PHILADELPHIA — When submitting diagnostic codes, always use the most specific code possible.
If very specific codes are not used, or if they are submitted with one or more less specific codes, payers will often reimburse based on the more general code and ignore anything else, Dr. Gregory L. Barkley said at the annual meeting of the American Epilepsy Society.
Providers should also add a fifth digit to the code when appropriate. The number 1 at the end of a code indicates the condition is intractable—both resistant to cure and so severe, the patient cannot live a normal life, said Dr. Barkley, director of the Comprehensive Epilepsy Center at Henry Ford Hospital in Detroit. For example, an ICD-9 code 345.91 means unspecified, intractable epilepsy. The counterpart code 345.90 is unspecified but not intractable epilepsy.
It's also important to specify what services were provided on each day of care. Several days of treatment should not be presented together. Instead, each day should be dealt with individually, with the charges calculated for each day and the coding clearly showing how the charges were determined. And every facet of care must be itemized for every day it was provided. For example, speaking with a patient can qualify as a hearing assessment. If that is relevant to the case, put this interaction into the claim and the patient's chart, Dr. Barkley advised.
For 2008, new codes include the 359 series for myotonia, including 359.21 for myotonic muscular dystrophy, 359.22 for myotonia congenital, 359.23 for myotonic chondrodystrophy, 359.24 for drug-induced myotonia, and 359.25 for other, specified myotonic disorder.
Also new is the 389 hearing loss series, including 389.05 for conductive hearing loss, unilateral; 389.17 for sensory hearing loss, unilateral; and 389.21 for mixed hearing loss, unspecified. Related is 388.45 for acquired auditory processing disorder.
There are new 787 codes for dysphagia, like 787.20 for dysphagia, unspecified; and 787.23 for dysphagia, pharyngoesophageal phase.
Deleted codes are 359.3, periodic paralysis; 389.14, central hearing loss; and 389.7, deaf, nonspeaking, not elsewhere classifiable.