Additional ICD-9 Codes Analysis and Processing Direction (Institutional Claims Only)

CR 6851, from which this article is taken, announces that (effective January 1, 2011) CMS is expanding the number of ICD-9 diagnosis and procedure codes processed on institutional claims. This expansion is being done to allow for:

1. Adding additional ICD-9 other (secondary) diagnosis codes (from 8 codes to 24 codes) as well as additional associated present on admission (POA) codes; and
2. Adding additional ICD-9 other (secondary) procedure codes (from 5 codes to 24 codes).

Matt Klischer from CMS, who authored the CR, was contacted for some additional clarification on what the secondary diagnosis codes meant and if the procedure codes represented CPT codes. Here is his response: “Secondary” is another word for “other”. Other ICD-9 diagnosis codes are defined in the UB-04 manual and in the HIPAA 837 institutional implementation guide (IG). There is only 1 principal diagnosis. Other diagnosis information allows for 12 codes per segment and the segment can repeat 2 times (24 codes total). Medicare currently only processes 8 of these codes and with this CR Medicare will process up to 24. ICD-9 procedure codes are not CPT codes.