There are new codes 49082-49083 for Abdominal paracentesis (diagnostic or therapeutic) with and without imaging guidance, and 40824 (Peritoneal lavage, including image guidance when performed).

A complete list of all the changes for 2012 can be found in Appendix B summary of Additions, Deletions, and Revisions found on page 572 of the 2012 CPT book.

ICD-9 Diagnosis Codes for 2011

Effective Oct. 1, 2011, several ICD-9 diagnosis codes became available that are relevant to emergency medicine. A full listing of ICD-9 additions, deletions, and changes may be found at www.cdc.gov/nchs/icd/icd10cm.htm#10update.

Although everyone is anticipating the transition to ICD-10 in October of 2013, there are some useful new diagnosis codes available for emergency physicians to demonstrate medical necessity for their claims based on the latest ICD-9 updates. Consider these ICD-9 code changes for dementia, which more clearly indicate how the disease impacted the care provided in the emergency department, including inability to obtain the normal history or physical exam requirements:

• New sub: 294.2 Dementia, unspecified (excludes mild memory disturbances, not amounting to dementia [310.89])
• New code: 294.20 Dementia, unspecified, without behavioral disturbance
• New code: 294.21 Dementia, unspecified, with behavioral disturbance

These new codes are an additional arrow in the quiver to prove to the payer the medical necessity for the visit.

Other ED-Relevant New ICD-9 codes

These new ICD-9 codes detail influenza with other specific respiratory manifestations:

• 488.81 Influenza due to identified novel influenza A virus with pneumonia
• 488.82 Influenza due to identified novel influenza A virus with other respiratory manifestations
• 488.89 Influenza due to identified novel influenza A virus with other manifestations

These new ICD-9 codes detail causes of anaphylactic shock and other reactions with greater specificity:

• 999.41 Anaphylactic reaction due to administration of blood and blood products
• 999.42 Anaphylactic reaction due to vaccination
• 999.49 Anaphylactic reaction due to other serum
• 999.51 Other serum reaction due to administration of blood and blood products
• 999.52 Other serum reaction due to vaccination
• 999.59 Other serum reaction

These new V codes expand the list of factors influencing health status and contact with health services that could help explain the reason for an ED visit:

• V12.21 Personal history of gestational diabetes
• V12.29 Personal history of other endocrine, metabolic, and immunity disorders
• V12.55 Personal history of pulmonary embolism
• V13.81 Personal history of anaphylaxis
• V13.89 Personal history of other specified diseases
• V23.42 Pregnancy with history of ectopic pregnancy
• V23.87 Pregnancy with inconclusive fetal viability
• V40.39 Other specified behavioral problem

Be sure to review the guide to the 2012 ICD-9 CM Updates published in the front of the diagnosis code, which notes changes effective for 2012. A complete listing of the ICD-9 code changes for 2012 (effective Oct. 1, 2011) is available on the CMS website at www.cms.gov/icd9providerdiagnosticcodes/07_summarytables.asp.

Other Resources

Resources for these and other topics can be found in the reimbursement section of the ACEP website.