Department of Health & Program Memorandum Human Services (DHHS) Centers for Medicare & Intermediaries/Carriers Medicaid Services (CMS) Transmittal AB-03-091 Date: JUNE 20, 2003 CHANGE REQUEST 2763 SUBJECT: Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) I. GENERAL INFORMATION A. Background: In 1979, use of ICD-9-CM codes became mandatory for reporting provider services on Form CMS-1450. On April 1, 1989, use of ICD-9-CM codes became mandatory for all physician services submitted on Form CMS-1500. Effective October 1, 2003 (refer to Transmittal B-03- 045, dated June 6, 2003) an ICD-9-CM code is required on all paper and electronic claims billed to Medicare carriers with the exception of ambulance claims (specialty type 59). The ICD-9-CM codes are updated annually. The CMS sends the ICD-9-CM Addendum out to the regional offices and Medicare contractors annually. B. Policy: This instruction serves as a reminder to Medicare contractors regarding the annual ICD-9-CM coding update to be effective for dates of service on or after October 1, 2003. The Addendum containing the new and revised codes is being sent as an attachment to this instruction. An ICD-9-CM code is now required for all professional claims, e.g., physicians, non-physician practitioners, independent clinical diagnostic laboratories, occupational and physical therapists, independent diagnostic testing facilities audiologist, and ambulatory surgical centers (ASCs). However, an ICD-9-CM code is not required for ambulance supplier claims. II. BUSINESS REQUIREMENTS • “Shall” denotes a mandatory requirement • “Should” denotes an optional requirement Requirement # Requirements Responsibility 2763.1 Medicare contractors shall install and accept the new and FI and Carrier revised 2003 ICD-9-CM update in order to process claims with dates of service on or after October 1, 2003. 2763.2 Medicare carriers shall accept both the old and new ICD-9- Carrier CM codes for dates of service October 1, 2003, through December 31, 2003. CMS-Pub. 60AB 2763.4 Medicare contractors shall include the CMS Web site FI and Carrier address www.cms.hhs.gov/medlearn/icd9code.asp in their own Web site notices to providers. This CMS Web site will contain the new, revised, and deleted ICD-9-CM codes that are effective for dates of service on or after October 1, 2003. Also, Medicare contractors should encourage providers to visit the National Center for Health Statistics (NCHS) Web site at www.cdc.gov/nchs/icd9.htm. NCHS is expecting to post the ICD-9-CM Addendum on their Web site by June 13, 2003. 2763.5 Medicare carriers shall also include information explaining Carrier the options available to providers for obtaining the updated ICD-9-CM codes. 2763.6 Medicare intermediaries shall encourage/remind hospitals FI to send a copy of the Addendum to the Director of Medical Records. 2763.7 Medicare intermediaries shall handle questions on the FI operation of GROUPER, MCE, and OCE, in accordance with regular procedures. 2763.8 For diagnosis coding questions, Medicare intermediaries FI should contact Donna Pickett or Amy Blum at 301-458- 4200 at NCHS. 2763.9 For procedure coding questions, Medicare intermediaries FI should contact Pat Brooks at 410-786-5318, Ann Fagan at 410-786-5662, or Amy Gruber at 410-786-1542, CMS Division of Acute Care. III. SUPPORTING INFORMATION AND POSSIBLE DESIGN CONSIDERATIONS A. Other Instructions: X-Ref Req. # Instructions N/A B. Design Considerations: X-Ref Req. # Recommendation for Medicare System Requirements N/A C. Interfaces: Grouper v21.0, Medicare Code Editor v20.0, and Outpatient Code Editor v4.3 D. Contractor Financial Reporting /Workload Impact: N/A E. Dependencies: The Addendum is being sent as an attachment to this instruction. IV. Attachment(s): Four Implementation Date: October 1, 2003 Effective Date: October 1, 2003 Discard Date: October 1, 2004 Funding: These instructions should be implemented within your current operating Post-Implementation Contact: budget. Appropriate Regional Office Page 1 of 10 Table 6A - New Diagnosis Codes Diagnosis Description Code 255.10 Primary aldosteronism 255.11 Glucocorticoid-remediable aldosteronism 255.12 Conn’s syndrome 255.13 Bartter’s syndrome 255.14 Other secondary aldosteronism 277.81 Primary carnitine deficiency 277.82 Carnitine deficiency due to inborn errors of metabolism 277.83 Iatrogenic carnitine deficiency 277.84 Other secondary carnitine deficiency 277.89 Other specified disorders of metabolism 282.41 Sickle-cell thalassemia without crisis 282.42 Sickle-cell thalassemia with crisis 282.49 Other thalassemia 282.64 Sickle-cell/Hb-C disease with crisis 282.68 Other sickle-cell disease without crisis 289.52 Splenic sequestration 289.81 Primary hypercoagulable state 289.82 Secondary hypercoagulable state 289.89 Other specified diseases of blood and blood- forming organs 331.11 Pick’s disease 331.19 Other frontotemporal dementia 331.82 Dementia with Lewy bodies 348.30 Encephalopathy, unspecified 348.31 Metabolic encephalopathy 348.39 Other encephalopathy 358.00 Myasthenia gravis without (acute) exacerbation 358.01 Myasthenia gravis with (acute) exacerbation 414.07 Coronary atherosclerosis, Of bypass graft (artery) (vein) of transplanted heart 458.21 Hypotension of hemodialysis 458.29 Other iatrogenic hypotension Page 2 of 10 Diagnosis Description Code 493.81 Exercise induced bronchospasm 493.82 Cough variant asthma 517.3 Acute chest syndrome 530.20 Ulcer of esophagus without bleeding 530.21 Ulcer of esophagus with bleeding 530.85 Barrett’s esophagus 600.00 Hypertrophy (benign) of prostate without urinary obstruction 600.01 Hypertrophy (benign) of prostate with urinary obstruction 600.10 Nodular prostate without urinary obstruction 600.11 Nodular prostate with urinary obstruction 600.20 Benign localized hyperplasia of prostate without urinary obstruction 600.21 Benign localized hyperplasia of prostate with urinary obstruction 600.90 Hyperplasia of prostate, unspecified, without urinary obstruction 600.91 Hyperplasia of prostate, unspecified, with urinary obstruction 607.85 Peyronie’s disease 674.50 Peripartum cardiomyopathy, unspecified as to episode of care or not applicable 674.51 Peripartum cardiomyopathy, delivered, with or without mention of antepartum condition 674.52 Peripartum cardiomyopathy, delivered, with mention of postpartum condition 674.53 Peripartum cardiomyopathy, antepartum condition or complication 674.54 Peripartum cardiomyopathy, postpartum condition or complication 719.7 Difficulty in walking 728.87 Muscle weakness 728.88 Rhabdomyolysis 752.81 Scrotal transposition 752.89 Other specified anomalies of genital organs 766.21 Post-term infant Page 3 of 10 Diagnosis Description Code 766.22 Prolonged gestation of infant 767.11 Epicranial subaponeurotic hemorrhage (massive) 767.19 Other injuries to scalp 779.83 Delayed separation of umbilical cord 780.93 Memory loss 780.94 Early satiety 781.94 Facial weakness 785.52 Septic shock 788.63 Urgency of urination 790.21 Impaired fasting glucose 790.22 Impaired glucose tolerance test (oral) 790.29 Other abnormal glucose 799.81 Decreased libido 799.89 Other ill-defined conditions 850.11 Concussion, with loss of consciousness of 30 minutes or less 850.12 Concussion, with loss of consciousness from 31 to 59 minutes 959.11 Other injury of chest wall 959.12 Other injury of abdomen 959.13 Fracture of corpus cavernosum penis 959.14 Other injury of external genitals 959.19 Other injury of other sites of trunk 996.57 Complication, Due to insulin pump V04.81 Need for prophylactic vaccination and inoculation, Influenza V04.82 Need for prophylactic vaccination and inoculation, Respiratory synctial virus (RSV) V04.89 Need for prophylactic vaccination and inoculation, Other viral diseases V15.87 History of Extracorporeal Membrane Oxygenation (ECMO) V25.03 Encounter for emergency contraceptive counseling and prescription V43.21 Organ or tissue replaced by other means, Heart assist device Page 4 of 10 Diagnosis Description Code V43.22 Organ or tissue replaced by other means, Fully implantable artificial heart V45.85 Insulin pump status V53.90 Fitting and adjustment, Unspecified device V53.91 Fitting and adjustment of insulin pump V53.99 Fitting and adjustment, Other device V54.01 Encounter for removal of internal fixation device V54.02 Encounter for lengthening/adjustment of growth rod V54.09 Other aftercare involving internal fixation device V58.63 Long-term (current) use of antiplatelet/antithrombotic V58.64 Long-term (current) use of non-steroidal anti- inflammatories V58.65 Long-term (current) use of steroids V64.41 Laparoscopic surgical procedure coverted to open procedure V64.42 Thoracoscopic surgical procedure converted to open procedure V64.43 Arthroscopic surgical procedure converted to open procedure V65.11 Pediatric pre-birth visit for expectant mother V65.19 Other person consulting on behalf of another person V65.46 Encounter for insulin pump training E928.4 External constriction caused by hair E928.5 External constriction caused by other object Page 5 of 10 TABLE 6B--NEW PROCEDURE CODES Procedure Description Code 00.15 High-dose infusion interleukin-2 (IL-2) 37.51 Heart transplantation 37.52 Implantation of total replacement heart system 37.53 Replacement or repair of thoracic unit of total replacement heart system 37.54 Replacement or repair of other implantable component of total replacement heart system 68.31 Laparoscopic supracervical hysterectomy (LSH) 68.39 Other subtotal abdominal