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Connection supplemental articles and policies - September 2010

Download the print version of Connection

Connection - September 2010

Supplemental articles

Disease Management Program supports provider care
Fraud, Waste, and Abuse Training Update
Visit our new Summit ElderCare^® Web site!
Important links to information about care
Utilization management incentives
Preventive Health Care Guidelines endorsed
Billing for vaccines
Reminder: PPI prescription protocol
Formulary updates – Commercial and Part D
ICD-9-CM annual code update

Payment policies

Revised policies – effective November 1, 2010
The following polices have been updated; details about the changes are indicated on the policies:

Ambulatory Surgery–Professional Payment Policy : Updated discussion of operative note review.
Anesthesia Payment Policy : Updated to reflect prior authorization requirement for anesthesia assistance for upper and/or lower GI endoscopic procedures.
Evaluation and Management Payment Policy : Updated to reflect changes in reimbursement for cervical/vaginal cancer screening, pelvic and clinical breast examination, and/or preparing and conveyance of cervical or vaginal smear services billed with preventive services. Reimbursement changes that are effective January 1, 2011, regarding problem focused services billed with preventive services are also included in this update.
Gastroenterology Payment Policy : Updated to reflect prior authorization requirement for anesthesia assistance for upper and/or lower GI endoscopic procedures.
Hospice Payment Policy : Updated to remove references to criteria now addressed in the FCHP Medical Policy for Hospice Services, to identify services that are limited or not covered for Commonwealth Care and FCHP MassHealth members, and to more clearly identify differences between commercial and Fallon Senior Plan.
Radiology/Diagnostic Imaging Payment Policy : Updated to indicate a change to 50% reduction for multiple imaging services on contiguous body areas for Fallon Senior Plan members.
Vaccine Payment Policy : Updated Addendum A table for 90650 and 90662 to indicate that these are now reimbursed.

Everyday affairs

Disease Management Program supports provider care

We wish to introduce you to our Disease Management Program, a proactive patient-centered program for those diagnosed with chronic diseases, such as asthma, diabetes and certain types of heart disease. It’s designed to reinforce standards of care by providing health education, health coaching, behavior change and self-management skills, ultimately leading towards empowerment of patients to take a more active role in improving and maintaining their health.

As you continue to direct your patient’s treatment plan, our registered nurses and health educators reinforce your efforts in order to achieve optimal clinical outcomes and patient satisfaction.

Our nurses and health educators reach out to patients with regular telephonic contact as well as meeting them in a group environment within their workplace or community. Throughout the year, patients will receive health-related newsletters, reminder cards and other important health information.

This program is voluntary and available to Fallon Community Health Plan members at no additional cost. Further, if patients choose not to participate in this program, their benefits will in no way be affected.

We look forward to working with you as we implement our Disease Management Program. If you have any questions, would like further information or you become aware of a patient that would benefit from our program, please call our team at 1-800-333-2535 x69898, Monday through Friday, from 8:30 a.m. to 5:00 p.m.

Let’s connect

Fraud, waste, and abuse training update

The Centers for Medicare & Medicaid Services (CMS) no longer requires health plans to offer annual fraud, waste, and abuse training for providers. CMS has determined that Medicare providers have already met FWA training requirements through enrollment into the Medicare program or accreditation as a durable medical equipment, prosthetics, orthotics and supplies supplier.

Although the online FWA training is not mandatory in 2010 for those providers who are deemed compliant, Fallon Community Health Plan continues to need your cooperation in the prevention, detection and reporting of suspected fraud, waste, and abuse.

Visit our new Summit ElderCare Web site!

We’ve redesigned our Summit ElderCare^® Web site, summiteldercare.org, to make it more accessible, more useful and more attractive to our diverse audiences. We particularly enhanced the navigation and content of the site to reflect the input of a wide range of users who expressed their needs, preferences and interests during usability testing and focus groups. Summit ElderCare is our Program of All-Inclusive Care for the Elderly (PACE), which helps older adults remain living in their community as an alternative to moving to a nursing home.

Information for our community referral sources is summarized in a designated section for quick and easy access. Also, caregivers who wish to learn more about Summit ElderCare can quickly find information that helps them to understand all aspects of our program—from eligibility, insurance protection and medical care to home care and other covered services.

Also, our current newsletters, plus menus and calendars of activities at our PACE adult day health centers, are now on the site—in addition to photos of each facility and a short video about our PACE model of care.

“More working caregivers are time-starved and turn to the Internet, Facebook and other networks to explore their options,” notes Karen Longo, Executive Director. “That’s why we made our Web site more user-friendly and packed it with clear information on the breadth and depth of all that Summit ElderCare has to offer people who may be caring for a loved ones at home.”

We invite you to visit our Web site today. You’ll likely learn something new about Summit ElderCare!

Quality focus

Important links to information about care

We hope you’ll take this time to visit our Web site, fchp.org, to learn how we work with you and our members to ensure the quality and safety of clinical care. If you would like to receive a copy of this information, please call our Provider Relations Department at 1-866-ASK-FCHP (1-866-275-3247), press 4.

Clinical criteria for utilization care services: Fallon Community Health Plan uses national, evidence-based criteria that are reviewed annually by a committee of health plan and community-based physicians to determine the medical appropriateness of selected services requested by physicians. These criteria are approved as being consistent with generally accepted standards of medical practice, including prudent layperson standards for emergency room care. Criteria are available on the FCHP Web site at fchp.org/providers/medical-management/medical_policies or as a paper copy upon request.
Learn more about our quality programs: FCHP is proud of its long history of quality accomplishments, including our “Excellent” accreditation from the National Committee for Quality Assurance. A detailed description of our quality program, goals and outcomes is available through at fchp.org/about-fchp/quality-standards.
We also welcome suggestions from our physicians about specific goals or projects that may further improve the quality of care and service available through our health plan projects.
Know our members’ rights: FCHP members have the right to receive information about an illness, the course of treatment and prospects for recovery in terms that they can understand. They have the right to actively participate in decisions regarding their own health and treatment options, including the right to refuse treatment. For a complete list of FCHP members’ rights and responsibilities, visit fchp.org/members/resources/rights.

Utilization management incentives

Fallon Community Health Plan affirms the following:

Utilization management decision-making is based only on appropriateness of care and service and existence of coverage.
FCHP does not specifically reward practitioners or other individuals for issuing denials of coverage or care.
Financial incentives for UM decision makers do not encourage decisions that result in underutilization.

For more details, see fchp.org/providers/provider-manual/managing-patient-care.

Preventive Health Care Guidelines endorsed

FCHP’s Clinical Practice Guideline Committee recently reviewed, and continues to endorse, the Massachusetts Health Quality Partners (MHQP) 2007/8 Adult and Pediatric Preventive Care Recommendations, along with the 2010 CDC Adult and Pediatric Immunization Schedules. The guidelines are posted at fchp.org/providers/medical-management/healthcare-guidelines. For a paper copy of these or any FCHP guideline, please contact our Quality and Health Services Department at 1-508-368-9103.

Billing bytes

Billing for vaccines

Billing for the “seasonal flu” vaccine
Fallon Community Health Plan requires that CPT codes 90655, 90656, 90657, 9068 and 90662 be billed for the seasonal flu vaccine and HCPCS code G0008 for the administration. If administered on the same day as a physician service is performed, use CPT codes 90645 - 90474 to report the administration of the vaccine. FCHP does not require an that invoice be submitted for the flu vaccine.
Billing for the pneumococcal vaccine
Fallon Community Health Plan requires that CPT code 90732 be billed for the pneumococcal vaccine and HCPCS code G0009 for the administration. If administered on the same day as a physician service is performed, use CPT code 90465 - 90474 to report the administration of the vaccine. FCHP does not require that an invoice be submitted for the pneumococcal vaccine.
Billing for the H1N1 (swine flu) vaccine
Fallon Community Health Plan will follow the recommendation of the AMA and require that CPT code 90663 be billed for the H1N1 (swine flu) vaccine. To report the administration of the vaccine use codes 90645 – 90474, depending on the route of administration and the patient’s age. FCHP does not require that an invoice be submitted for the H1N1 (swine flu) vaccine.

Please note:

If the vaccine is state-supplied, claims should be submitted with the CPT code for the vaccine and the –SL modifier and a charge of $0.00. The administration code and charge should also be submitted.
If the vaccine is not available through the state, the CPT code must be submitted without the –SL modifier and the appropriate charge. The administration code and the charge should also be submitted.
Members are not required to pay a copayment.

Script alert

Reminder: PPI prescription protocol

Last January, Fallon Community Health Plan made a benefit change that gave you new options in treating your FCHP commercial-member patients and potentially saving them money. In March, the benefit change was extended to FCHP MassHealth members.

FCHP began covering prescriptions for over-the-counter proton pump inhibitors (PPIs)—Prilosec OTC, Prevacid 24HR and generic omeprazole OTC—for just a $5 copayment for 42 tablets, no matter what pharmacy plan a member is on or what copayment level a member has. The member needs a prescription for the OTC medication to be covered.

At the same time, we added Dexilant®, formerly known as Kapidex, to the FCHP commercial plan formulary as a Tier 3 medication. Also, the formulary continues to include Aciphex® and Nexium,® but these medications still require a prior authorization from FCHP. Patients must have tried and failed on all FCHP alternative medications prior to getting one of these products.

Important note concerning Fallon Senior Plan™ (Medicare Advantage) members: The only changes FCHP made for its Fallon Senior Plan members was that we added Dexilant® (formerly Kapidex) as a Tier 2 medication on our Part D formulary and removed Protonix/pantoprazole from the formulary. Prescriptions for OTC heartburn medications are not covered.

If you have any questions about PPI protocol, please call our Provider Relations Department at 1-866-ASK-FCHP (1-866-275-3247), and select prompt 5 for Pharmacy Services.

Formulary updates

Fallon Community Health Plan often makes changes to its formularies, including changing prior authorization requirements and adding new medications. Below are the latest changes to our commercial plan and Part D formularies.

Commercial plan formulary Effective September 1, 2010

Step therapies

Antihyperlipidemics

Antara (fenofibrate, micronized) - must have tried and failed fenofibrate (generic product) AND gemfibrozil (generic product).
Crestor (rosuvastatin) – must have tried and failed Lipitor (atorvastatin) AND simvastatin (generic product).
Tricor (fenofibrate) - must have tried and failed fenofibrate (generic product) AND gemfibrozil (generic product).
Trilipix (fenofibric acid) - must have tried and failed fenofibrate (generic product) AND gemfibrozil (generic product).

Nasal steroids

Beconase-AQ (beclomethasone) – must have tried and failed flunisolide (generic product) AND fluticasone (generic product).
Nasarel (flunisolide) - must have tried and failed flunisolide (generic product) AND fluticasone (generic product).
Rhinocort Aqua (budesonide) - must have tried and failed flunisolide (generic product) AND fluticasone (generic product).

Quantity limits

ProAir-HFA (albuterol)	2 x 8.5 gm canisters/30 days
Proventil-HFA (albuterol)	2 x 6.7 gm canisters/30 days
Ventolin-HFA (albuterol)	2 x 18 gm canisters/30 days
Advair-HFA (fluticasone/salmeterol)	1 x 12 gm canister/30 days
Advair Diskus (fluticasone/salmeterol)	60 per 30 days
Flovent-HFA (fluticasone)	44 mcg: 1 x 10.6 gm canister/30 days 110 mcg and 220 mcg: 1 x 12 gm canister/30 days
Flovent Diskus (fluticasone)	60 per 30 days
Pulmicort Flexhaler/Turbohaler (bedesonide)	1 canister/30 days

Prior authorization required

Tretinoin Topical (Retin-A and generics) – PA required if member is greater than 25 years of age.

Antihistamines (Effective October 1, 2010) - Commercial formulary will no longer include the following non-sedating antihistamines:

Allegra
Allegra-D
cetirizine
Clarinex
Clarinex-D
fexofenadine
fexofenadine/PSE
Xyzal

Additions

Ampyra (dalfampridine)	Tier 3, PA required
Cayston (aztreonam inh)	Tier 3, PA required
Cimzia (certolizumab)	Tier 3, PA required
Embeda (morphine/naltrexone)	Tier 3, PA required
Intuniv (guanfacine 24H)	Tier 3, PA required
Jalyn (dutasteride/tamsulosin)	Tier 3, QL 30
NitroMist (nitroglycerine aero)	Tier 3
Orbivan (butalbital/APAP/Caffeine)	Tier 3
Tirosint (levothyroxine sodium, cap)	Tier 3, QL 30
Victoza (liraglutide)	Tier 3, PA required
Xifaxan (rifaximin) 550 mg	Tier 3, PA required

New to market policy*

Cambia (diclofenac potassium pwdr)
Exalgo (hydrmorphone SR)
Hizentra (immune globulin, SC)
Livalo (piavastatin)
Lysteda (tranexamic acid)
Oleptro (trazodone 24hr)
Oravig (miconazole, buccal)
Pennsaid (diclofenac soln)
Zirgan (ganciclovir, oph)
Zortress (everolimus)
Zyclara (imiquimod)
Zymaxid (gatifloxacin 0.5%)

* 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.

Part D formulary changes

Part D Tier 3 additions

Part D Tier 4 additions

Product description	Tier	PA	Quantity limit
BUDESONIDE 0.25MG/2ML SUSP	1
BUDESONIDE 0.5MG/2ML SUSP	1
CALCITONIN-SALMON 200UNIT/ACT SOLN	1
CLOZAPINE 200MG TABS	1
DEXILANT 30MG CPDR	2		30 per 30 days
DEXILANT 60MG CPDR	2		30 per 30 days
DILTIAZEM HCL ER 180MG TB24	1
DILTIAZEM HCL ER 240MG TB24	1
DILTIAZEM HCL ER 300MG TB24	1
DILTIAZEM HCL ER 360MG TB24	1
DILTIAZEM HCL ER 420MG TB24	1
DOXYCYCLINE MONOHYDRATE 100MG CAPS	1
DOXYCYCLINE MONOHYDRATE 50MG CAPS	1
FLUOXETINE DR 90MG CPDR	1	PA	4 per 28 days
IMIQUIMOD 5% CREA	1
INVEGA SUSTENNA 117MG/0.75ML SUSP	3	PA
INVEGA SUSTENNA 156MG/ML SUSP	3	PA
INVEGA SUSTENNA 234MG/1.5ML SUSP	3	PA
INVEGA SUSTENNA 39MG/0.25ML SUSP	3	PA
INVEGA SUSTENNA 78MG/0.5ML SUSP	3	PA
LOSARTAN POTASSIUM 100MG TABS	1
LOSARTAN POTASSIUM 25MG TABS	1
LOSARTAN POTASSIUM 50MG TABS	1
LOSARTAN POTASSIUM/HYDROCHLOROTHIAZIDE 12.5MG; 100MG TABS	1		30 per 30 days
LOSARTAN POTASSIUM/HYDROCHLOROTHIAZIDE 12.5MG; 50MG TABS	1		30 per 30 days
LOSARTAN POTASSIUM/HYDROCHLOROTHIAZIDE 25MG; 100MG TABS	1		30 per 30 days
METAXALONE 800MG TABS	1
NAPROXEN 500MG TABS	1
PHENYTOIN SODIUM EXTENDED 200MG CAPS	1
PHENYTOIN SODIUM EXTENDED 300MG CAPS	1
ROXICODONE 5MG TABS	3
SORIATANE 17.5MG CAPS	2
SORIATANE 22.5MG CAPS	2
TAMSULOSIN HCL 0.4MG CAPS	1
VAGIFEM 10MCG TABS	3
VALCYTE 50MG/ML SOLR	3	PA
WELCHOL 3.75GM PACK	3

Coding corner

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, 2010. An ICD-9-CM diagnosis code is required on all paper and electronic claims billed to Fallon Community Health Plan.

New diagnosis codes - Effective October 1, 2010

The final addendum providing complete information on changes to the diagnosis part of ICD-9-CM is posted on CDC’s Web site at: cdc.gov/nchs/icd9.htm

Diagnosis code	Description
237.73	Schwannomatosis
237.79*	Other neurofibromatosis
275.01	Hereditary hemochromatosis
275.02	Hemochromatosis due to repeated red blood cell transfusions
275.03	Other hemochromatosis
275.09	Other disorders of iron metabolism
276.61	Transfusion associated circulatory overload
276.69	Other fluid overload
278.03	Obesity hypoventilation syndrome
287.41	Posttransfusion purpura
287.49	Other secondary thrombocytopenia
315.35*	Childhood onset fluency disorder
447.71	Thoracic aortic ectasia
447.72	Abdominal aortic ectasia
447.73	Thoracoabdominal aortic ectasia
488.01*	Influenza due to identified avian influenza virus with pneumonia
488.02*	Influenza due to identified avian influenza virus with other respiratory manifestations
488.09*	Influenza due to identified avian influenza virus with other manifestations
488.11*	Influenza due to identified novel H1N1 influenza virus with pneumonia
488.12*	Influenza due to identified novel H1N1 influenza virus with other respiratory manifestations
488.19*	Influenza due to identified novel H1N1 influenza virus with other manifestations
560.32	Fecal impaction
724.03	Spinal stenosis, lumbar region, with neurogenic claudication
752.31	Agenesis of uterus
752.32	Hypoplasia of uterus
752.33	Unicornuate uterus
752.34	Bicornuate uterus
752.35	Septate uterus
752.36	Arcuate uterus
752.39	Other anomalies of uterus
752.43	Cervical agenesis
752.44	Cervical duplication
752.45	Vaginal agenesis
752.46	Transverse vaginal septum
752.47	Longitudinal vaginal septum
780.33	Post traumatic seizures
780.66	Febrile nonhemolytic transfusion reaction
784.52*	Fluency disorder in conditions classified elsewhere
784.92	Jaw pain
786.30	Hemoptysis, unspecified
786.31	Acute idiopathic pulmonary hemorrhage in infants [AIPHI]
786.39	Other hemoptysis
787.60	Full incontinence of feces
787.61	Incomplete defecation
787.62	Fecal smearing
787.63	Fecal urgency
799.51	Attention or concentration deficit
799.52	Cognitive communication deficit
799.53	Visuospatial deficit
799.54	Psychomotor deficit
799.55	Frontal lobe and executive function deficit
799.59	Other signs and symptoms involving cognition
970.81	Poisoning by cocaine
999.61	ABO incompatibility with hemolytic transfusion reaction not specified as acute or delayed
999.62	ABO incompatibility with acute hemolytic transfusion reaction
999.63	ABO incompatibility with delayed hemolytic transfusion reaction
999.69	Other ABO incompatibility reaction
999.70	Rh incompatibility reaction, unspecified
999.71	Rh incompatibility with hemolytic transfusion reaction not specified as acute or delayed
999.72	Rh incompatibility with acute hemolytic transfusion reaction
999.73	Rh incompatibility with delayed hemolytic transfusion reaction
999.74	Other Rh incompatibility reaction
999.75	Non-ABO incompatibility reaction, unspecified
999.76	Non-ABO incompatibility with hemolytic transfusion reaction not specified as acute or delayed
999.77	Non-ABO incompatibility with acute hemolytic transfusion reaction
999.78	Non-ABO incompatibility with delayed hemolytic transfusion reaction
999.79	Other non-ABO incompatibility reaction
999.80	Transfusion reaction, unspecified
999.83	Hemolytic transfusion reaction, incompatibility unspecified
999.84	Acute hemolytic transfusion reaction, incompatibility unspecified
999.85	Delayed hemolytic transfusion reaction, incompatibility unspecified
E000.2	Volunteer activity
V11.4	Personal history of combat and operational stress reaction
V13.23	Personal history of vaginal dysplasia
V13.24	Personal history of vulvar dysplasia
V13.62	Personal history of other (corrected) congenital malformations of genitourinary system
V13.63	Personal history of (corrected) congenital malformations of nervous system
V13.64	Personal history of (corrected) congenital malformations of eye, ear, face and neck
V13.65	Personal history of (corrected) congenital malformations of heart and circulatory system
V13.66	Personal history of (corrected) congenital malformations of respiratory system
V13.67	Personal history of (corrected) congenital malformations of digestive system
V13.68**	Personal history of (corrected) congenital malformations of integument, limbs, and musculoskeletal systems
V15.53	Personal history of retained foreign body fully removed
V25.11	Encounter for insertion of intrauterine contraceptive device
V25.12	Encounter for removal of intrauterine contraceptive device
V25.13	Encounter for removal and reinsertion of intrauterine contraceptive device
V49.86	Do not resuscitate status
V49.87*	Physical restraints status
V62.85	Homicidal ideation
V85.41	Body Mass Index 40.0-44.9, adult
V85.42	Body Mass Index 45.0-49.9, adult
V85.44	Body Mass Index 60.0-69.9, adult
V85.45	Body Mass Index 70 and over, adult
V88.11	Acquired total absence of pancreas
V88.12	Acquired partial absence of pancreas
V90.01	Retained depleted uranium fragments
V90.09	Other retained radioactive fragments
V90.10	Retained metal fragments, unspecified
V90.11	Retained magnetic metal fragments
V90.12	Retained nonmagnetic metal fragments
V90.2	Retained plastic fragments
V90.31	Retained animal quills or spines
V90.32	Retained tooth
V90.33	Retained wood fragments
V90.39	Other retained organic fragments
V90.81	Retained glass fragments
V90.83	Retained stone or crystalline fragments
V90.89	Other specified retained foreign body
V90.9	Retained foreign body, unspecified material
V91.00	Twin gestation, unspecified number of placenta, unspecified number of amniotic sacs
V91.01	Twin gestation, monochorionic/monoamniotic (one placenta, one amniotic sac)
V91.02	Twin gestation, monochorionic/diamniotic (one placenta, two amniotic sacs)
V91.03	Twin gestation, dichorionic/diamniotic (two placentae, two amniotic sacs)
V91.09	Twin gestation, unable to determine number of placenta and number of amniotic sacs
V91.10	Triplet gestation, unspecified number of placenta and unspecified number of amniotic sacs
V91.11	Triplet gestation, with two or more monochorionic fetuses
V91.12	Triplet gestation, with two or more monoamniotic fetuses
V91.19	Triplet gestation, unable to determine number of placenta and number of amniotic sacs
V91.20	Quadruplet gestation, unspecified number of placenta and unspecified number of amniotic sacs
V91.21	Quadruplet gestation, with two or more monochorionic fetuses
V91.22	Quadruplet gestation, with two or more monoamniotic fetuses
V91.29	Quadruplet gestation, unable to determine number of placenta and number of amniotic sacs
V91.90	Other specified multiple gestation, unspecified number of placenta and unspecified number of amniotic sacs
V91.91	Other specified multiple gestation, with two or more monochorionic fetuses
V91.92	Other specified multiple gestation, with two or more monoamniotic fetuses
V91.99	Other specified multiple gestation, unable to determine number of placenta and number of amniotic sacs

Notes:
* These diagnosis codes were discussed at the March 9-10, 2010, ICD-9-CM Coordination and Maintenance Committee meeting and were not finalized in time to include in the proposed rule. However, they will be implemented on October 1, 2010. Please note that new code 237.78, “Other neuro-fibromatosis,” which was listed as a new diagnosis code in the proposed rule, has been modified to new code 237.79. New code 799.50, “Unspecified signs and symptoms involving cognition,” which was listed in the proposed rule as a new code. has been deleted and will not be implemented on October 1, 2010.

**The code title has changed from the proposed rule.

New procedure codes - Effective October 1, 2010

The final addendum that describes all changes to the procedure part of ICD-9-CM is posted on CMS’ Web site at: cms.hhs.gov/ICD9ProviderDiagnosticCodes

Procedure code	Description
00.60	Insertion of drug-eluting stent(s) of superficial femoral artery
01.20*	Cranial implantation or replacement of neurostimulator pulse generator
01.29*	Removal of cranial neurostimulator pulse generator
17.71*	Non-coronary intra-operative fluorescence vascular angiography [IFVA]
32.27	Bronchoscopic bronchial thermoplasty, ablation of airway smooth muscle
35.97*	Percutaneous mitral valve repair with implant
37.37*	Excision or destruction of other lesion or tissue of heart, thoracoscopic approach
38.97*	Central venous catheter placement with guidance
39.81	Implantation or replacement of carotid sinus stimulation device, total system
39.82	Implantation or replacement of carotid sinus stimulation lead(s) only
39.83	Implantation or replacement of carotid sinus stimulation pulse generator only
39.84	Revision of carotid sinus stimulation lead(s) only
39.85	Revision of carotid sinus stimulation pulse generator
39.86	Removal of carotid sinus stimulation device, total system
39.87	Removal of carotid sinus stimulation lead(s) only
39.88	Removal of carotid sinus stimulation pulse generator only
39.89	Other operations on carotid body, carotid sinus and other vascular bodies
81.88	Reverse total shoulder replacement
84.94*	Insertion of sternal fixation device with rigid plates
85.55*	Fat graft to breast
86.87*	Fat graft of skin and subcutaneous tissue
86.90*	Extraction of fat for graft or banking

Notes:
* These procedure codes were discussed at the March 9-10, 2010 ICD-9-CM Coordination and Maintenance Committee meeting and were not finalized in time to include in the proposed rule. However, they will be implemented on October 1, 2010.

Invalid diagnosis codes - Effective October 1, 2010

The final addendum providing complete information on changes to the diagnosis part of ICD-9-CM is posted on CDC’s Web site at www.cdc.gov/nchs/icd9.htm

Diagnosis code	Description
275.0	Disorders of iron metabolism
276.6	Fluid overload
287.4	Secondary thrombocytopenia
488.0*	Influenza due to identified avian influenza virus
488.1*	Influenza due to identified novel H1N1 influenza virus
752.3	Other anomalies of uterus
786.3	Hemoptysis
787.6	Incontinence of feces
970.8	Poisoning by other specified central nervous system stimulants
999.6	ABO incompatibility reaction
999.7	Rh incompatibility reaction
V25.1	Encounter for insertion of intrauterine contraceptive device
V85.4	Body Mass Index 40 and over, adult

Notes:
* These diagnosis codes were discussed at the March 9-10, 2010 ICD-9-CM Coordination and Maintenance Committee meeting and were not finalized in time to include in the proposed rule. However, they will be deleted on October 1, 2010.

Invalid procedure codes Effective - October 1, 2010

The final addendum that describes all changes to the procedure part of ICD-9-CM is posted on CMS’ Web site at cms.hhs.gov/ICD9ProviderDiagnosticCodes

Procedure code	Description
39.8	Operations on carotid body, carotid sinus and other vascular bodies

Revised diagnosis code titles - Effective October 1, 2010