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by Janet McCarty
Clinicians who must use ICD-9-CM diagnosis codes should use those that are the most complete and accurate-and the more precise, the better. That usually means providing an ICD-9-CM code carried to the fifth digit. Like most private payers, the Centers for Medicare and Medicaid Services (CMS) require all Medicare providers to use ICD-9-CM diagnosis codes with the highest specificity as requested by the Health Insurance Portability and Accountability Act (HIPAA). For example, clinicians using code 784.6 (symbolic dysfunction) to describe language/cognitive impairments of an organic nature may have this code rejected.
Because the code category has five-digit subclassifications, clinicians should select the most specific subcategory. This might be 784.60 (symbolic dysfunction, unspecified), 784.61 (alexia and dyslexia) or 784.69 (other; acalculia, agnosia, agraphia, apraxia). Code 784.69 is intended to include multiple diagnoses, some of which may differ significantly, according to David Berglund, a coding specialist at the National Committee on Vital and Health Statistics at the Centers for Disease Control and Prevention. But this five-digit code provides the greatest specificity in that category and therefore should be used instead of 784.6. Keep in mind that 784.60, 784.61, and 784.69 are subclassifications of 784.6, using them does not exclude 784.6.
Following the specificity rule, assign three-digit codes when there are no four-digit codes within the category. (To date the only three-digit code identified as relevant for ASHA members is 931-foreign body in ear.) For categories with no five-digit codes, assign four-digit codes.
Providers should also be aware that codes marked NOS (not otherwise specified) or "unspecified" indicate that there is insufficient information in the medical record to assign a more specific code. NEC (not elsewhere classifiable) means that ICD-9-CM does not have a code that describes the condition.
Janet McCarty is director of private health plans advocacy. Contact her at jmccarty@asha.org.
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