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Syndrome X Is Among the New Diagnosis Codes That Go Into Effect on Oct. 1

CMS has issued its annual update of ICD-9 codes that will go into effect Oct. 1, 2001. The list includes a new code (277.7, dysmetabolic syndrome X) that many physicians and coders may not be familiar with, as well as mammography code changes. Medicare carriers, which handle Part B claims, have a 90-day grace period in which they may accept both old and new ICD-9 claims. The grace period ends Dec. 21, 2001. However, fiscal intermediaries, which handle Part A claims, are required to accept only the new ICD-9 codes as of Oct. 1. The new outpatient code editor (OCE) 2.3 will also go into effect on that date to review coding.
 
According to CMS PM AB-01-91 dated June 28, 2001, these changes are particularly important for OPPS providers because of the relationship between coding and payment. "Encourage hospitals to send a copy to the directors of medical records," the transmittal states. Amy Blum, RHIA, medical classification specialist with the National Center for Health Statistics, which assigns the new codes, says hospitals will not find too many surprises in the new update.

Adding Syndrome X
 
Dysmetabolic syndrome X is defined by the American Association of Clinical Endocrinologists (AACE) as "an increased cellular resistance to insulin." However, the syndrome is still evolving and the definition has changed over time. According to Michael B. Fowler, MD, at a meeting of the American College of Cardiology, patients with the condition have an extremely high risk of cardiovascular disease that can lead to the cardiovascular complications of diabetes before the patients actually develop diabetes. "There is no simple, everyday test to identify this condition," Fowler says.
 
At a meeting of the ICD-9 coordination and maintenance committee last year, several questions were raised about how the syndrome should be documented in the medical record. Others attendees questioned how coders would know when to link syndrome X with its associated conditions, like hypertension. The new ICD-9 requires use of an additional code for associated manifestations, such as cardiovascular disease (414.00-414.05) and obesity (278.00-278.01).
 
The new code could cause some headaches for both physicians and coders because physicians now are more likely to document the condition as "insulin resistance" and list associated conditions separately. 

New Fracture Codes
 
The update also adds codes to distinguish stress fractures from pathological fractures. According to Blum, stress fractures are the effect of repetitive trauma to a bone caused by activities like running, which result in weakness at the point of fracture. Pathological fractures occur at sites weakened by an existing disease of the bone, such as a neoplasm or necrosis. The new codes are:
 

733.93 -- stress fracture of tibia or fibula (stress reaction of tibia or fibula)
 


- Published on 2001-09-01