Humana's Your Practice

New ICD-9-CM Codes

In October 2008, the Centers for Medicare & Medicaid Services (CMS) introduced 91 new ICD-9-CM diagnosis codes within its Hierarchical Condition Category (HCC) risk adjustment model. These 91 new diagnosis codes fall within 18 HCC categories. Physician offices should have begun using these new codes Oct. 1, 2008; these codes will impact payment in 2009 and beyond.

Remember, the HCC risk adjustment model depends upon physicians coding to the highest level of specificity. These new ICD-9-CM codes are intended to help physicians categorize their patients’ diagnoses more accurately. Each year, the World Health Organization (WHO) updates and publishes a new, updated ICD-9-CM reference book. In order to capture an accurate picture of members’ health, it is critically important that physician offices maintain an up-to-date ICD-9-CM book and use it for coding patient encounters. The ICD-9-CM book can be ordered from the American Academy of Professional Coders (AAPC) at Aapc.com or from Ingenix at Ingenix.com.

The new codes are summarized below. To view a complete list of all risk model diagnosis codes, click here.

ICD-9-CM Code	ICD-9 Description	CMS-HCC Model Category
03812	MRSA SEPTICEMIA	2
20402	ACT LYMP LEUK IN RELAPSE	7
20502	ACT MYEL LEUK IN RELAPSE	7
20602	ACT MONO LEUK IN RELAPSE	7
20702	AC ERTH/ERYLK IN RELAPSE	7
20802	AC LEUK UNS CL RELAPSE	7
20512	CHR MYEL LEUK IN RELAPSE	8
20522	SBAC MYL LEUK IN RELAPSE	8
20532	MYEL SARCOMA IN RELAPSE	8
20582	OTH MYEL LEUK IN RELAPSE	8
20592	MYEL LEUK NOS IN RELAPSE	8
20612	CHR MONO LEUK IN RELAPSE	8
20622	SBAC MONO LEU IN RELAPSE	8
20682	OTH MONO LEUK IN RELAPSE	8
20692	MONO LEUK NOS RELAPSE	8
20712	CHR ERYTHRMIA IN RELAPSE	8
20722	MGKRYCYT LEUK IN RELAPSE	8
20782	OTH SPF LEUK IN RELAPSE	8
20302	MULT MYELOMA IN RELAPSE	9
20312	PLSM CEL LEUK IN RELAPSE	9
20382	OTH IMNPRLF NEO-RELAPSE	9
20412	CHR LYMP LEUK IN RELAPSE	9
20422	SBAC LYM LEUK IN RELAPSE	9
20482	OTH LYM LEUK IN RELAPSE	9
20492	LYMP LEUK NOS RELAPSE	9
20812	CH LEU UNS CL IN RELAPSE	9
20822	SBAC LEU UNS CL-RELAPSE	9
20882	OTH LEUK UNS CL-RELAPSE	9
20892	LEUKEMIA NOS IN RELAPSE	9
1992	MALIG NEOPL-TRANSP ORGAN	10
20900	MAL CRCNOID SM INTST NOS	10
20901	MALIG CARCINOID DUODENUM	10
20902	MALIG CARCINOID JEJUNUM	10
20903	MALIG CARCINOID ILEUM	10
20910	MAL CRCNOID LG INTST NOS	10
20911	MALIG CARCINOID APPENDIX	10
20912	MALIG CARCINOID CECUM	10
20913	MAL CRCNOID ASCEND COLON	10
20914	MAL CRCNOID TRANSV COLON	10
20915	MAL CARCINOID DESC COLON	10
20916	MAL CARCINOID SIG COLON	10
20917	MALIG CARCINOID RECTUM	10
20920	MAL CRCND PRIM SITE UNKN	10
20921	MAL CARCINOID BRONC/LUNG	10
20922	MALIG CARCINOID THYMUS	10
20923	MALIG CARCINOID STOMACH	10
20924	MALIG CARCINOID KIDNEY	10
20925	MAL CARCNOID FOREGUT NOS	10
20926	MAL CARCINOID MIDGUT NOS	10
20927	MAL CARCNOID HINDGUT NOS	10
20929	MALIG CARCINOID OTH SITE	10
20930	MALIG NEUROENDO CA NOS	10
24940	SEC DM RENL NT ST UNCNTR	15
24941	SEC DM RENAL UNCONTRLD	15
24970	SEC DM CIRC NT ST UNCNTR	15
24971	SEC DM CIRC UNCONTRLD	15
24960	SEC DM NEURO NT ST UNCN	16
24961	SEC DM NEURO UNCONTRLD	16
24980	SEC DM OTH NT ST UNCONTR	16
24981	SEC DM OTHER UNCONTRLD	16
24910	SEC DM KETO NT ST UNCNTR	17
24911	SEC DM KETOACD UNCNTRLD	17
24920	SEC DM HPROS NT ST UNCNR	17
24921	SEC DM HPROSMLR UNCNTRLD	17
24930	SEC DM OT CMA NT ST UNCN	17
24931	SEC DM OTH COMA UNCNTRLD	17
24950	SEC DM OPHTH NT ST UNCN	18
24951	SEC DM OPHTH UNCONTRLD	18
24990	SEC DM UNSP NT ST UNCON	18
24991	SEC DM UNSP UNCONTROLD	18
24900	SEC DM WO CMP NT ST UNCN	19
24901	SEC DM WO COMP UNCONTRLD	19
57142	AUTOIMMUNE HEPATITIS	27
27950	GRAFT-VERSUS-HOST NOS	45
27951	AC GRAFT-VERSUS-HOST DIS	45
27952	CHRONC GRAFT-VS-HOST DIS	45
27953	AC ON CHRN GRFT-VS-HOST	45
78072	FUNCTIONAL QUADRIPLEGIA	67
33700	IDIO PERPH AUTO NEUR NOS	71
33709	IDIO PERPH AUTO NEUR NEC	71
48242	METH RES PNEU D/T STAPH	111
V4511	RENAL DIALYSIS STATUS	130
V4512	NONCMPLNT W RENAL DIALYS	130
70720	PRESSURE ULCER,STAGE NOS	148
70721	PRESSURE ULCER, STAGE I	148
70722	PRESSURE ULCER, STAGE II	148
70723	PRESSURE ULCER,STAGE III	148
70724	PRESSURE ULCER, STAGE IV	148
70725	PRESSURE ULCER,UNSTAGEBL	148
99731	VENTLTR ASSOC PNEUMONIA	164
99739	RESPIRATORY COMP NEC	164