There are approximately 129 new valid diagnosis codes that will become effective
on October 1, 2010. Many of these new additions are found in Chapter 14 among
the codes for congenital anomalies of female genital organs, in Chapter 16 under
symptoms involving the respiratory and digestive systems, and in Chapter 17 for
injuries and poisoning. Significant changes were made to the supplementary classification
chapter. Fifty-five of the new diagnosis codes effective on October 1st are new
V codes.

Expanded Avian and H1N1 Codes

Both avian and H1N1 influenza have been expanded into three codes each. They
now include codes with pneumonia, with other respiratory manifestations, and
with other manifestations.

New Congenital Anomaly Codes

The new codes for congenital anomalies of female genital organs center on unique
codes for Müllerian anomalies, which encompass all congenital anomalies
of the uterus, cervix, and vagina since they stem from the same embryonic origin.
The American Society of Reproductive Medicine recognizes seven types of uterine
anomalies. Only two of the seven recognized types currently have specified codes
in ICD-9-CM, but it is important to be able to differentiate between the anomalies
because of the different gynecologic and obstetric implications they cause.
The creation of new codes for these anomalies is meant to enhance communication
about these conditions, and thereby improve patient care and management for
conception and pregnancy issues.

New Signs and Symptoms Codes

New subcategory additions for symptoms involving the respiratory system expand
hemoptysis, which has previously been used to code both an unspecified pulmonary
hemorrhage and coughing up blood or bloody sputum. The new codes will now supply
separate codes for unspecified hemoptysis (pulmonary hemorrhage NOS) and other
hemoptysis (coughing up blood) as well as identify the rare case of acute idiopathic
pulmonary hemorrhage in an infant over 28 days old.

Codes for symptoms of the digestive system expand fecal incontinence to distinguish
between its different presenting symptoms, particularly incomplete defecation.
A new code for fecal impaction was also created in the digestive system chapter,
and tabular instructions distinguish between different presenting symptoms of
incontinence and the other codes for impaction and constipation, which are not
the same.

Also within Chapter 16, a new subcategory was created for signs and symptoms
involving cognition that would allow the coding of cognitive symptoms related
to other neurologic conditions or traumatic brain injury as supplementary codes
that can present a clinical picture when there is no other more specific diagnosis
available. These codes include cognitive symptoms such as attention or concentration
deficit, visuospatial or psychomotor deficit, and frontal lobe and executive
function deficit.

New Injury and Poisoning Codes

Very important changes within the injuries and poisoning chapter include the
addition of a code specifically for poisoning by cocaine, or crack, 970.81,
since this is a major central nervous system drug responsible for drug abuse
and overdose that has not been specifically referenced in ICD-9-CM.

Category 999 Complications of medical care, not elsewhere classified has significant
new diagnosis codes added for several conditions specifically related to the
transfusion of blood or blood components, such as hemolytic transfusion reaction
or HTR, for which no code currently exists in the classification system. Many
of these transfusion disorders or reactions are currently under-recognized and
under-reported, even though some can become debilitating or cause transfusion-related
deaths. It is critical that these conditions are reported when they occur.

HTR is a blood transfusion reaction that causes an increased destruction of
red blood cells due to some kind of incompatibility between the donor blood
and the recipient. There is currently no provision in the classification system
for distinguishing blood group ABO from non-ABO type hemolytic transfusion reactions,
nor acute from delayed reactions, so unique codes have been created to help
raise increased awareness of the prevalence of these conditions among recipients
of blood transfusions and allow tracking for effectiveness of treatment.

New V Codes

V codes were created to report many new personal history conditions, such as
a personal history of vaginal and vulvar dysplasia, personal history of combat
and operational stress reaction, and personal history of corrected congenital
malformations. The codes for insertion, routine checking, removal, and subsequent
reinsertion of IUDs have been modified into more specific codes in order to
report these encounters more accurately, specifically, the ability to code removal
with immediate reinsertion of IUD.

Body mass index (BMI) codes have also been expanded for reporting adult BMI
measurements over 40 to distinguish specific ranges of BMI between 40 and 69.9,
and 70 and over. This was necessary to track the population of morbid obesity
as Americans are becoming more and more obese.

Two entirely new sections of V codes have been created—V90 Retained Foreign
Body and V91 Multiple Gestation Placenta Status. The new category for retained
foreign bodies reports cases of fragments or splinters embedded in an injured
person that cannot be removed. Because of the potential health risks and hazards
of embedded foreign bodies, the Department of Defense requested new codes to
report an embedded fragment status that would identify the type of material,
such as different types of metal, plastic, or organic matter. Although these
codes are useful mainly for military purposes in cases of injuries from explosive
devices, they are also applicable to any injury resulting in embedded fragments.
The codes for multiple gestation placenta status were instituted to distinguish
the number of placentae and amniotic sacs in cases of twin, triplet, quadruplet
or other specified multiple gestation pregnancies.

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