2012 Texas Medicaid ICD-9-CM Updates Now Available Information posted September 30, 2011

On October 1, 2011, TMHP will implement the annual 2012 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) additions, changes, and deletions that are effective for dates of service on or after October 1, 2011.

The following program and coding changes, which were made during the 2012 ICD-9-CM updates, affect Texas Medicaid providers.

New Diagnosis Codes The following table lists the new ICD-9-CM diagnosis codes:

Diagnosis Codes Descriptions 04141 Shiga toxin-producing Escherichia coli [E coli] (stec) O157 04142 Other specified Shiga toxin-producing Escherichia coli [E coli] (stec) 04143 Shiga toxin-producing Escherichia coli [E coli] (stec), unspecified 04149 Other and unspecified Escherichia coli [E coli] 17300 Unspecified malignant neoplasm of skin of lip 17301 Basal cell carcinoma of skin of lip 17302 Squamous cell carcinoma of skin of lip 17309 Other specified malignant neoplasm of skin of lip 17310 Unspecified malignant neoplasm of eyelid, including canthus 17311 Basal cell carcinoma of eyelid, including canthus 17312 Squamous cell carcinoma of eyelid, including canthus 17319 Other specified malignant neoplasm of eyelid, including canthus 17320 Unspecified malignant neoplasm of skin of ear and external auditory canal 17321 Basal cell carcinoma of skin of ear and external auditory canal 17322 Squamous cell carcinoma of skin of ear and external auditory canal 17329 Other specified malignant neoplasm of skin of ear and external auditory

canal 17330 Unspecified malignant neoplasm of skin of other and unspecified parts of

face 17331 Basal cell carcinoma of skin of other and unspecified parts of face 17332 Squamous cell carcinoma of skin of other and unspecified parts of face 17339 Other specified malignant neoplasm of skin of other and unspecified parts

of face 17340 Unspecified malignant neoplasm of scalp and skin of neck 17341 Basal cell carcinoma of scalp and skin of neck

Diagnosis Codes Descriptions 17342 Squamous cell carcinoma of scalp and skin of neck 17349 Other specified malignant neoplasm of scalp and skin of neck 17350 Unspecified malignant neoplasm of skin of trunk, except scrotum 17351 Basal cell carcinoma of skin of trunk, except scrotum 17352 Squamous cell carcinoma of skin of trunk, except scrotum 17359 Other specified malignant neoplasm of skin of trunk, except scrotum 17360 Unspecified malignant neoplasm of skin of upper limb, including shoulder 17361 Basal cell carcinoma of skin of upper limb, including shoulder 17362 Squamous cell carcinoma of skin of upper limb, including shoulder 17369 Other specified malignant neoplasm of skin of upper limb, including

shoulder 17370 Unspecified malignant neoplasm of skin of lower limb, including hip 17371 Basal cell carcinoma of skin of lower limb, including hip 17372 Squamous cell carcinoma of skin of lower limb, including hip 17379 Other specified malignant neoplasm of skin of lower limb, including hip 17380 Unspecified malignant neoplasm of other specified sites of skin 17381 Basal cell carcinoma of other specified sites of skin 17382 Squamous cell carcinoma of other specified sites of skin 17389 Other specified malignant neoplasm of other specified sites of skin 17390 Unspecified malignant neoplasm of skin, site unspecified 17391 Basal cell carcinoma of skin, site unspecified 17392 Squamous cell carcinoma of skin, site unspecified 17399 Other specified malignant neoplasm of skin, site unspecified 28240 Thalassemia, unspecified 28243 Alpha thalassemia 28244 Beta thalassemia 28245 Delta-beta thalassemia 28246 Thalassemia minor 28247 Hemoglobin e-beta thalassemia 28411 Antineoplastic chemotherapy induced pancytopenia 28412 Other drug-induced pancytopenia 28419 Other pancytopenia 28652 Acquired hemophilia 28653 Antiphospholipid antibody with hemorrhagic disorder 28659 Other hemorrhagic disorder due to intrinsic circulating anticoagulants,

antibodies, or inhibitors

Diagnosis Codes Descriptions 29420 Dementia, unspecified, without behavioral disturbance 29421 Dementia, unspecified, with behavioral disturbance 31081 Pseudobulbar affect 31089 Other specified nonpsychotic mental disorders following organic brain

damage 3316 Corticobasal degeneration 34882 Brain death 35830 Lambert-Eaton syndrome, unspecified 35831 Lambert-Eaton syndrome in neoplastic disease 35839 Lambert-Eaton syndrome in other diseases classified elsewhere 36505 Open angle with borderline findings, high risk 36506 Primary angle closure without glaucoma damage 36570 Glaucoma stage, unspecified 36571 Mild stage glaucoma 36572 Moderate stage glaucoma 36573 Severe stage glaucoma 36574 Indeterminate stage glaucoma 37927 Vitreomacular adhesion 4144 Coronary atherosclerosis due to calcified coronary lesion 41513 Saddle embolus of pulmonary artery 42511 Hypertrophic obstructive cardiomyopathy 42518 Other hypertrophic cardiomyopathy 44401 Saddle embolus of abdominal aorta 44409 Other arterial embolism and thrombosis of abdominal aorta 48881 Influenza due to identified novel influenza a virus with pneumonia 48882 Influenza due to identified novel influenza a virus with other respiratory

manifestations 48889 Influenza due to identified novel influenza a virus with other manifestations 5082 Respiratory conditions due to smoke inhalation 5122 Postoperative air leak 51281 Primary spontaneous pneumothorax 51282 Secondary spontaneous pneumothorax 51283 Chronic pneumothorax 51284 Other air leak 51289 Other pneumothorax 51630 Idiopathic interstitial pneumonia, not otherwise specified

Diagnosis Codes Descriptions 51631 Idiopathic pulmonary fibrosis 51632 Idiopathic non-specific interstitial pneumonitis 51633 Acute interstitial pneumonitis 51634 Respiratory bronchiolitis interstitial lung disease 51635 Idiopathic lymphoid interstitial pneumonia 51636 Cryptogenic organizing pneumonia 51637 Desquamative interstitial pneumonia 5164 Lymphangioleiomyomatosis 5165 Adult pulmonary Langerhans cell histiocytosis 51661 Neuroendocrine cell hyperplasia of infancy 51662 Pulmonary interstitial glycogenosis 51663 Surfactant mutations of the lung 51664 Alveolar capillary dysplasia with vein misalignment 51669 Other interstitial lung diseases of childhood 51851 Acute respiratory failure following trauma and surgery 51852 Other pulmonary insufficiency, not elsewhere classified, following trauma

and surgery 51853 Acute and chronic respiratory failure following trauma and surgery 53901 Infection due to gastric band procedure 53909 Other complications of gastric band procedure 53981 Infection due to other bariatric procedure 53989 Other complications of other bariatric procedure 5735 Hepatopulmonary syndrome 59681 Infection of cystostomy 59682 Mechanical complication of cystostomy 59683 Other complication of cystostomy 59689 Other specified disorders of bladder 62931 Erosion of implanted vaginal mesh and other prosthetic materials to

surrounding organ or tissue 62932 Exposure of implanted vaginal mesh and other prosthetic materials into

vagina 6310 Inappropriate change in quantitative human chorionic gonadotropin (HCG)

in early pregnancy 6318 Other abnormal products of conception 64981 Onset (spontaneous) of labor after 37 completed weeks of gestation but

before 39 completed weeks gestation, with delivery by (planned) Cesarean section, delivered, with or without mention of antepartum condition

Diagnosis Codes Descriptions 64982 Onset (spontaneous) of labor after 37 completed weeks of gestation but

before 39 completed weeks gestation, with delivery by (planned) Cesarean section, delivered, with mention of postpartum complication

70441 Pilar cyst 70442 Trichilemmal cyst 72613 Partial tear of rotator cuff 74731 Pulmonary artery coarctation and atresia 74732 Pulmonary arteriovenous malformation 74739 Other anomalies of pulmonary artery and pulmonary circulation 79311 Solitary pulmonary nodule 79319 Other nonspecific abnormal finding of lung field 79551 Nonspecific reaction to tuberculin skin test without active tuberculosis 79552 Nonspecific reaction to cell mediated immunity measurement of gamma

interferon antigen response without active tuberculosis 80844 Multiple closed pelvic fractures without disruption of pelvic circle 80854 Multiple open pelvic fractures without disruption of pelvic circle 99688 Complications of transplanted organ, stem cell 99732 Postprocedural aspiration pneumonia 99741 Retained cholelithiasis following cholecystectomy 99749 Other digestive system complications 99800 Postoperative shock, unspecified 99801 Postoperative shock, cardiogenic 99802 Postoperative shock, septic 99809 Postoperative shock, other 99932 Bloodstream infection due to central venous catheter 99933 Local infection due to central venous catheter 99934 Acute infection following transfusion, infusion, or injection of blood and

blood products 99941 Anaphylactic reaction due to administration of blood and blood products 99942 Anaphylactic reaction due to vaccination 99949 Anaphylactic reaction due to other serum 99951 Other serum reaction due to administration of blood and blood products 99952 Other serum reaction due to vaccination 99959 Other serum reaction V1221 Personal history of gestational diabetes V1229 Personal history of other endocrine, metabolic, and immunity disorders V1255 Personal history of pulmonary embolism

Diagnosis Codes Descriptions V1381 Personal history of anaphylaxis V1389 Personal history of other specified diseases V1911 Family history of glaucoma V1919 Family history of other specified eye disorder V2342 Pregnancy with history of ectopic pregnancy V2387 Pregnancy with inconclusive fetal viability V4031 Wandering in diseases classified elsewhere V4039 Other specified behavioral problem V5482 Aftercare following explantation of joint prosthesis V5868 Long term (current) use of bisphosphonates V8702 Contact with and (suspected) exposure to uranium V8821 Acquired absence of hip joint V8822 Acquired absence of knee joint V8829 Acquired absence of other joint

Discontinued Diagnosis Codes The following table lists diagnosis codes that have been discontinued:

Diagnosis Code Description 0414 Escherichia coli [E. coli] infection in conditions classified elsewhere

and of unspecified site 1730 Other malignant neoplasm of skin of lip 1731 Other malignant neoplasm of skin of eyelid, including canthus 1732 Other malignant neoplasm of skin of ear and external auditory canal 1733 Other malignant neoplasm of skin of other and unspecified parts of

face 1734 Other malignant neoplasm of scalp and skin of neck 1735 Other malignant neoplasm of skin of trunk, except scrotum 1736 Other malignant neoplasm of skin of upper limb, including shoulder 1737 Other malignant neoplasm of skin of lower limb, including hip 1738 Other malignant neoplasm of other specified sites of skin 1739 Other malignant neoplasm of skin, site unspecified 2841 Pancytopenia 2865 Hemorrhagic disorder due to intrinsic circulating anticoagulants 3108 Other specified nonpsychotic mental disorders following organic brain

damage 4251 Hypertrophic obstructive cardiomyopathy 4440 Embolism and thrombosis of abdominal aorta 5128 Other spontaneous pneumothorax 5163 Idiopathic fibrosing alveolitis 5185 Pulmonary insufficiency following trauma and surgery

Diagnosis Code Description 5968 Other specified disorders of bladder 631 Other abnormal product of conception 71860 Unspecified intrapelvic protrusion of acetabulum, site unspecified 7473 Anomalies of pulmonary artery 7931 Nonspecific (abnormal) findings on radiological and other

examination of lung field 7955 Nonspecific reaction to tuberculin skin test without active tuberculosis 9974 Digestive system complications, not elsewhere classified 9980 Postoperative shock 9994 Anaphylactic shock due to serum 9995 Other serum reaction, not elsewhere classified V122 Personal history of endocrine, metabolic, and immunity disorders V138 Personal history of other specified diseases V191 Family history of other eye disorders V403 Other behavioral problems

Revised Diagnosis Codes The following table lists diagnosis codes that have been revised:

Diagnosis Code Old Description New Description 317 Mild mental retardation Mild intellectual disabilities 3180 Moderate mental retardation Moderate intellectual disabilities 3181 Severe mental retardation Severe intellectual disabilities 3182 Profound mental retardation Profound intellectual disabilities 319 Unspecified mental retardation Unspecified intellectual disabilities32341 Other encephalitis and

encephalomyelitis due to infection classified elsewhere

Other encephalitis and encephalomyelitis due to other infections classified elsewhere

32342 Other myelitis due to infection classified elsewhere

Other myelitis due to other infections classified elsewhere

36501 Open angle with borderline findings

Open angle with borderline findings, low risk

48811 Influenza due to identified novel h1n1 influenza virus with pneumonia

Influenza due to identified 2009 h1n1 influenza virus with pneumonia

48812 Influenza due to identified novel h1n1 influenza virus with other respiratory manifestations

Influenza due to identified 2009 h1n1 influenza virus with other respiratory manifestations

48819 Influenza due to identified novel h1n1 influenza virus with other manifestations

Influenza due to identified 2009 h1n1 influenza virus with other manifestations

64670 Liver disorders in pregnancy-unspecified

Liver and biliary tract disorders in pregnancy, unspecified as to episode of care or not applicable

64671 Liver disorders in pregnancy-delivered

Liver and biliary tract disorders in pregnancy, delivered, with or

Diagnosis Code Old Description New Description

without mention of antepartum condition

64673 Liver disorders in pregnancy-antepartum condition

Liver and biliary tract disorders in pregnancy, antepartum condition or complication

80843 Multiple pelvic fractures with disruption of pelvic circle; closed

Multiple closed pelvic fractures with disruption of pelvic circle

80853 Multiple pelvic fractures with disruption of pelvic circle; open

Multiple open pelvic fractures with disruption of pelvic circle

9685 Surface {topical} and infiltration anesthetics

Surface (topical) and infiltration anesthetics

9950 Other anaphylactic shock Other anaphylactic reaction 99560 Anaphylactic shock due to

unspecified food Anaphylactic reaction due to unspecified food

99561 Anaphylactic shock due to peanuts

Anaphylactic reaction due to peanuts

99562 Anaphylactic shock due to crustaceans

Anaphylactic reaction due to crustaceans

99563 Anaphylactic shock due to fruits and vegetables

Anaphylactic reaction due to fruits and vegetables

99564 Anaphylactic shock due to tree nuts and seeds

Anaphylactic reaction due to tree nuts and seeds

99565 Anaphylactic shock due to fish Anaphylactic reaction due to fish 99566 Anaphylactic shock due to food

additives Anaphylactic reaction due to food additives

99567 Anaphylactic shock due to milk products

Anaphylactic reaction due to milk products

99568 Anaphylactic shock due to eggs Anaphylactic reaction due to eggs 99569 Anaphylactic shock due to other

specified food Anaphylactic reaction due to other specified food

99931 Infection due to central venous catheter

Other and unspecified infection due to central venous catheter

V184 Family history of mental retardation

Family history of intellectual disabilities

V792 Special screening for mental retardation

Special screening for intellectual disabilities

The following diagnosis codes have also been revised by the Centers for Medicare & Medicaid Services (CMS):

Revised CMS Diagnosis Codes 34601 34611 34621 34631 34641 34651 34661 34671 34681 34691

Providers can refer to the CMS website at www.cms.gov/ICD9ProviderDiagnosticCodes for additional information.

Texas Medicaid Medical Policy Updates

Procedure Code(s) Added Diagnosis Codes

Discontinued Diagnosis Codes

Revised Diagnosis Codes*

Aerosol Treatments – Outpatient Setting

Refer to: 2011 Texas Medicaid Provider Procedures Manual, Hospital Services Handbook, subsection 2.3.3.19.1, “Aerosol Treatment,” and the Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 8.2.3, “Aerosol Treatment.” 94640, 94644, 94645, J7605, J7608, J7622, J7626, J7631, J7633, J7639, J7644, J7682, revenue code 412

5082, 48881, 48882 N/A 48811, 48812

Ambulance Services

Refer to: 2011 Texas Medicaid Provider Procedures Manual, Ambulance Services Handbook, subsections 2.4.6, “Emergency Transport Billing,” and 2.4.7, “Nonemergency Transport Billing.” Emergency ambulance services

Condition codes: 99941, 99942, 99949

Condition code: 5185

N/A

Antihemophilic Factor (AHF)

Refer to: 2011 Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians and Physicians Assistants Handbook, subsection 8.2.37.7, “Antihemophilic Factor.” J1680, J7185, J7186, J7187, J7189, J7190, J7191, J7192, J7194, J7198, J7199

28652 N/A N/A

J1680, J7185, J7186, J7187, J7190, J7191, J7192, J7194, J7198, J7199

N/A 2865 N/A

Blood Pressure Devices

Refer to: 2011 Texas Medicaid Provider Procedures Manual, Children’s Services Handbook, subsection 2.5.4, “Blood Pressure Devices,” on page CH-35, and the Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.6, “Blood Pressure Devices,” on page DM-32, for more information. A4660, A4670 42511, 42518 4251

N/A

Cytogenetics Testing

Refer to: 2011 Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 8.2.39.6, “Cytogenetics Testing.” 88230, 88233, 88235, 88237, 88239, 88245,

6318, 74732 631, 7473 317, 3180, 3181, 3182,

Procedure Code(s) Added Diagnosis Codes

Discontinued Revised Diagnosis Diagnosis Codes Codes*

88248, 88249, 88261, 88262, 88263, 88264, 88280, 88283, 88285, 88289, 88271, 88272, 88273, 88274, 88275, 88291

319, V184

Developmental and Neurological Assessment and Testing

Refer to: 2011 Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 8.2.23.4, “Neurobehavioral Testing.” 96116 29420, 29421, 31081,

31089, 3316 3108 317, 3180,

3181, 3182, 319, 32341, 32342, V792

Diagnostic Doppler Sonography

Refer to: 2011 Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 8.2.25, “Diagnostic Doppler Sonography.” 93886, 93888, 93890, 93892, 93893

34882 N/A N/A

93922, 93923, 93924, 93925, 93926, 93930, 93931

41513, 44401, 44409, V1255

4440 N/A

93965, 93970, 93971 41513, 44401, 44409, V1255

N/A N/A

93875, 93880, 93882 N/A 9980 N/A Doctor of Dentistry Services as a Limited Physician

Refer to: 2011 Texas Medicaid Provider Procedures Manual, Children’s Services Handbook, subsection 4.1.5, “Doctor of Dentistry Practicing as a Limited Physician” and the Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 8.3, “Doctor of Dentistry Practicing as a Limited Physician.” Patient evaluation and management services, and consultation procedure codes

17300, 17301, 17302, 17309, 17330, 17331, 17332, 17339, 17340, 17341, 17342, 17349,

1730, 1733 N/A

Electromyography and Nerve Conduction Studies

Refer to: 2011 Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 8.2.24.7, “Electrodiagnostic (EDX) Testing.” 51784, 51785, 95860, 95861, 95863, 95864, 95865, 95866, 95867, 95868, 95869, 95870,

35830, 35831, 35839 N/A N/A

Procedure Code(s) Added Diagnosis Codes

Discontinued Revised Diagnosis Diagnosis Codes Codes*

95872, 95875, 95900, 95903, 95904, 95905, 95930, 95933, 95934, 95936, 95937 Hyperbaric Oxygen Therapy

Refer to: 2011 Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 8.2.31, “Hyperbaric Oxygen Therapy (HBOT).” 99183 N/A 9980 N/A Inpatient Behavioral Health

Refer to: 2011Texas Medicaid Provider Procedures Manual, Behavioral Health, Rehabilitation, and Case Management Services Handbook, section 7, “Physician, Psychologist, and Licensed Psychological Associate (LPA) Providers.” 90801, 90802, 90816, 90817, 90818, 90819, 90821, 90822, 90823, 90824, 90826, 90827, 90828, 90829, 90847, 90862, 96101, 96118

29420, 29421, 31081, V4031, V4039

3108 317, 3180, 3181, 3182, 319, V792

Outpatient Behavioral Health Services

Refer to: 2011 Texas Medicaid Provider Procedures Manual, Behavioral Health, Rehabilitation, and Case Management Services Handbook, section 5, "Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), and Licensed Professional Counselor (LPC)," and section 7, “Physician, Psychologist, and Licensed Psychological Associate (LPA) Providers.” 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90814, 90815, 90847, 90853, 90857, 90862, 90865, 96101, 96118, M0064

29420, 29421, 31081, V4031, V4039

3108 317, 3180, 3181, 3182, 319, V792

Physician Evaluation and Management Services

Refer to: The article titled "Changes to Benefit Criteria for Physician Evaluation and Management Services for Texas Medicaid," on page 49 of the May/June 2011 Texas Medicaid Bulletin, No. 235. 99078 with modifier TH

V2342 N/A N/A

Pulmonary Function Studies

Refer to: 2011 Texas Medicaid Provider Procedures Manual, Hospital Services Handbook, subsection 2.3.3.19.3, “Pulmonary Function Studies.”

Procedure Code(s) Added Diagnosis Codes

Discontinued Revised Diagnosis Diagnosis Codes Codes*

94452, 94453 N/A 5163 N/A Respiratory Equipment and Supplies – Home Health

Refer to: 2011 Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.19, “Respiratory Equipment and Supplies.” A4617, A7003, A7004, A7005, A7006, A7011, A7013, A7014, A7015, E0570

48881, 48882 N/A 48811, 48812

E0500 51630, 51631, 51632, 51633, 51634, 51635, 51636, 51637, 51662, 51669, 51851, 51852, 51853

5163, 5185 N/A

Respiratory Syncytial Virus Prophylaxis

Refer to: 2011 Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistant Handbook, subsection 8.2.65, “Respiratory Syncytial Virus (RSV) Prophylaxis.” 90378 N/A 4251, 7473 N/A Texas Health Steps (THSteps) Therapeutic Dental Services

Refer to: 2011 Texas Medicaid Provider Procedures Manual, Children Services Handbook, section 4, “Texas Health Steps (THSteps) Dental.” D9920 N/A N/A 317, 3180,

3181, 3182, 319 Therapeutic Apheresis

Refer to: 2011 Texas Medicaid Provider Procedure Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 8.2.72, “Therapeutic Apheresis.” 36514, 36515 28652, 35831 N/A

N/A

Transplants – Nonsolid Organ

Refer to: 2011 Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 8.2.47.7.1, “Allogenic and Autologous Bone Marrow and Stem Cell Transplantation.” 38206, 38230, 38240, 38241, 38242, S2142

N/A 2841 N/A

Vision Services Nonsurgical

Refer to: 2011 Texas Medicaid Provider Procedures Manual, Vision and Hearing Services Handbook, subsections 4.3.5, “Vision Testing,” and 4.3.5.9, “Other Professional

Procedure Code(s) Added Diagnosis Codes

Discontinued Revised Diagnosis Diagnosis Codes Codes*

Services.” 92002, 92004, 92012, 92014,

36505, 36506, 36570, 36571, 36572, 36573, 36574

N/A N/A

92120 36505, 36506, 36570, 36571, 36572, 36573, 36574, V1911

N/A N/A

92285, 92286, 92287 36505, 36506, 36570, 36571, 36572, 36573, 36574, 37927

3108, 4251, 71860, 7473, 9974, 9980, 9994

317, 3180, 3181, 3182, 319, 36501, V792

* Refer to the Revised Diagnosis Descriptions section of this article for description changes.

Inpatient Hospital ICD-9-CM Procedure Code and Diagnosis Related Group (DRG) Updates This section lists the procedure and DRG code changes for inpatient hospital providers. Providers should refer to the appropriate copyright holder’s code listing for the new, discontinued, and revised descriptions for the procedure codes indicated below. All discontinued codes will not be reimbursed for dates of service on or after October 1, 2011.

The following table lists all of the new, discontinued, and revised surgical procedure codes:

Note: These procedure codes are surgical codes used to assign the proper DRG for an inpatient hospital stay and are processed as informational only.

New Procedure Codes 00221 00222 01267 01753 01754 01755 01756 01781 03505 03506 03507 03508 03509 03826 03977 03978 04382 06824 06825 Discontinued Procedure Code 00220 Revised Procedure Codes 00056 00061 00062 00064 00066 00239 01365 03520 03521 03522 03523 03524 03525 03526 03527 03528 03736 03950 03971 03972 04389 08695 08698

The following table lists all of the new, discontinued, and revised DRG codes:

New DRG Codes 016 017 570 571 572 Discontinued DRG Code 015

Revised DRG Codes 237 573 574 575 576 577 578 640 641 642

Providers may refer to this website for the complete list of DRG relative weights, mean lengths of stay, and day thresholds for effective dates of admission on or after October 1, 2011. The information is available on the Code Updates – ICD-9-CM web page. Refer to the article titled “MS-DRG 2012 Updates Effective October 1, 2011.”

For more information, call the TMHP Contact Center at 1-800-925-9126.