Dedicated to Lymphedema Patients and the Therapists Who Treat Them
ICD-9-CM Medical Diagnosis Codes
The International Statistical Classification of Diseases and Related Health Problems (commonly known as the ICD) provides alpha-numeric codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. Nearly every health condition can be assigned to a unique category and given a code, up to six characters long. Such categories usually include a set of similar diseases.
ICD-9-CM and its "Official ICD-9-CM Guidelines for Coding and Reporting" have been selected as the approved coding set for entities covered under the Health Insurance Portability and Accountability Act (HIPAA) for reporting diagnoses and inpatient procedures. This requires the use of ICD-9-CM and its official coding and reporting guidelines by most health plans (including Medicare) by October 16, 2002.
The "Official ICD-9-CM Guidelines for Coding and Reporting" provides guidance on coding. The "ICD-9-CM Coding Guidelines for Outpatient Services," which is part of the "Official ICD-9-CM Guidelines for Coding and Reporting," provides guidance on diagnosis coding specific to outpatient facilities and physician offices.
Beneficiaries are not required to submit ICD-9 codes on beneficiary-submitted claims. Beneficiary-submitted claims are filed on Form CMS-1490S. For beneficiary-submitted claims, the carrier must develop the claim to determine a current and valid ICD-9 code and may enter the code on the claim. For outpatient claims, providers report the full ICD-9-CM code for the diagnosis shown to be chiefly responsible for the outpatient services. So, for example if the patient has lymphedema subsequent to breast cancer, the ICD-9 code is the code for lymphedema, and not for breast surgery. For outpatient claims, providers report the full ICD-9-CM codes for up to eight other diagnoses that coexisted in addition to the diagnosis reported as the principal diagnosis. The reason that this may be important is if a patient requires lengthier CDT exceeding the annual cap because of the co-morbidities, then it will be easier to obtain treatment coverage.
The three most used lymphedema codes are: 457.0 Mastectomy-related lymphedema syndrome; 457.1 Other lymphedema; 757.0 Congenital lymphedema of the lower limbs. There are other less-used codes used for lymphedema of the vulva, testes, penis, legs, eyes, etc.
On October 1, 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets.