The October 1, 2009, updates to the ICD-9-CM volume 1 and volume 3 code sets have been released via the ICD-9-CM Tabular Addenda and the FY 2010 Final Addenda. An ICD-9-CM code is required for all professional claims and for all institutional claims; however, an ICD-9-CM code is not required for ambulance supplier claims. New procedure codes include: 17.51, 33.73 and 46.87 and new diagnosis codes include: 209.70, 453.50, and V15.52.

CMS has determined that open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and open and laparoscopic biliopancreatic diversion with duodenal switch in Medicare beneficiaries who have type 2 diabetes mellitus (T2DM) and a body mass index (BMI) less than 35 is no longer considered reasonable and necessary. It has been determined that these same procedures do improve health in patients with T2DM with a BMI greater than 35 so they are still considered reasonable and necessary in those situations.

CMS has decided there is no longer a need to distinguish between diagnostic and therapeutic clinical trial services. This decision by CMS goes into effect July 10, 2009 and applies to all claims submitted with dates of service on or after January 1, 2008. The ICD-9 diagnosis code of V70.7 is still required to be reported on all claims that were submitted with either the QV or Q1 modifier.

CMS has determined that open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and open and laparoscopic biliopancreatic diversion with duodenal switch in Medicare beneficiaries who have type 2 diabetes mellitus (T2DM) and a body mass index (BMI) less than 35 is no longer considered reasonable and necessary. It has been determined that these same procedures do improve health in patients with T2DM with a BMI greater than 35 so they are still considered reasonable and necessary in those situations.

The final rule to implement the ICD-10 code set, which was released on January 16, 2009 and them promptly put on hold by the Obama Administration on January 21, 2009 for further review, has been officially released. It has been determined that the effective date will not be extended and the comment period will not be re-opened.

On Wednesday, January 21st, the Obama Administration put the ICD-10 final rule, along with others that are pending, on hold while further review is conducted. Don’t start cheering yet!

It looks like there finally is an official plan to implement the ICD-10 code set in the United States.

CMS Proposes Adopting ICD-10 Codes as Standard

The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) have been proposed to be concurrently adopted as the standard code sets for coding diagnoses and inpatient hospital procedures, respectively.

Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (PubLNo 110-275)

The Social Security Act sections related to the Medicare and Medicaid programs, as published in the CCH Medicare and Medicaid Guide, have been updated to reflect the “Medicare Improvements for Patients and Providers Act of 2008” (MIPPA) (PubLNo 110-275). The law section now includes revisions of existing law, the addition of new sections enacted by MIPPA, and updated amendment notes and histories.

Medicare Improvements for Patients and Providers Act of 2008

On July 15, 2008, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (PubLNo 110-275) was enacted. As a result of this new legislation many payment systems and other Medicare programs were immediately affected. Below is a brief summary of how different providers are affected by this new legislation.