Accurate ICD-9 Codes for Follow-up and 368.10 Now Joins Palmetto LCD ICD-9 Choices

Read these two scenarios and see what ICD-9 codes apply.

410.31 or 410.32 applies to Follow-Up?

Question: The patient is there in the hospital for a 410.31, and after that is discharged. The patient is arranged to be seen in the office again for a follow-up visit. Concerning this follow-up visit, which is certainly less than 8 weeks from the myocardial infarction, is it suitable to use the fifth digit of "2" on the MI (410.32), or would you still use ICD-9 code 410.31?

Answer: You must use 410.32 (Acute myocardial infarction of inferoposterior wall; subsequent episode of care) for this particular follow-up visit. ICD-9 notes with the 410.xx fifth digit selections state that you must use fifth-digit 2 to specify an episode of care succeeding the initial episode when the patient is admitted for additional observation, evaluation or for treating a myocardial infarction that has been offered initial treatment, but is still less than 8 weeks old."

You must report 410.31 (Acute myocardial infarction of inferoposterior wall; initial episode of care) only in the initial episode of care. The fifth digit "1" is applicable until the patient is discharged, irrespective of where the cardiologist offers the care. Notes in the ICD-9 manual explain that you use "1" for the initial episode of care, irrespective of the number of times a patient may be transferred in the initial episode of care."

In case documentation doesn't mention the episode of care (initial or subsequent), you must use fifth digit "0" (Episode of care unspecified).

In case the patient returns more than eight weeks post infarction, you must use 414.8 (Other specified forms of chronic ischemic heart disease). Notes with this code agree it is suitable for any condition classifiable to 410 defined as chronic, or presenting with symptoms post 8 weeks from date of infarction."

368.10 Joins Palmetto LCD ICD-9 Options

Question: You see a notice that your LCD for Noninvasive Vascular Testing (L31712) was reviewed. How has it changed?

Answer: The Palmetto GBA local coverage determination (LCD) you talk about has had two revisions since September. Both add ICD-9 codes backing up coverage for a variety of services.

For example: The revision adds ICD-9 codes 454.8 (Varicose veins of lower extremities with other complications) and 586 (Renal failure unspecified) to the list of ICD9 codes supporting these particular procedure codes:

93965 (Noninvasive physiologic studies of extremity veins, complete bilateral study (e.g., Doppler waveform analysis with responses to compression and other maneuvers, phleborheography, impedance plethysmography)
93970 (Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study
93971 (Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study)