Most of the changes involve descriptions associated with the ICD-9- codes. There are 171 new codes, 205 code description revisions, and 25 deleted codes.

The highlights of these 2005 codes are detailed herein.

Some of the new codes for 2005 include the much-needed code for allergic rhinitis, due to animal (cat or dog) hair and dander, which is 477.2. There have been additions to the West Nile Fever codes by adding 5^th digits to further explain West Nile Fever, unspecified (066.40), West Nile Fever with encephalitis (066.41) and West Nile Fever with other neurologic manifestation (066.42).

The area of OB/GYN saw the addition of 5^th digits to many of their codes, some of which are:

· 618.00 Cystocele, midline.

· 618.09 Other prolapse of vaginal walls without mention of uterine prolapse.

· 618.82 Incompetence or weakening of rectovaginal tissue.

· 621.31 Simple endometrial hyperplasia, unspecified.

· 622.11 Mild dysplasia of cervix.

· V72.31 Routine gynecological examination.

· V72.40 Pregnancy examination or test, pregnancy unconfirmed.

· V95.08 Nonspecific abnormal Pap smear of cervix, unsatisfactory smear.

The ICD-9-CM 2005 provides us with a code that illustrates a normal Pap Smear following an initial abnormal smear. This code will assist physicians when coding medical necessity of repeat Pap smears:

· V72.32 Encounter for Pap cervical smear to confirm findings of recent normal smear following initial abnormal smear.

Although some areas within the ICD-9-CM 2005 contain major description changes, other changes seem to be cases of "wordsmithing." For example, the code for hormone replacement therapy for the year 2004 is described as V07.4: Postmenopausal hormone replacement therapy. The code for 2005 is described as V07.4: Hormone replacement therapy (postmenopausal).

The code for Decubitus Ulcer, 707.0, has been expanded to nine codes with 5^th digits that identify the location of the ulcer, e.g., Decubitus ulcer, hip (707.04), Decubitus ulcer, ankle (707.06), Decubitus ulcer, buttock (707.05) and so on. Because of the current research, which shows that high levels of C-reactive protein may be an indicator of heart disease, we have also been provided with a new code for reporting an Elevated C-reactive protein (790.95).

Of the 205 revised codes for 2005, we find 40 of them to be for the reporting of Diabetes.

Some of these changes are merely a change in easier-to-understand wording. Phrases such as non-insulin dependent type (NIDDM) and insulin dependent type (IDDM) have been replaced with more simplistic phrases such as Type I and Type II. Physicians need to document whether the patient has Type I or Type II when providing a diagnosis of Diabetes Mellitus.

Other changes for 2005 include changes in the Mental Health section. One area of mental health, bipolar disorders, contains 30 revised descriptions for bipolar disorders. There have also been 18 revised codes for schizophrenia.

There are 25 codes that have been deleted from the 2005 ICD-9-CM book. Most have been altered, either requiring a 5^th digit, or they contain a change in the description. For example, Gynecological examination (V72.3) was deleted and replaced with Routine Gynecological examination (V72.31). Code V72.4 for Pregnancy examination or test, pregnancy unconfirmed, has been deleted and replaced with two codes, V72.40: Pregnancy examination or test, pregnancy unconfirmed and V72.41: Pregnancy examination or test, negative result.

What can your staff do to prepare now for these changes? First, all medical practices should order the 2005 ICD-9-CM book. Once the practice has received the new books, all new codes relating to the specialty of the practice should be reviewed in detail and the appropriate changes should be made in the computer and on the patient encounter form. These new codes should also be discussed with the office staff. Medical necessity is the number one reason for denial on Medicare claims. For a service to be deemed medically necessary, most third-party payors require documentation to support that the service or procedure was medically required and appropriate for diagnosing and treating the patient’s condition, and they must be consistent with the standards of care.

The ICD-10 is quietly looming, waiting for an implementation date for the United States. This update contains major changes in formatting. The ICD-9 codes as we know them today will not be in the same format. All codes under the new system will be in an alphanumeric format, i.e., one letter followed by two numbers at the three character level as opposed to the three numeric characters in the main classification of the ICD-9-CM book. All letters except the letter "U" are used. This new version will use up to six digits instead of the four or five we currently have. This new update will provide an increase in clinical detail from the currently used version. It will contain two new chapters, Diseases of the Eye and Adnexa and Disorders of the Ear and Mastoid Process. Another new feature is in the descriptors. The ICD-10 uses complete descriptions, where the ICD-9-CM uses phrases. This new version represents the need to change not only the codebooks, but the computer software and HCFA forms as well.

No one seems to know when we can expect the implementation date for the ICD-10 to be released. Until that time, we must all continue to follow the biannual updates to the ICD-9-CM, remembering that there is no grace period for implementation.