The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), parts of the Department of Health and Human Services (DHHS), have updated their guidelines effective April 1, 2005. Used by all providers, the new guidelines allow appropriate and uniform code selection when reporting procedures performed in accordance with the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM).

The recent changes should help to clarify, simplify, and permit more specific diagnosis codes to better reflect the complexity of your services. The most significant changes concern the sections on diagnosis coding for patients with diabetes mellitus, cerebral infarction/CVA, and chronic obstructive pulmonary disease (COPD).

Your referring physicians may need to be informed to obtain the additional information, including the type of diabetes. For example, a fifth digit is required for all category 250 series codes. Coders must know if the diabetes is controlled or uncontrolled. The coding for COPD was also made clearer. It directs you to select the most severe condition type, and encourages the use of the patient's chronic condition, such as bronchitis, emphysema, or asthma. When no specifics are available it designates code 496, chronic airway obstruction. More details can be found in the detailed guidelines located at: http://www.cdc.gov/nchs/data/icd9/icdguide.pdf