Connection supplemental articles and policies - November 2009

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Connection - November 2009 (pdf, 330 KB)

Connection print supplement - November 2009 (pdf, 165 KB)

Supplemental articles

Feds require dependent student coverage for medical leaves
Study reports FCHP outperforms traditional Medicare
Formulary updates: Commercial and Medicare Part D
Coding issue: Operative notes
New ICD-9-CM codes available

Payment policies

The following policies have been reviewed. Changes are indicated on the policies and summarized in the print version of Connection:

Every day affairs

Feds require dependent student coverage for medical leaves

Michelle’s Law (P.L. 110-381) creates a new federal coverage mandate ensuring that dependent students who take a medically necessary leave of absence do not lose health coverage. The law becomes effective for plan years beginning on or after October 1, 2009. For most plans, this means an effective date of January 1, 2010, or July 1, 2010. FCHP will be complying with all implementation and notification provisions of the law. Michelle’s Law applies to group and individual coverage.

Under Massachusetts law, full-time students and/or child federal tax dependents are eligible for dependent coverage until their 26th birthday, or for two years after the end of the calendar year in which such persons last qualified as dependents for federal tax purposes, whichever comes first.

To qualify under Michelle’s Law, the following requirements must be met:

The student must be enrolled as a full-time student immediately before the leave of absence or schedule reduction.
The treating physician must certify in writing that the leave or schedule reduction is necessary due to a severe illness or injury.
The leave or reduced schedule must have triggered the loss of student status under the health plan.

If qualified, the child will continue to be covered until one year from the date the leave of absence begins, or until the date on which the coverage would otherwise end, whichever comes first.

If you have any questions about this change, please call the Provider Relations Department at 1-866-ASK-FCHP, prompt 4.

Study reports FCHP outperforms traditional Medicare

A new analysis shows that Medicare Advantage is controlling costs and ensuring quality of care through lower rates of avoidable hospitalizations.

In the study, authored by Johns Hopkins University researcher Gerald Anderson, Ph.D., and commissioned by the Alliance of Community Health Plans, Fallon Community Health Plan also was found to have significantly lower rates of avoidable hospital readmissions, as well as preventable admissions and emergency department visits than traditional Medicare.

Based on data reported by most of the health plans that are members of ACHP, including FCHP, Medicare Advantage outperformed traditional Medicare in all categories:

On average, the hospital readmission rate for the ACHP Medicare Advantage plans was 27% lower than the national average for traditional Medicare (FCHP’s rate was 18% lower). Hospital readmissions cost Medicare $17.4 billion in 2004.
The ACHP plans had an average preventable emergency department visit rate that was 86% lower than the traditional Medicare national average (FCHP’s rate was 90% lower). The average Medicare payment for an emergency department visit is $510.
On preventable inpatient admissions, the ACHP plans’ average rate was 87% lower than traditional Medicare’s national average (FCHP’s rate was 88% lower). The average Medicare payment per discharge in 2007 was $8,396.

“The fact that, as a Medicare Advantage plan, FCHP is outperforming traditional Medicare on these key metrics is no accident,” said Elizabeth C. Malko, M.D., FCHP’s Senior Vice President and Chief Medical Officer. “In providing care to Medicare beneficiaries, FCHP and its partners, particularly Fallon Clinic, work as a team to achieve these outcomes through very focused efforts. The results of this report confirm that the funding Medicare Advantage health plans receive is a real investment in the health of this country’s Medicare beneficiaries.”

To review the full report, The Benefits of Care Coordination: A Comparison of Medicare Fee-for-Service and Medicare Advantage, please go to Alliance of Community Health Plans Web site at achp.org.

Script alert

Formulary updates

Fallon Community Health Plan often makes changes to its formularies, including changing prior authorization requirements and adding new medications.

Commercial plan formulary

Additions

Product description	Details
Acuvail (ketorolac) 0.45%	Tier 3
Afinitor (everolimus)	Tier 3, PA required
Alvesco (ciclesonide)	Tier 3, PA required
Aplenzin (bupropion HBr)	Tier 3, PA required
Epiduo (adapaline/bp)	Tier 3, PA required
Gelnique (oxybutynin)	Tier 3, PA required
Kapidex (dexlansoprazole)	Tier 3, PA required
Nuvigil (armodafinil)	Tier 3, PA required
Onglyza (saxagliptin)	Tier 3, QLL 30, Must have used other diabetic meds
Plan B One Step	Tier 3, 1 per fill, Age restriction
Ryzolt (tramadol biphasic)	Tier 3, PA required
Savella (milnacipran)	Tier 3, PA required
Simponi (golimumab)	Tier 3, PA required
Trilipix (choline fenofibrate)	Tier 3, PA required
Vectical (calcitriol)	Tier 3, PA required

Changes

Product description	Changes
Mobic (meloxicam)	PA removed
Aclovate	Tier change from 2 to 3
Brevoxyl Cleansing	Tier change from 2 to 3
Cafergot	Tier change from 2 to 3
Carmol	Tier change from 2 to 3
Cipro	Tier change from 2 to 3
Coreg	Tier change from 2 to 3
Effexor	Tier change from 2 to 3
Glucotrol	Tier change from 2 to 3
Glucovance	Tier change from 2 to 3
Macrobid	Tier change from 2 to 3
Norvasc	Tier change from 2 to 3
Paxil	Tier change from 2 to 3
Vantin	Tier change from 2 to 3
Wellbutrin-SR	Tier change from 2 to 3
Zoloft	Tier change from 2 to 3

New to Market policy*

Adcirca (tadalafil)
Embeda (morphine/naltrexone)
Extavia (interferon beta-1B)
Multaq (dronedarone)
Onsolis (fentanyl buccal film)
Ryzolt (tramadol biphasic)
Sabril (vigabatrin)
Saphris (asenapine)
Tyvaso (treprostinil inhal)
Zipsor (diclofenac potassium)

* FCHP’s New to Market policy was enacted to ensure patient safety and to allow for adequate time for the development, review and approval of clinical criteria. When a new medication first becomes available, it will fall under this policy and be excluded from coverage. A process is in place that allows for the quick review of provider requests for non-covered pharmaceuticals.

Medicare Part D formulary

Product description	Effective date of change	Changes
Afinitor 10 mg tablets	07/01/09	Added, Tier 3, PA required
Afinitor 5 mg tablets	07/01/09	Added, Tier 3, PA required
Aptivus 100 mg/ml SOLN	08/01/09	Added, Tier 3
Banzel 200 mg tablets	07/01/09	Added, Tier 3, PA required
Banzel 400 mg tablets	07/01/09	Added, Tier 3, PA required
Bicalutamide 50 mg tablets	08/01/09	Added, Tier 1
Carbamazepine ER 200 mg TB12	07/01/09	Added, Tier 1
Carbamazepine ER 400 mg TB12	07/01/09	Added, Tier 1
Colestipol HCL for oral suspension 5 gm pack	07/01/09	Added, Tier 1
Degarelix 120 mg SOLR	07/01/09	Added, Tier 3, PA required
Degarelix 80 mg SOLR	07/01/09	Added, Tier 3, PA required
Exforge HCT 10 mg; 12.5 mg; 160 mg tablets	07/01/09	Added, Tier 3, QL 30 per 30 days
Exforge HCT 10 mg; 25 mg; 160 mg tablets	07/01/09	Added, Tier 3, QL 30 per 30 days
Exforge HCT 10 mg; 25 mg; 320 mg tablets	07/01/09	Added, Tier 3, QL 30 per 30 days
Exforge HCT 5 mg; 12.5 mg; 160 mg tablets	07/01/09	Added, Tier 3, QL 30 per 30 days
Exforge HCT 5 mg; 25 mg; 160 mg tablets	07/01/09	Added, Tier 3, QL 30 per 30 days
Flovent Diskus 100 mcg/blist AEPB	08/01/09	Added, Tier 2
Flovent Diskus 250 mcg/blist AEPB	08/01/09	Added, Tier 2
Flovent Diskus 50 mcg/blist AEPB	08/01/09	Added, Tier 2
Gavilyte-G SOLR	08/01/09	Added, Tier 1
Liothyronine Sodium 25 mcg tablets	08/01/09	Added, Tier 1
Liothyronine Sodium 50 mcg tablets	08/01/09	Added, Tier 1
Liothyronine sSodium 5 mcg tablets	08/01/09	Added, Tier 1
Mycophenolate Mofetil 250 mg capsules	07/01/09	Added, Tier 1, PA required
Mycophenolate Mofetil 500 mg tablets	07/01/09	Added, Tier 1, PA required
Nitro-Bid 2% ointment	08/01/09	Added, Tier 3
Prezista 75 mg tablets	07/01/09	Added, Tier 3
Ribasphere 400 mg tablets	07/01/09	Tier change from 3 to 1
Ribasphere 600 mg tablets	07/01/09	Tier change from 3 to 1
Risperidone ODT 0.25 mg TBDP	08/01/09	Added, Tier 2, QL 60 per 30 days
Risperidone ODT 0.5 mg TBDP	07/01/09	Added, Tier 1, QL 60 per 30 days
Risperidone ODT 2 mg TBDP	07/01/09	Added, Tier 1, QL 60 per 30 days
Risperidone ODT 3 mg TBDP	08/01/09	Added, Tier 1, QL 60 per 30 days
Risperidone ODT 4 mg TBDP	08/01/09	Added, Tier 1, QL 60 per 30 days
Seconal 100 mg capsules	07/01/09	Added, Tier 3
Seroquel XR150 mg TB24	08/01/09	Added, Tier 3
Seroquel XR 50 mg TB24	08/01/09	Added, Tier 3
Sprycel 100 mg tablets	07/01/09	Added, Tier 3, PA required
Stavudine 1 mg/ml SOLR	07/01/09	Added, Tier 1
Suprax 400 mg tablets	07/01/09	Added, Tier 3
Topiramate 100mg tablets	07/01/09	Added, Tier 1
Topiramate 15 mg CPSP	07/01/09	Added, Tier 1
Topiramate 200 mg tablets	07/01/09	Added, Tier 1
Topiramate 25 mg CPSP	07/01/09	Added, Tier 1
Topiramate 25 mg tablets	07/01/09	Added, Tier 1
Topiramate 50 mg tablets	07/01/09	Added, Tier 1
Tri-Lo-Sprintec tablets	08/01/09	Added, Tier 1
Ursodiol 250 mg tablets	08/01/09	Added, Tier 1
Ursodiol 500 mg tablets	08/01/09	Added, Tier 1
Vimpat 100 mg tablets	07/01/09	Added, Tier 3, PA required
Vimpat 150 mg tablets	07/01/09	Added, Tier 3, PA required
Vimpat 200 mg tablets	07/01/09	Added, Tier 3, PA required
Vimpat 50 mg tablets	07/01/09	Added, Tier 3, PA required

Coding corner

Coding issue: Operative notes

At times, a claim is rejected for incomplete procedure notes. This is done when the operative/procedure notes are missing significant pieces of information necessary to confirm the CPT codes billed.

The physician may go back, review his/her documentation and make an amendment, based on other supporting chart documentation. Please be aware this amendment to the procedure note is not done to support the coding, but rather to complete the documentation. The amendment must be done only by the provider, and must be initialed and dated indicating when the amendment was made.

This additional documentation must be faxed with a request for further review to our Claims Nurse reviewer at 1-508-797-4292, attention: Chris. A careful review of all operative/procedure notes for completeness before they are filed in the patient record is recommended.

New ICD-9-CM codes available

The annual update of the ICD-9-CM diagnosis and procedure codes is effective for dates of service on or after October 1, 2009. An ICD-9-CM diagnosis code is required on all paper and electronic claims billed to Fallon Community Health Plan.

New ICD-9-CM diagnostic codes, effective October 1, 2009

CODE	DESCRIPTION
209.31	MERKEL CELL CARCINOMA OF THE FACE
209.32	MERKEL CELL CARCINOMA OF THE SCALP AND NECK
209.33	MERKEL CELL CARCINOMA OF THE UPPER LIMB
209.34	MERKEL CELL CARCINOMA OF THE LOWER LIMB
209.35	MERKEL CELL CARCINOMA OF THE TRUNK
209.36	MERKEL CELL CARCINOMA OF OTHER SITES
209.70	SECONDARY NEUROENDOCRINE TUMOR, UNSPECIFIED SITE
209.71	SECONDARY NEUROENDOCRINE TUMOR OF DISTANT LYMPH NODES
209.72	SECONDARY NEUROENDOCRINE TUMOR OF LIVER
209.73	SECONDARY NEUROENDOCRINE TUMOR OF BONE
209.74	SECONDARY NEUROENDOCRINE TUMOR OF PERITONEUM
209.75	SECONDARY MERKEL CELL CARCINOMA
209.79	SECONDARY NEUROENDOCRINE TUMOR OF OTHER SITES
239.81	NEOPLASMS OF UNSPECIFIED NATURE, RETINA AND CHOROID
239.89	NEOPLASMS OF UNSPECIFIED NATURE, OTHER SPECIFIED SITES
274.00	GOUTY ARTHROPATHY, UNSPECIFIED
274.01	ACUTE GOUTY ARTHROPATHY
274.02	CHRONIC GOUTY ARTHROPATHY WITHOUT MENTION OF TOPHUS (TOPHI)
274.03	CHRONIC GOUTY ARTHROPATHY WITH TOPHUS (TOPHI)
277.88	TUMOR LYSIS SYNDROME
279.41	AUTOIMMUNE LYMPHOPROLIFERATIVE SYNDROME
279.49	AUTOIMMUNE DISEASE, NOT ELSEWHERE CLASSIFIED
285.3	ANTINEOPLASTIC CHEMOTHERAPY INDUCED ANEMIA
348.81	TEMPORAL SCLEROSIS
348.89	OTHER CONDITIONS OF BRAIN
359.71	INCLUSION BODY MYOSITIS
359.79	OTHER INFLAMMATORY AND IMMUNE MYOPATHIES, NEC
372.06	ACUTE CHEMICAL CONJUNCTIVITIS
416.2	CHRONIC PULMONARY EMBOLISM
438.13	LATE EFFECTS OF CEREBROVASCULAR DISEASE, DYSARTHRIA
438.14	LATE EFFECTS OF CEREBROVASCULAR DISEASE, FLUENCY DISORDER
453.50	CHRONIC VENOUS EMBLSM & THROMBOSIS OF UNS VESSEL OF LOW EXT
453.51	CHRONIC VENOUS EMBLSM & THROMBOSIS OF VESSEL OF PROX LOW EXT
453.52	CHRONIC VENOUS EMBLSM & THROMBOSIS OF VESSEL DISTAL LOW EXT
453.6	VENOUS EMBLSM & THROMBOSIS OF SUPRFCL VESSELS OF LOW EXT
453.71	CHRONIC VENOUS EMBLSM & THROMBOSIS OF SUPRFCL VEIN OF UP EXT
453.72	CHRONIC VENOUS EMBLSM & THROMBOSIS OF DEEP VEINS OF UP EXT
453.73	CHRONIC VENOUS EMBLSM & THROMBOSIS OF UP EXT, UNS
453.74	CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF AXILLARY VEINS
453.75	CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF SUBCLAVIAN VEINS
453.76	CHRONIC VENOUS EMBLSM & THROMBOSIS OF INTERNAL JUGULAR VEINS
453.77	CHRONIC VENOUS EMBLSM & THROMBOSIS OF OTH THORACIC VEINS
453.79	CHRONIC VENOUS EMBLSM & THROMBOSIS OF OTH SPECIFIED VEINS
453.81	ACUTE VENOUS EMBLSM & THROMBOSIS OF SUPRFCL VEINS OF UP EXT
453.82	ACUTE VENOUS EMBLSM & THROMBOSIS OF DEEP VEINS OF UP EXT
453.83	ACUTE VENOUS EMBLSM & THROMBOSIS OF UP EXT, UNS
453.84	ACUTE VENOUS EMBOLISM AND THROMBOSIS OF AXILLARY VEINS
453.85	ACUTE VENOUS EMBOLISM AND THROMBOSIS OF SUBCLAVIAN VEINS
453.86	ACUTE VENOUS EMBLSM & THROMBOSIS OF INTERNAL JUGULAR VEINS
453.87	ACUTE VENOUS EMBOLISM AND THROMBOSIS OF OTHER THORACIC VEINS
453.89	ACUTE VENOUS EMBLSM & THROMBOSIS OF OTH SPECIFIED VEINS
488.0	INFLUENZA DUE TO IDENTIFIED AVIAN INFLUENZA VIRUS
488.1	INFLUENZA DUE TO IDENTIFIED NOVEL H1N1 INFLUENZA VIRUS
569.71	POUCHITIS
569.79	OTHER COMPLICATIONS OF INTESTINAL POUCH
569.87	VOMITING OF FECAL MATTER
621.34	BENIGN ENDOMETRIAL HYPERPLASIA
621.35	ENDOMETRIAL INTRAEPITHELIAL NEOPLASIA [EIN]
670.10	PUERPERAL ENDOMETRITIS, UNS EPISODE OF CARE OR N/A
670.12	PUERPERAL ENDOMETRITIS, DELIVERED, WITH POSTPARTUM COMPL
670.14	PUERPERAL ENDOMETRITIS, POSTPARTUM CONDITION OR COMPLICATION
670.20	PUERPERAL SEPSIS, UNS EPISODE OF CARE OR N/A
670.22	PUERPERAL SEPSIS, DELIVERED, WITH POSTPARTUM COMPL
670.24	PUERPERAL SEPSIS, POSTPARTUM CONDITION OR COMPLICATION
670.30	PUERPERAL SEPTIC THROMBOPHLEBITIS, UNS EPISODE OF CARE
670.32	PUERPERAL SEPTIC THROMBOPHLEB, DELIVERED W/ POSTPART COMPL
670.34	PUERPERAL SEPTIC THROMBOPHLEBITIS, POSTPARTUM OR COMPL
670.80	OTH MAJOR PUERPERAL INFEC, UNS EPISODE OF CARE OR N/A
670.82	OTH MAJOR PUERPERAL INFEC, DELIVERED, WITH POSTPARTUM COMPL
670.84	OTH MAJOR PUERPERAL INFEC, POSTPARTUM CONDITION OR COMPL
756.72	OMPHALOCELE
756.73	GASTROSCHISIS
768.70	HYPOXIC-ISCHEMIC ENCEPHALOPATHY, UNSPECIFIED
768.71	MILD HYPOXIC-ISCHEMIC ENCEPHALOPATHY
768.72	MODERATE HYPOXIC-ISCHEMIC ENCEPHALOPATHY
768.73	SEVERE HYPOXIC-ISCHEMIC ENCEPHALOPATHY
779.31	FEEDING PROBLEMS IN NEWBORN
779.32	BILIOUS VOMITING IN NEWBORN
779.33	OTHER VOMITING IN NEWBORN
779.34	FAILURE TO THRIVE IN NEWBORN
784.42	DYSPHONIA
784.43	HYPERNASALITY
784.44	HYPONASALITY
784.51	DYSARTHRIA
784.59	OTHER SPEECH DISTURBANCE
787.04	BILIOUS EMESIS
789.7	COLIC
793.82	INCONCLUSIVE MAMMOGRAM
799.21	NERVOUSNESS
799.22	IRRITABILITY
799.23	IMPULSIVENESS
799.24	EMOTIONAL LABILITY
799.25	DEMORALIZATION AND APATHY
799.29	OTHER SIGNS AND SYMPTOMS INVOLVING EMOTIONAL STATE
799.82	APPARENT LIFE THREATENING EVENT IN INFANT
813.46	TORUS FRACTURE OF ULNA (ALONE)
813.47	TORUS FRACTURE OF RADIUS AND ULNA
832.2	NURSEMAID'S ELBOW
969.00	POISONING BY ANTIDEPRESSANT, UNSPECIFIED
969.01	POISONING BY MONOAMINE OXIDASE INHIBITORS
969.02	POISONING BY SEROTONIN & NOREPINEPHRINE REUPTAKE INHIBITORS
969.03	POISONING BY SELECTIVE SEROTONIN REUPTAKE INHIBITORS
969.04	POISONING BY TETRACYCLIC ANTIDEPRESSANTS
969.05	POISONING BY TRICYCLIC ANTIDEPRESSANTS
969.09	POISONING BY OTHER ANTIDEPRESSANTS
969.70	POISONING BY PSYCHOSTIMULANT, UNSPECIFIED
969.71	POISONING BY CAFFEINE
969.72	POISONING BY AMPHETAMINES
969.73	POISONING BY METHYLPHENIDATE
969.79	POISONING BY OTHER PSYCHOSTIMULANTS
995.24	FAILED MODERATE SEDATION DURING PROCEDURE
E000.0	CIVILIAN ACTIVITY DONE FOR INCOME OR PAY
E000.1	MILITARY ACTIVITY
E000.8	OTHER EXTERNAL CAUSE STATUS
E000.9	UNSPECIFIED EXTERNAL CAUSE STATUS
E001.0	ACTIVITIES INVOLVING WALKING, MARCHING AND HIKING
E001.1	ACTIVITIES INVOLVING RUNNING
E002.0	ACTIVITIES INVOLVING SWIMMING
E002.1	ACTIVITIES INVOLVING SPRINGBOARD AND PLATFORM DIVING
E002.2	ACTIVITIES INVOLVING WATER POLO
E002.3	ACTIVITIES INVOLVING WATER AEROBICS AND WATER EXERCISE
E002.4	ACTIVITIES INVOLVING UNDERWATER DIVING AND SNORKELING
E002.5	ACTIVITIES INVOLVING ROWING, CANOEING, KAYAKING, RAFTING
E002.6	ACTIVITIES INVOLVING WATER SKIING AND WAKE BOARDING
E002.7	ACTIVITIES INVOLVING SURFING, WINDSURFING & BOOGIE BOARDING
E002.8	ACTIVITIES INVOLVING WATER SLIDING
E002.9	OTHER ACTIVITY INVOLVING WATER AND WATERCRAFT
E003.0	ACTIVITIES INVOLVING ICE SKATING
E003.1	ACTIVITIES INVOLVING ICE HOCKEY
E003.2	ACTIVITIES INVOLVING SNOW SKIING, SNOW BOARDING, SLEDDING
E003.3	ACTIVITIES INVOLVING CROSS COUNTRY SKIING
E003.9	OTHER ACTIVITY INVOLVING ICE AND SNOW
E004.0	ACTIVITIES INVOLVING MOUNTAIN, ROCK & WALL CLIMBING
E004.1	ACTIVITIES INVOLVING RAPPELLING
E004.2	ACTIVITIES INVOLVING BASE JUMPING
E004.3	ACTIVITIES INVOLVING BUNGEE JUMPING
E004.4	ACTIVITIES INVOLVING HANG GLIDING
E004.9	OTH ACTIVITY INVOLVING CLIMBING, RAPPELLING & JUMPING OFF
E005.0	ACTIVITIES INVOLVING DANCING
E005.1	ACTIVITIES INVOLVING YOGA
E005.2	ACTIVITIES INVOLVING GYMNASTICS
E005.3	ACTIVITIES INVOLVING TRAMPOLINE
E005.4	ACTIVITIES INVOLVING CHEERLEADING
E005.9	OTH ACTIVITY INVOLVING DANCING & OTH RHYTHMIC MOVEMENTS
E006.0	ACTIVITIES INVOLVING ROLLER SKATING (INLINE) & SKATEBOARDING
E006.1	ACTIVITIES INVOLVING HORSEBACK RIDING
E006.2	ACTIVITIES INVOLVING GOLF
E006.3	ACTIVITIES INVOLVING BOWLING
E006.4	ACTIVITIES INVOLVING BIKE RIDING
E006.5	ACTIVITIES INVOLVING JUMPING ROPE
E006.6	ACTIVITIES INVOLVING NON-RUNNING TRACK AND FIELD EVENTS
E006.9	OTH ACTIVITY INVOLVING OTH SPORTS & ATHLETICS PLAYED INDIV
E007.0	ACTIVITIES INVOLVING AMERICAN TACKLE FOOTBALL
E007.1	ACTIVITIES INVOLVING AMERICAN FLAG OR TOUCH FOOTBALL
E007.2	ACTIVITIES INVOLVING RUGBY
E007.3	ACTIVITIES INVOLVING BASEBALL
E007.4	ACTIVITIES INVOLVING LACROSSE AND FIELD HOCKEY
E007.5	ACTIVITIES INVOLVING SOCCER
E007.6	ACTIVITIES INVOLVING BASKETBALL
E007.7	ACTIVITIES INVOLVING VOLLEYBALL (BEACH) (COURT)
E007.8	ACTIVITIES INVOLVING PHYSICAL GAMES ASSOC W/ SCHOOL, CAMP
E007.9	OTH ACTIVITY INVOLVING OTH SPORTS & ATHLETES PLAYED AS A GRP
E008.0	ACTIVITIES INVOLVING BOXING
E008.1	ACTIVITIES INVOLVING WRESTLING
E008.2	ACTIVITIES INVOLVING RACQUET AND HAND SPORTS
E008.3	ACTIVITIES INVOLVING FRISBEE
E008.4	ACTIVITIES INVOLVING MARTIAL ARTS
E008.9	OTHER SPECIFIED SPORTS AND ATHLETICS ACTIVITY
E009.0	ACTIVITY INVOLVING EXERCISE MACHINE FOR CARDIO CONDITIONING
E009.1	ACTIVITY INVOLVING CALISTHENICS
E009.2	ACTIVITY INVOLVING AEROBIC AND STEP EXERCISE
E009.3	ACTIVITY INVOLVING CIRCUIT TRAINING
E009.4	ACTIVITY INVOLVING OBSTACLE COURSE
E009.5	ACTIVITY INVOLVING GRASS DRILLS
E009.9	OTHER ACTIVITY INVOLVING CARDIORESPIRATORY EXERCISE
E010.0	ACTIVITY INVOLVING EXERCISE MACHINE FOR MUSCLE STRENGTHENING
E010.1	ACTIVITY INVOLVING PUSH-UPS, PULL-UPS, SIT-UPS
E010.2	ACTIVITY INVOLVING FREE WEIGHTS
E010.3	ACTIVITY INVOLVING PILATES
E010.9	OTH ACTIVITY INVOLVING OTH MUSCLE STRENGTHENING EXERCISES
E011.0	ACTIVITIES INVOLVING COMPUTER KEYBOARDING
E011.1	ACTIVITIES INVOLVING HAND HELD INTERACTIVE ELECTRONIC DEVICE
E011.9	OTH ACTIVITY INVOLVING COMPUTER TECH & ELECTRONIC DEVICES
E012.0	ACTIVITIES INVOLVING KNITTING AND CROCHETING
E012.1	ACTIVITIES INVOLVING SEWING
E012.2	ACTIVITIES INVOLVING FURNITURE BUILDING AND FINISHING
E012.9	ACTIVITY INVOLVING OTHER ARTS AND HANDCRAFTS
E013.0	ACTIVITIES INVOLVING PERSONAL BATHING AND SHOWERING
E013.1	ACTIVITIES INVOLVING LAUNDRY
E013.2	ACTIVITIES INVOLVING VACUUMING
E013.3	ACTIVITIES INVOLVING IRONING
E013.4	ACTIVITIES INVOLVING FLOOR MOPPING AND CLEANING
E013.5	ACTIVITIES INVOLVING RESIDENTIAL RELOCATION
E013.8	OTHER PERSONAL HYGIENE ACTIVITY
E013.9	OTHER HOUSEHOLD MAINTENANCE
E014.0	CAREGIVING INVOLVING BATHING
E014.1	CAREGIVING INVOLVING LIFTING
E014.9	OTHER ACTIVITY INVOLVING PERSON PROVIDING CAREGIVING
E015.0	ACTIVITIES INVOLVING FOOD PREPARATION AND CLEAN UP
E015.1	ACTIVITIES INVOLVING GRILLING AND SMOKING FOOD
E015.2	ACTIVITIES INVOLVING COOKING AND BAKING
E015.9	OTHER ACTIVITY INVOLVING COOKING AND GRILLING
E016.0	ACTIVITIES INVOLVING DIGGING, SHOVELING AND RAKING
E016.1	ACTIVITIES INVOLVING GARDENING AND LANDSCAPING
E016.2	ACTIVITIES INVOLVING BUILDING AND CONSTRUCTION
E016.9	OTH ACTIVITY INVOLVING PROPERTY, LAND, MAINTENANCE, BUILDING
E017.0	ACTIVITIES INVOLVING ROLLER COASTER RIDING
E017.9	OTHER ACTIVITY INVOLVING EXTERNAL MOTION
E018.0	ACTIVITIES INVOLVING PIANO PLAYING
E018.1	ACTIVITIES INVOLVING DRUM & OTH INSTRUMENT PLAYING
E018.2	ACTIVITIES INVOLVING STRING INSTRUMENT PLAYING
E018.3	ACTIVITIES INVOLVING WINDS AND BRASS INSTRUMENT PLAYING
E019.0	ACTIVITIES INVOLVING WALKING AN ANIMAL
E019.1	ACTIVITIES INVOLVING MILKING AN ANIMAL
E019.2	ACTIVITIES INVOLVING GROOMING AND SHEARING AN ANIMAL
E019.9	OTHER ACTIVITY INVOLVING ANIMAL CARE
E029.0	REFEREEING A SPORTS ACTIVITY
E029.1	SPECTATOR AT AN EVENT
E029.2	ROUGH HOUSING AND HORSEPLAY
E029.9	OTHER ACTIVITY
E030	UNSPECIFIED ACTIVITY
E830.7	ACCIDENT TO WATERCRAFT CAUSING SUBMERSION, ANY TYPE
E831.7	ACCIDENT TO WATERCRAFT CAUSING OTH INJURY, ANY TYPE
E832.7	OTH ACCIDENT SUBMER OR DROWNING IN WATER TRANSPORT, ANY TYPE
E833.7	FALL ON STAIRS OR LADDERS IN WATER TRANSPORT, ANY TYPE
E834.7	OTH FALL ONE LEVEL TO ANOTH IN WATER TRANSPORT, ANY TYPE
E835.7	OTH & UNS FALL IN WATER TRANSPORT, MILITARY, ANY TYPE
E836.7	MACHINERY ACCIDENT IN WATER TRANSPORT, MILITARY, ANY TYPE
E837.7	EXPLOSION, FIRE OR BURNING IN WATERCRAFT, MILITARY, ANY TYPE
E838.7	OTH & UNS WATER TRANSPORT ACCIDENT, MILITARY, ANY TYPE
E876.6	PERFORMANCE OF OPERATION ON PATIENT NOT SCHEDULED FOR SURG
E876.7	PERFORMANCE OF CORRECT OPERATION ON WRONG SIDE/BODY PART
E928.7	ENVIRONMENTAL & ACCIDENTAL CAUSES OF FIREARM & AIR GUN
E990.1	INJURY DUE TO WAR OPERATIONS FROM FLAMETHROWER
E990.2	INJURY DUE TO WAR OPERATIONS FROM INCENDIARY BULLET
E990.3	INJURY DUE TO WAR FROM FIRE CAUSED INDIRECT CONVENT WEAPON
E991.4	INJURY DUE TO WAR OPERATIONS BY FRAGMENTS FROM MUNITIONS
E991.5	INJURY DUE TO WAR BY FRAGMENTS FROM PERSON-BORNE IED
E991.6	INJURY DUE TO WAR BY FRAGMENTS FROM VEHICLE-BORNE IED
E991.7	INJURY DUE TO WAR BY FRAGMENTS FROM OTH IED
E991.8	INJURY DUE TO WAR OPERATIONS BY FRAGMENTS FROM WEAPONS
E992.0	INJURY DUE TO TORPEDO
E992.1	INJURY DUE TO DEPTH CHARGE
E992.2	INJURY DUE TO MARINE MINES
E992.3	INJURY DUE TO SEA-BASED ARTILLERY SHELL
E992.8	INJURY DUE TO WAR OPERATIONS BY OTHER MARINE WEAPONS
E992.9	INJURY DUE TO WAR OPERATIONS BY UNSPECIFIED MARINE WEAPON
E993.0	INJURY DUE TO WAR OPERATIONS BY AERIAL BOMB
E993.1	INJURY DUE TO WAR OPERATIONS BY GUIDED MISSILE
E993.2	INJURY DUE TO WAR OPERATIONS BY MORTAR
E993.3	INJURY DUE TO WAR BY PERSON-BORNE IED
E993.4	INJURY DUE TO WAR BY VEHICLE-BORNE IED
E993.5	INJURY DUE TO WAR BY OTH IED
E993.6	INJURY DUE TO WAR BY UNINTENT DETONATION OF OWN MUNITIONS
E993.7	INJURY DUE TO WAR BY DISCHARGE OF OWN MUNITION LAUNCH DEVICE
E993.8	INJURY DUE TO WAR OPERATIONS BY OTHER SPECIFIED EXPLOSION
E993.9	INJURY DUE TO WAR OPERATIONS BY UNSPECIFIED EXPLOSION
E994.0	INJURY DUE TO WAR BY DESTRUCT OF AIRCRAFT DUE TO ENEMY FIRE
E994.1	INJURY DUE TO WAR BY DESTRUCT OF AIRCRAFT DUE TO OWN EXPL
E994.2	INJURY DUE TO WAR BY DESTRUCT OF AIRCRAFT DUE TO COLLISION
E994.3	INJURY DUE TO WAR BY DESTRUCT AIRCRAFT DUE TO ONBOARD FIRE
E994.8	INJURY DUE TO WAR BY OTH DESTRUCTION OF AIRCRAFT
E994.9	INJURY DUE TO WAR BY UNS DESTRUCTION OF AIRCRAFT
E995.0	INJURY DUE TO WAR OPERATIONS BY UNARMED HAND-TO-HAND COMBAT
E995.1	INJURY DUE TO WAR OPERATIONS, STRUCK BY BLUNT OBJECT
E995.2	INJURY DUE TO WAR OPERATIONS BY PIERCING OBJECT
E995.3	INJURY DUE TO WAR BY INTENTIONAL RESTRICTION OF AIR & AIRWAY
E995.4	INJURY DUE TO WAR BY UNINTENTIONAL DROWNING
E995.8	INJURY DUE TO WAR BY OTH FORMS OF CONVENTIONAL WARFARE
E995.9	INJURY DUE TO WAR BY UNS FORM OF CONVENTIONAL WARFARE
E996.0	INJURY DUE TO WAR BY DIRECT BLAST OF NUCLEAR WEAPON
E996.1	INJURY DUE TO WAR BY INDIRECT BLAST OF NUCLEAR WEAPON
E996.2	INJURY DUE TO WAR BY THERMAL RADIATION OF NUCLEAR WEAPON
E996.3	INJURY DUE TO WAR OPERATIONS BY NUCLEAR RADIATION EFFECTS
E996.8	INJURY DUE TO WAR BY OTH EFFECTS OF NUCLEAR WEAPONS
E996.9	INJURY DUE TO WAR BY UNS EFFECT OF NUCLEAR WEAPON
E997.3	INJURY DUE TO WAR BY WEAPON OF WMD, UNS
E998.0	INJURY DUE TO WAR AFTER CEASE BY EXPLOSION OF MINES
E998.1	INJURY DUE TO WAR AFTER CEASE BY EXPLOSION OF BOMBS
E998.8	INJURY DUE TO OTH WAR BUT OCCURRING AFTER CEASE
E998.9	INJURY DUE TO UNS WAR BUT OCCURRING AFTER CEASE
V10.90	PERSONAL HISTORY OF UNSPECIFIED MALIGNANT NEOPLASM
V10.91	PERSONAL HISTORY OF MALIGNANT NEUROENDOCRINE TUMOR
V15.52	PERSONAL HISTORY OF TRAUMATIC BRAIN INJURY
V15.80	PERSONAL HISTORY OF FAILED MODERATE SEDATION
V15.83	PERSONAL HISTORY OF UNDERIMMUNIZATION STATUS
V20.31	HEALTH SUPERVISION FOR NEWBORN UNDER 8 DAYS OLD
V20.32	HEALTH SUPERVISION FOR NEWBORN 8 TO 28 DAYS OLD
V26.42	ENCOUNTER FOR FERTILITY PRESERVATION COUNSELING
V26.82	ENCOUNTER FOR FERTILITY PRESERVATION PROCEDURE
V53.50	FITTING AND ADJUSTMENT OF INTESTINAL APPLIANCE AND DEVICE
V53.51	FITTING AND ADJUSTMENT OF GASTRIC LAP BAND
V53.59	FITTING & ADJUST OF OTH GASTROINTESTINAL APPLIANCE & DEVICE
V60.81	FOSTER CARE (STATUS)
V60.89	OTHER SPECIFIED HOUSING OR ECONOMIC CIRCUMSTANCES
V61.07	FAMILY DISRUPTION DUE TO DEATH OF FAMILY MEMBER
V61.08	FAMILY DISRUPTION DUE TO OTH EXTENDED ABSENCE OF FAM MBR
V61.23	COUNSELING FOR PARENT-BIOLOGICAL CHILD PROBLEM
V61.24	COUNSELING FOR PARENT-ADOPTED CHILD PROBLEM
V61.25	COUNSELING FOR PARENT (GUARDIAN)-FOSTER CHILD PROBLEM
V61.42	SUBSTANCE ABUSE IN FAMILY
V72.60	LABORATORY EXAMINATION, UNSPECIFIED
V72.61	ANTIBODY RESPONSE EXAMINATION
V72.62	LAB EXAM ORDERED AS PART OF A ROUTINE GENERAL MED EXAM
V72.63	PRE-PROCEDURAL LABORATORY EXAMINATION
V72.69	OTHER LABORATORY EXAMINATION
V80.01	SPECIAL SCREENING FOR TRAUMATIC BRAIN INJURY
V80.09	SPECIAL SCREENING FOR OTHER NEUROLOGICAL CONDITIONS
V87.32	CONTACT WITH AND (SUSPECTED) EXPOSURE TO ALGAE BLOOM
V87.43	PERSONAL HISTORY OF ESTROGEN THERAPY
V87.44	PERSONAL HISTORY OF INHALED STEROID THERAPY
V87.45	PERSONAL HISTORY OF SYSTEMIC STEROID THERAPY
V87.46	PERSONAL HISTORY OF IMMUNOSUPPRESSIVE THERAPY

New ICD-9-CM procedural codes, effective October 1, 2009

CODE	DESCRIPTION
17.51	IMPLANTATION OF RECHARGEABLE CCM, TOTAL SYSTEM
17.52	IMPLANTATION OR REPLACEMENT OF CCM RECHARGE PULSE GENERATOR
17.61	LITT OF LESION OR TISSUE OF BRAIN UNDER GUIDANCE
17.62	LITT OF LESION OR TISSUE OF HEAD & NECK UNDER GUIDANCE
17.63	LITT OF LESION OR TISSUE OF LIVER UNDER GUIDANCE
17.69	LITT OF LESION OR TISSUE OF OTH & UNSPEC SITE UNDER GUIDANCE
17.70	INTRAVENOUS INFUSION OF CLOFARABINE
33.73	ENDOSCOPIC INSERTION OR REPLACEMENT OF BRONCHIAL VALVE(S)
38.24	INTRAVASCULAR IMAGING OF CORONARY VESSEL(S) BY OCT
38.25	INTRAVASCULAR IMAGING OF NON-CORONARY VESSEL(S) BY OCT
39.75	ENDOVASCULAR EMBOLIZATION OR OCCLUSION OF HEAD/NECK VESSEL
39.76	ENDOVASCULAR EMBOLIZATION OR OCCLUSION OF HEAD/NECK VESSEL
46.86	ENDOSCOPIC INSERTION OF COLONIC STENT(S)
46.87	OTHER INSERTION OF COLONIC STENT(S)

ICD-9-CM diagnostic codes with revised descriptions, effective October 1, 2009.

CODE	DESCRIPTION
041.3	KLEBSIELLA PNEUMONIAE
041.86	HELICOBACTER PYLORI [H. PYLORI]
453.2	OTHER VENOUS EMBOLISM AND THROMBOSIS OF INFERIOR VENA CAVA
453.40	ACUTE VENOUS EMBOLISM & THROMBOSIS, UNSPEC VESSEL, LOWER
453.41	ACUTE VENOUS EMBOLISM & THROMBOSIS, DEEP VESSEL, PROXIMAL
453.42	ACUTE VENOUS EMBOLISM & THROMBOSIS, DEEP VESSEL, DISTAL
572.2	HEPATIC ENCEPHALOPATHY
584.5	ACUTE KIDNEY FAILURE WITH LESION OF TUBULAR NECROSIS
584.6	ACUTE KIDNEY FAILURE WITH LESION OF RENAL CORTICAL NECROSIS
584.7	ACUTE KIDNEY FAILURE WITH LESION OF RENAL MEDULLARY NECROSIS
584.8	ACUTE KIDNEY FAILURE W/ OTHER SPECIFIED PATHOLOGICAL LESION
584.9	ACUTE KIDNEY FAILURE, UNSPECIFIED
639.3	KIDNEY FAILURE FOLLOWING ABORTION, ECTOPIC & MOLAR PREGNANCY
669.30	ACUTE KIDNEY FAILURE FOLLOWING LABOR, UNSPEC CARE OR N/A
669.32	ACUTE KIDNEY FAILURE FOLLOWING LABOR, W/ POSTPARTUM COMPLIC
669.34	ACUTE KIDNEY FAILURE FOLLOWING LABOR, POSTPARTUM COMPLIC
670.00	MAJOR PUERPERAL INFECTION, UNSPEC EPISODE OF CARE OR N/A
670.02	MAJOR PUERPERAL INFECT, UNSPEC, DELIVERED, W/ POSTPART COMP
670.04	MAJOR PUERPERAL INFECTION, UNSPEC, POSTPARTUM COMPLIC
757.6	SPECIFIED CONGENITAL ANOMALIES OF BREAST
772.0	FETAL BLOOD LOSS AFFECTING NEWBORN
776.9	UNSPECIFIED HEMATOLOGICAL DISORDER SPECIFIC TO NEWBORN
784.40	VOICE AND RESONANCE DISORDER, UNSPECIFIED
784.49	OTHER VOICE AND RESONANCE DISORDERS
793.0	NONSPEC (ABNORMAL) FINDINGS ON RAD & OTH EXAM, SKULL & HEAD
793.1	NONSPEC (ABNORMAL) FINDINGS ON RAD & OTH EXAM, LUNG FIELD
793.2	NONSPEC (ABNORMAL) FINDINGS ON RAD & OTH EXAM, OTHER ORGANS
793.3	NONSPEC (ABNORMAL) FINDINGS ON RAD & OTH EXAM, BILIARY TRACT
793.4	NONSPEC (ABNORMAL) FINDINGS ON RAD & OTH EXAM, GASTROINTEST
793.5	NONSPEC (ABNORMAL) FINDINGS ON RAD & OTHER EXAM, GENI ORGANS
793.6	NONSPEC (ABNORMAL) FINDINGS ON RAD & OTH EXAM, ABDOMINAL
793.7	NONSPEC (ABNORMAL) FINDINGS ON RAD & OTH EXAM, MUSCULOSKELET
793.89	OTHER (ABNORMAL) FINDINGS ON RADIOLOGICAL EXAM OF BREAST
793.99	OTHER NONSPEC (ABNORMAL) FINDINGS ON RAD & OTH EXAM, BODY
813.45	TORUS FRACTURE OF RADIUS (ALONE)
996.43	BROKEN PROSTHETIC JOINT IMPLANT
E876.5	PERFORMANCE OF WRONG OPERATION ON CORRECT PATIENT
V15.06	ALLERGY TO INSECTS AND ARACHNIDS
V15.84	PERSONAL HISTORY OF CONTACT & EXPOSURE TO ASBESTOS
V15.85	PERSONAL HISTORY OF CONTACT & EXPOSURE TO HAZARDOUS FLUIDS
V15.86	PERSONAL HISTORY OF CONTACT & (SUSPECTED) EXPOSURE TO LEAD
V57.3	CARE INVOLVING SPEECH-LANGUAGE THERAPY
V61.29	OTHER PARENT-CHILD PROBLEMS
V65.11	PEDIATRIC PRE-BIRTH VISIT FOR EXPECTANT PARENT(S)
008.65	ENTERITIS DUE TO CALICIVIRUS

ICD-9-CM procedural codes with revised descriptions effective October 1, 2009.

CODE	DESCRIPTION
80.05	ARTHROTOMY FOR REMOVAL OF PROSTHESIS W/O REPLACEMENT, HIP
80.06	ARTHROTOMY FOR REMOVAL OF PROSTHESIS W/O REPLACEMENT, KNEE
80.07	ARTHROTOMY FOR REMOVAL OF PROSTHESIS W/O REPLACEMENT, ANKLE
80.08	ARTHROTOMY FOR REMOVAL OF PROSTHESIS W/O REPLACEMENT, FOOT
80.09	ARTHROTOMY FOR REMOVAL OF PROSTHESIS W/O REPLACEMENT, OTHER
00.56	INSERTION OR REPLACEMENT OF IMPLANTABLE PRESSURE SENSOR
00.57	IMPLANTATION OR REPLACEMENT OF SUBCUTANEOUS DEVICE
33.71	ENDOSCOPIC INSERTION OR REPLACEMENT OF BRONCHIAL VALVE(S)
39.72	ENDOVASCULAR EMBOLIZATION OR OCCLUSION OF HEAD & NECK VESSEL
39.79	OTHER ENDOVASCULAR PROCEDURES ON OTHER VESSELS
39.90	INSERTION OF NON-DRUG-ELUTING PERIPHERAL VESSEL STENT(S)
80.00	ARTHROTOMY FOR REMOVAL OF PROSTHESIS W/O REPLACEMENT, UNSPEC
80.01	ARTHROTOMY FOR REMOVAL OF PROSTH W/O REPLACEMENT, SHOULDER
80.02	ARTHROTOMY FOR REMOVAL OF PROSTHESIS W/O REPLACEMENT, ELBOW
80.03	ARTHROTOMY FOR REMOVAL OF PROSTHESIS W/O REPLACEMENT, WRIST
80.04	ARTHROTOMY FOR REMOVAL OF PROSTHESIS W/O REPLACEMENT, HAND

ICD-9-CM diagnostic codes termed, effective October 1, 2009

TERMED CODES
239.8	784.5	E996
274.0	799.2	E998
279.4	969.0	V10.9
348.8	969.7	V53.5
453.8	E992	V60.8
488	E993	V72.6
768.7	E994	V80.0
779.3	E995

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