For those providing critical care transport of pediatric patients, there are now two new codes to report these services. Codes 99289/99290 were deleted, and the new codes for face-to-face physician care during critical care transport of pediatric patients (24 months or younger) are 99466/99467.

Effective Oct. 1, 2009, several ICD-9 diagnosis code additions and revisions appear that are relevant to emergency medicine:

• 038.12: Methicillin-resistant Staphylococcus aureus (MRSA) septicemia.
• 041.12: Methicillin-resistant Staphylococcus aureus (MRSA), bacterial infection.
• A new set of codes for secondary diabetes is found in the 249.XX code set.
• A new set of headache codes in the 339 series, including: 339.00 (cluster headache syndrome, unspecified); 339.10 (tension-type headache, unspecified); 339.21 (acute post-traumatic headache); 339.22 (chronic post-traumatic headache, other); 339.42 (new daily persistent headaches); and 339.43 (primary thunderclap headache).
• Many new, more specific migraine codes in series 346 describe migraines in greater detail, such as those with aura, intractable migraine, cerebral infarction, and status migrainosus.
• Greater detail is available to report pleural effusion, including 511.81 (malignant pleural effusion).
• Hematuria codes are now more specific, with 599.70 (hematuria, unspecified), 599.71 (gross hematuria), and 599.72 (microscopic hematuria).
• Nonspecific vaginal pain is now a reportable diagnosis, 625.70 (vulvodynia, unspecified).
• The spectrum of illness involving Stevens-Johnson syndrome and erythema multiforme has been expanded to include 695.10 (erythema multiforme, unspecified); 695.11 (erythema multiforme minor); 695.12 (erythema multiforme major); 695.13 (Stevens-Johnson syndrome); and 695.19 (other erythema multiforme).
• Important new fever codes include 780.60 (fever, unspecified); 780.61 (fever presenting with conditions classified elsewhere); 780.62 (post-procedural fever); 780.63 (post-vaccination fever); 780.64 (chills (without fever)); and 780.65 (hypothermia not associated with low environmental temperature).
• Wound dehiscence codes are further refined by 998.30 (disruption of wound, unspecified) and 998.33 (disruption of traumatic wound repair).

See the 2009 ICD-9 book for a complete list of new and deleted codes, or visit the new ICD-9 FAQs on www.acep.org.

Other Resources

Resources for these and other topics can be found in the reimbursement section of the ACEP Web site (www.acep.org). The ACEP Coding and Nomenclature Advisory Committee, the ACEP Reimbursement Committee, and ACEP Reimbursement Department staff members David McKenzie and Mary Ellen Fletcher are available to field your questions. Finally, ACEP holds coding and reimbursement educational conferences twice a year.

Dr. Granovsky is a member of ACEP’s Coding and Nomenclature Advisory Committee. He is president of Medical Reimbursement Systems Inc. (MRSI), an ED billing and coding company.