Recommendations and comments are carefully
reviewed and evaluated before any final decisions
are made. No decisions are made at the meetings.
The ICD-9-CM Coordination and Maintenance
Committee's role is advisory, with all final decisions
made by the Director of NCHS and the
Administrator of CMS. Final decisions made after
the fall meeting generally become effective
October 1 of the following year.
Some changes for October 2009 include changing
the wording from renal to kidney or vice versa. Other
changes add a new code and remove the diagnosis
for the new code from a previous code. Some
changes were just grammatical, changing a small let-
ter to a capital letter. New codes were added for the
new H1N1 flu. There were changes made for new-
born exams, for those under 28 days. New codes for
ordering lab work for a physical exam and for a pre-
op exam have been added, and those who use an
electronic health record will especially find these ben-
eficial. Some of the new, revised, and deleted codes
effective October 1, 2009 include:
• 272.2 Mixed hyperlipidemia
•• Add Combined hyperlipidemia
•• Add Elevated cholesterol with elevated
triglycerides NEC
•• 272.4 Other and unspecified hyperlipidemia
•• Delete Combined hyperlipidemia
• 274.0 Gouty arthropathy
•• New 274.00 Gouty arthropathy, unspecified
•• New 274.01 Acute gouty arthropathy
■
Acute gout
■
Gout attack
■
Gout flare
■
Podagra
• New 274.02 Chronic gouty arthropathy with-
out mention of tophus (tophi)
• New 274.03 Chronic gouty arthropathy with
tophus (tophi)
■
Chronic tophaceous gout
■
Gout with tophi NOS
• 274.8 Gout with other specified manifestations
• 274.82 Gouty tophi of other sites
•• Add Excludes: gout with tophi NOS
(274.03) and
•• Add gouty arthropathy with tophi (274.03)
• 345 Epilepsy and recurrent seizures - The fol-
lowing fifth-digit subclassification is for use
with categories 345.0, .1, .4-.9:
■
1 with intractable epilepsy
•• Add pharmacoresistant (pharmacologically
resistant)
•• Add poorly controlled
•• Add refractory (medically)
•• Add treatment resistant
• 372.0 Acute conjunctivitis
•• New 372.06 Acute chemical conjunctivitis
•• Acute toxic conjunctivitis
DECODING CODES
Jan DiSantostefano
www.npjournal.org The Journal for Nurse Practitioners - JNP 687
Although the ICD-9-CM Coordination and Maintenance Committee is a Federal
Committee, suggestions for coding modifications come from both the public and pri-
vate sectors. Interested parties are asked to submit recommendations for modifica-
tion 2 months prior to a scheduled meeting. Proposals for a new code should include
a description of the code being requested, and rationale for why the new code is
needed, along with any supporting references and literature.
October 2009 ICD-9-CM Changes