New ICD-9-CM procedure codes take effect October 1

by Melanie Endicott, MBA/HCM, RHIA, CCS, CCS-P

Editor’s note: This is the second article of a two-part series about ICD-9-CM code changes that will take effect October 1, 2011. Part two addresses the new procedure codes. Part one focused on new diagnosis codes.

In this last regular annual update to the ICD-9-CM code set before the partial code freeze commences in preparation for ICD-10-CM/PCS, the ICD-9-CM Volume 3 has added 19 new procedure codes. There were also 23 revised codes as well as one deleted code. Note the following code changes that will take effect October 1.

External ventricular drainage

There are two new codes for subcategory 02.2 (ventriculostomy) to distinguish between an external ventricular drain (code 02.21) and an intracranial shunt (02.22). Instead of the code title for existing code 02.39, “other operations to establish drainage of ventricle,” the revised code is for “ventricular shunt to extracranial site [not elsewhere classified]” to better differentiate these procedures.

Use code 02.21 (insertion or replacement of external ventricular drain [EVD]) for procedures such as an EVD set-up, placement of a ventricular catheter for drainage or sampling of cerebrospinal fluid, or for an injection of medication or other substance. Code 02.22 (intracranial ventricular shunt or anastomosis) is appropriate for procedures such as an insertion of a Holter valve into the intracranial system, insertion of a shunt between two intracranial ventricles, or a ventriculocisternostomy.

Aqueous drainage device

New procedure code 12.67 describes the insertion of a sub-conjunctival aqueous drainage shunt. Physicians perform this procedure on patients with glaucoma who have failed medical and surgical interventions to relieve intraocular pressure.

The purpose of this shunt is to capture aqueous fluid from the anterior chamber of the eye and transport the fluid out of the device, where it is eventually absorbed into the lymph and blood vessels around the eye. This is a minimally invasive procedure that physicians can perform using local or topical anesthesia.

Atherectomies

An atherectomy is a minimally invasive catheter-based procedure to remove plaque from arteries. It is particularly useful for cases in which the plaque is very hard due to calcification. To treat a blockage, the physician advances the atherectomy catheter to the blocked area within the artery, and a high-speed rotating device (i.e., burr) or a sharp blade at the tip of the catheter grinds or shaves the plaque away. Multiple passes with the atherectomy catheter may be necessary to remove the plaque from the artery. Following this procedure, the physician may also perform a balloon angioplasty or stent insertion.

Currently, coders use code 00.66 to report both percutaneous transluminal coronary angioplasties (PTCA) and percutaneous transluminal coronary atherectomies. However, beginning October 1, coders should use procedure code 00.66 only for PTCAs. Report new code 17.55 (transluminal coronary atherectomy) for the atherectomy procedure.

Three other new codes describe atherectomies performed on vessels other than the coronary arteries, they are as follows:

  • Code 17.53 (percutaneous atherectomy of extracranial vessel[s])
  • Code 17.54 (percutaneous atherectomy of intracranial vessel[s])
  • Code 17.56 (percutaneous atherectomy of other non-coronary vessel[s])

Take note of new “code also” notes that follow several codes to indicate the appropriate use of the new atherectomy codes (e.g., code also any insertion of coronary artery stents [36.06–36.07]).

Antimicrobial envelope

Physicians often use antimicrobial envelopes during the insertion of pacemakers and defibrillators to reduce postoperative infections. Reference new subcategory 17.8 to describe “other adjunct procedures.” Use new code 17.81 under this subcategory to indicate the insertion of an antimicrobial envelope.

Endovascular and transapical valve replacement

Traditionally, physicians replaced heart valves via open heart surgery. Recently, transcatheter heart valve replacement has emerged as a viable treatment option. During the transcatheter procedure, the native valve is destroyed in situ and the new valve is implanted on top of its remains to replace the native valve’s structure and function. Physicians can use this technique to replace the aortic valve and the pulmonary valve with either an endovascular or transapical approach.

Five new codes under subcategory 35.0 (closed heart valvotomy or transcatheter replacement of heart valve) to describe this new technique:

  • Code 35.05 (endovascular replacement of aortic valve)
  • Code 35.06 (transapical replacement of aortic valve)
  • Code 35.07 (endovascular replacement of pulmonary valve)
  • Code 35.08 (transapical replacement of pulmonary valve)
  • Code 35.09 (endovascular replacement of unspecified heart valve)

Implantable pressure sensor

Use new procedure code 38.26 to report the insertion of implantable pressure sensor without lead for intracardiac or great vessel hemodynamic monitoring. A note under this code states, “The sensor is a standalone device and is not physically connected to a separately implanted monitor.”

Endovascular procedures on vessels

Two new codes under subcategory 39.7 (endovascular procedures on vessels) classify:

  • Procedures in which the vessel is partially or temporarily occluded via an endovascular balloon catheter (code 39.77)
  • Endovascular implantation of branching or fenestrated graft(s) in aorta (code 39.78)

Sleeve gastrectomy

A sleeve gastrectomy, also called vertical sleeve gastrectomy (VSG), is a common procedure physicians use to treat obesity.

During this procedure, the physician removes the greater curvature of the stomach, with the remaining portion of the stomach being approximately the size and shape of a banana. The physician can perform the sleeve gastrectomy as a definitive, one-stage procedure or as the first of a two-stage operation. For the first stage, the physician would perform the sleeve gastrectomy, allowing the patient to lose significant weight prior to undergoing the second procedure, gastric bypass or duodenal switch, several months later.

The new code is 42.82 (laparoscopic vertical [sleeve] gastrectomy).

Uterine artery embolization

Until now, we have not had a unique code to identify uterine artery embolization (UAE). Previously, there was much confusion among coders regarding how to code these procedures correctly. Two new codes may help alleviate this confusion:

  • 68.24 (UAE with coils)
  • 68.25 (UAE without coils)

Access CMS website for complete list of procedure code changes

For further information, obtain new coding books, review the American Hospital Association’s Coding Clinic 4th Quarter 2011, and download the addenda documents with the index and tabular changes. The 2012 addenda with the all the changes to the ICD-9-CM procedure tabular and alphabetic index (Volume 3) is located on the CMS website.

Editor’s note: Melanie Endicott, MBA/HCM, RHIA, CCS, CCS-P, is a professional practice manager at the American Health Information Management Association in Chicago. E-mail questions to Endicott at Melanie.endicott@ahima.org.

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