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Radiology Coding Alert

Add a Fifth Digit to That Hyperplasia Diagnosis

Radiology practices will finally be able to specify prostate hyperplasia and hypertrophy diagnoses, thanks to a new ICD-9 Code series that takes effect Oct. 1. CMS unveiled the new diagnosis codes in the May 19, 2003, Federal Register, revealing dozens of new diagnosis codes that will affect radiology practices.

"Because radiology reads for all of the specialties, we use the whole ICD-9 Codes book," says Linda Thornton, CPC, billing supervisor at St. Louis University's SLUCare. The majority of the new codes, therefore, should apply to radiologists, during either CT studies, x-rays, interventional procedures or radiation oncology.

If a patient presents to the radiologist with prostate hypertrophy or hyperplasia, you can choose from the five codes in the 600.0-600.9 range. Beginning in October, codes 600.1 (Nodular prostate), 600.2 (Benign localized hyperplasia of prostate) and 600.9 (Hyperplasia of prostate, unspecified) are invalid in favor of the following new five-digit codes:
      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.   Because these codes are more specific than the current ICD-9 codes, radiologists should be able to paint a clearer picture of the patients' conditions on their claim forms, telling insurers exactly why certain procedures are medically necessary. Revamp Your Esophagus Codes CMS deletes the four-digit code 530.2 (Ulcer of esophagus) and replaces it for 2004 with two five-digit codes 530.20 (Ulcer of esophagus without bleeding) and 530.21 (Ulcer of esophagus with bleeding). The new ICD-9 will also include an additional "other specified disorders of esophagus" code, designated as 530.85 (Barrett's esophagus). 
The following new codes will also be useful for radiologists who perform interventional procedures, Thornton says. These codes will replace diagnosis code 348.3 (Encephalopathy, unspecified):
348.30 Encephalopathy, unspecified
  348.31 Metabolic encephalopathy
  348.39 Other encephalopathy.   Welcome, 728.87! CMS replaces the unspecified code 728.9 (Unspecified disorder of muscle, ligament and fascia) with 728.87 (Muscle weakness) for 2004. Most physicians are unsure what unspecified codes such as 728.9 include.

"Anytime they take a code that was previously in the 'other' range and specify it, it's going to make coding easier and more precise, which is what we all want for data collection and clear reporting," says Deborah Ovall, CMA, CCS, CIC, coder at the Medical College Hospitals of Ohio at Toledo.

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