52)x AHA: 3Q, ’05, 3-9; 3Q, ‘90, 11 Right 37.98 <¥Replacement> of automatic cardioverter atrium ¥defibrillator> pulse generator only wNote: Device testing during procedure— omit codex EXCLUDES replacement of cardiac resyn- Delivery Device chronization defibrillator, catheter implanted pulse generator device in left atrial only [CRT-D] (00.54) appendage AHA: 1Q, ‘99, 3; 3Q, ‘90, 11

17 Valid OR procedure code if accompanied by one of the following codes: 37.70, 37.71, 37.73, 37.76

BI Bilateral ProcedureNC Non-covered ProcedureLC Limited Coverage Procedure wx Revised Text l New Code s Revised Code Title 112 — Volume 3 • October 2006 2007 ICD•9•CM IHEU IHES IHP Front Matter 7/13/06 12:02 PM Page xvi

Summary of AHA’s Coding Clinic for ICD-9-CM Topics

The following overview of topics represents a brief summary of the topics Dural Tear/ Postoperative Pseudomeningocele presented in AHA’s Coding Clinic for ICD-9-CM, first quarter 2006. Please refer Pseudomeningocele is a postoperative complication that occurs secondarily to to the Coding Clinic for the full discussion, including the coding question, a dural tear that was a result of spinal disc or spinal stenosis surgery, coding scenarios, and official advice. traumatic injury, or tumor removal. Assign the code for central nervous system complication and an additional code for disorders of the meninges to Bilateral Carotid Artery Stenosis further describe the pseudomeningocele. Assign both code 433.10 Occlusion and stenosis of precerebral arteries, Carotid artery, without mention of cerebral infarction, and code 433.30 Emergency Department Encounter Secondary to Trauma Occlusion and stenosis of precerebral arteries, Multiple and bilateral, without Trauma does not always indicate injury, and the physician should be queried mention of cerebral infarction, to completely capture artery specificity and for more specific information when assigning a code describing the reason for laterality for bilateral carotid artery stenosis. the encounter for diagnostic testing. It is appropriate to assign a code for presenting symptoms. In the absence of symptoms and if there are no Bipolar Disorder Depressed with Moderate Stress findings after the diagnostic test has been performed, assign V71.4 The fifth-digit code assignment for episodic mood disorders (296) describes Observation following other accident, as the reason for the encounter. the severity of illness. In order to assign a specific fifth-digit, the documentation must specify the severity of illness; otherwise, assign a fifth- Inflammation of Spinal Canal (Myelitis) digit of 0, unspecified. Currently ICD-9-CM does not distinguish between myelitis and encephalitis. New codes for fiscal 2007 have been created that differentiate between Birdshot Chorioretinopathy encephalitis/encephalomyelitis and myelitis due to infection, immunization Birdshot chorioretinopathy is a rare, potentially serious, inflammatory procedures, and toxic drugs. disorder of the choroids and retina, possibly of autoimmune etiology, characterized by multiple cream-colored lesions. Other symptoms include Interbody Spinal Fusion with Stem Cell Aspiration vitreous hemorrhage, choroidal neovascularization, vitritis, retinal Bone marrow aspirate from the iliac crest that is combined with vasculopathy, cystoidal macular edema, and papilledema. There is a strong demineralized bone graft material to form a paste is applied during spinal association with human leukocyte antigen-A29. Assign two codes to describe fusion to assist in the formation of bone tissue at the site of the fusion. This birdshot chorioretinopathy: 363.8 Other disorders of choroids, and 362.10 demineralized bone marrow aspirate and bone graft combination is not Background retinopathy, unspecified. recombinant morphogenic (rhBMP) protein. Nor is this process considered bone marrow stem cell transplant in which the stem cells are used to treat Bone Flap Removal and Replacement Status Post cancer. Decompressive Hemicraniectomy for Head Trauma The correct code assignment for the application of bone marrow aspirate with For the initial decompression hemicraniectomy admission following head demineralized bone to enhance new bone tissue formation is 99.79 trauma, assign the appropriate code for the trauma. Then assign code 01.25 Therapeutic apheresis or other injection. When performed as part of a spinal Other craniectomy, for the decompressive hemicraniectomy and bone flap, fusion or re-fusion procedure, code 99.79 is coded in addition to the primary which is removed and then saved in a bone bank for reimplantation during a spinal fusion procedure. subsequent operative session. Upon readmission for the reimplantation of the saved bone flap, assign code 738.19 Other acquired deformity of the head, as the principal diagnosis. Assign code 02.06 Other cranial osteoplasty, for the NeuraWrap Nerve Protector hemicranioplasty using the saved bone flap for the reimplantation procedure. NeuraWrap is an absorbable collagen implant that provides a nonconstricting encasement for injured peripheral nerves. Code assignment is 04.79 Other Brittle Diabetes neuroplasty. The term “brittle” is a nonessential modifier under the main term “Diabetes, diabetic” in the Alphabetic Index, therefore the term does not affect code Nonmaturing Dialysis Fistula assignment. Assign the appropriate diabetes code according to documented A nonmaturing fistula may occur in 25 percent to 40 percent of cases due information with regard to complications, type of diabetes, and whether it is primarily to narrowing of a vein or presence of multiple competing veins. stated as uncontrolled, or not stated as uncontrolled. Balloon angioplasty is the preferred treatment option for narrowing the vein. Other options include revision of the AV fistula, creation of a new arteriovenous fistula, or closing off the competing veins using various Coding from Pathology Reports techniques. The diagnosis code assignment of nonmaturing dialysis fistula is For inpatient admission, coders should not code metastatic sites or other 996.1 Mechanical complication of other vascular device. The procedure code abnormal findings based upon pathology reports without confirmation of the assignment is determined by the treatment option chosen. clinical significance by the attending physician. Prenatal Teeth Coding Specific Site of Pain for Encounter for Diagnostic Natal, fetal, or prenatal teeth refer to teeth that are present upon birth.. Tests These teeth may be removed after birth to prevent aspiration of the teeth. Coding guidelines specify that coders must assign codes based upon what is Two codes are required since the index does not provide a specific code for known at the time. If pain is the reason a physician orders a diagnostic test, prenatal teeth. Assign codes 779.89 Other specified conditions originating in code the pain to the site being examined. Coders may use the radiology the perinatal period, as well as code 520.6 Disturbances in tooth eruption. report to provide greater specificity. In the outpatient setting, once the physician has interpreted the findings, the diagnosis may be modified. Pseudoaddiction There is no ICD-9-CM code classification for “pseudoaddiction,” nor does the Correct Coding of Mass, Lump, or Lesion American Psychiatric Association recognize the term. Assign a code for any Coders should follow the index cross-references when assigning a code for a presenting symptoms. diagnosis of “mass,” “lesion,” or “lump.” It is inappropriate to refer to the neoplasm table for code selection in these cases. If there is no specific index Possible or Probable Malignancy entry for the affected organ or site under “mass,” “lump,” or “lesion,” then If diagnosis upon discharge from inpatient admission is stated as “probable,” look for the organ or site under “Disease, diseased.” “possible,” “suspected,” “likely,” or “still to be ruled out,” code as if the condition was established. This rule applies to unconfirmed malignancies. The exceptions to this guideline are cases of HIV infection.

xvi 2007 ICD•9•CM a Pharmlisting 7/13/06 3:32 PM Page 1 Pharmacological Listings Pharmacological Listings

Pharmacology Considerations Medications are listed by classification and brand name for each of the chapters of ICD-9-CM. The list includes many of the common medications and should not be considered exhaustive. The pharmacology considerations that follow are presented as guidance only for the recognition of the link between implication of disease process and treatment. Fulvicin P/G Fungilin Roferon-A Thioguanine Infectious and Parasitic Diseases Fungizone Fungoid Xeloda (001-139) Grifulvin Grisactin Cytotoxic Agents Gris-PEG Lamisil AIDS Related Complex (ARC) Therapeutic Adriamycin BiCNU Lotrimin Lotrisone CeeNU Cerubidine Agents Monistat Mycelex-G Cytosar-U Doxorubicin Agenerase Crixivan Mycolog Mycostatin Gemzar Hexalen Epivir Fortovase Nilstst Nizoral Hydrea Intron A Hivid Intron A Spectazole Sporanox Invirase Norvir Matulane Mutamycin Pentam Rescriptor Tuberculosis Preparations Myleran Novantrone Retrovir Rimactane Capastat INH Tablets Paraplatin Platinol Roferon-A Sustiva Lamprene Laniazid Zanosar Videx Viracept Myambutol Mycobutin Hormones Priftin Pyrazinamide Vitravene Zerit Arimidex Aromasin Rifadin Rifamate Ziagen Zovirax Depo-Provera Eligard Rimactane Seromycin Emcyt Estinyl Antibiotics Sodium P.A.S. Streptomycin Estradurin Fareston Achromycin-V Amikin Trecator-SC Amoxicillin Amoxil Lupron Megace Ampicillin Ancef Viral Agents Stilphostrol Teslac Augmentin Azactam Abreva Agenerase Zoladex Bactrim Bicillin Combivir Crixivan Nitrogen Mustard Derivatives Cytovene Emtriva Biocef Ceclor Alkeran Cytoxan Epivir Famvir Cefizox• Cefobid Leukeran Mustargen Flumadine Fortovase Cefotan Ceftin Neosar Thiotepa Chloromycetin Cipro Foscavir Fuzeon Claforan Cleocin Herplex Hepsera Steroids and Combinations Duricef E-Mycin Hivid Invirase Celestone Soluspan ERYC Ery-Tab Lexiva Norvir Other Relenza Rescriptor Erythromycin Factive Camptosar DTIC-Dome Floxin Fortaz Retrovir Reyataz Sustiva Symmetrel Elspar Etopophos Garamycin Levaquin Iressa Navelbine Macrobid Maxipime Tamiflu Valtrex Videx Viracept Oncaspar Oncovin Mefoxin Minocin Phosphocol P32 Photofrin Nebcin Neo-fradin Viramune Virazole Vistide Vitravene Proleukin Rituxan PCE Dispertab Penicillin G Semzar Taxol Penicillin V Pfizerpen Zerit Ziagen Zovirax Taxotere TICE Pipracil Primaxin Velban Velcade Proloprim Septra Neoplasms (140-239) VePesid Vesanoid Spectrobid Suprax Vumon Synersid Tazicef Adjunct Tazidime Terramycin Anzemet Arrestin Endocrine, Nutritional and Metabolic Tetracycline HCl Ticar Compazine Epogen Diseases and Immunity Disorders Timentin Totacillin Ergamisol Kytril Trimox Trimpex Leukine Martinol (240-279) Unasyn Unipen Metastron Neumega Acidifier and Alkalinizers Vancocin Vibramycin Neupogen Procrit Ammonium chloride Citrocarbonate Vibra-Tabs Wycillin Prokine Quadramet Sodium bicarbonate Sodium lactate Zefazone Zinacef Reglan Relcomide Tham Zithromax Zosyn Salagen Sandostatin Zymar Zinecard Zofran Antigout Agents Antiparasitics Androgen Inhibitor Anturane Benemid Colchicine Probalan Antiminth Aralen Casodex Eulexin Zyloprim Daraprim Flagyl Lupron Nilandron G-well Helidac Zoladex Antilipemics MepronnebuPent Pentam 300 Antibiotic Derivatives atorvastatin calcium fluvastatin sodium Penticarinat Pin-X Lescol Lipitor Adriamycin Blenoxane Protostat Vermox lovastatin Mevacor Cerubidine Cosmegen Pravachol pravastatin sodium Corticosteroids Doxorubicin Idamycin simvastatin Tricor Aristocort Celestone Mutamycin Mithracin Vytorin Zetia Cortastat Cortef Nipent Novantrone Zocor Cortenema Cortone Acetate Pacis Rubex Dalalone Decadron TheraCys Antioxidants Deltasone Depo-Medrol Antiestrogen Aquasol E Calcium-D Florinef acetate Hydeltrasol Calcium Health Packs Carotene-E Femara Nolvadex Hydrocortisone Hydrocortone Carotene Health Packs Glutathione Medralone Medrol Antimetabolites Performance Packs Pure-E Orasone Predalone Adrucil Cytarabine Appetite Suppressants Prednisone Prelone Cytosar-U Droxia Adipex-P Adipost Protocort Solu-Cortef Efudex Folex Biphetamine Bontril Fludara Fluoroplex Fungal Medications Desoxyn Didrex Fluorouracil FUDR Abelcet AmBisome Fastin Ionamin Intron A Leustatin Amphocin Amphotec Mazanor Meridia Methotrexate Purinethol Ancobon Diflucan Phentride Plegine

2007 ICD•9•CM Resources — 1