Many coding changes have gone into effect since October 1; these changes will impact neurology and the way diagnoses are reported. The Academy has been involved in several decisions to update or expand codes.
One major change is the expansion of headache codes. This proposal, brought forth by the American Headache Society, will greatly benefit neurologists: since the code for tension type headache has been removed from chapter 5, a psychiatric diagnosis will only be used if the origin is psychiatric in nature.
This year has also seen a new ICD-9 "V"-code. The Academy advocated for the adoption of the new code, which has been approved by the Centers for Medicare & Medicaid Services (CMS) to identify patients who are given tPA (rt-PA) at a differing institution within 24 hours of an admission for ischemic stroke. There is an immediate need to identify the patients who have tPA initiated in one hospital's emergency room and are then transferred for advanced care at a stroke center—a procedure commonly called "drip and ship."
"The Academy urges hospital billing staff to begin using this code along with the appropriate primary diagnosis code on October 1, when the new V-code goes into effect," said Powers. "The use of this code will allow CMS to determine if modifications to existing DRGs are needed, or if a new set of DRGs is needed, by tracking the number of patients this scenario affects."