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July/August 2004 1
Major Changes to ICD-9-CMInclude 75 New Codes for OMSIn addition to the elimination of the 90-day grace period for using discontinued ICD-9-CM, CPT and HCPCS codes (asreported in the May/June 2004 issue of AAOMS Today), there are some other significant changes for which all providersmust be prepared.
The May 18, 2004 CMS Proposed Rule: Proposed Changes to the Hospital Inpatient Prospective Payment Systems andFiscal Year 2005 Rates sets forth a list of 171 new ICD-9-CM codes, including more than 75 additions relevant to oraland maxillofacial surgery. The majority of the changes increase specificity by adding fifth digits to existing four-digit codes.Existing categories affected by the expansion fall within the 521.0 – 528.79 range. To avoid rejections of claims submittedwith discontinued codes or those missing a fifth digit, it is absolutely imperative that providers and their systems beprepared to use these new codes on claims for all dates of service from October 1, 2004 and later. Be advised, there will beno grace period to slowly phase in the new codes. The new codes must be used immediately starting on October 1.
If this isn’t enough to keep you busy, beginning April 1, 2005, ICD-9-CM will be updated twice a year on April 1 andOctober 1, rather than the current once a year. Details of this requirement, established by a provision in the MedicarePrescription Drug, Improvement and Modernization Act (MMA), have not been spelled out in terms of when and wherethe annual April 1 code changes will be released. AAOMS is watching this issue and will provide more information as itbecomes available.
Following is a list of the OMS relevant additions, revisions and deletions. A complete listing of changes can be found inthe May 18, 2004 Federal Register: http://a257.g.akamaitech.net/7/257/2422/19may20040800/edocket.access.gpo.gov/2004/pdf/04-10932.pdf .
520 Disorders of tooth development anderuption
520.6 Disturbances in tooth eruption
Delete Excludes: impacted or embeddedteeth with abnormalposition of such teeth oradjacent teeth (524.3)
521 Diseases of hard tissues of teeth
521.0 Dental caries
521.05 OdontoclasiaRevise Excludes: internal and external
resorption of teeth(521.40-521.49)
New code 521.06 Dental caries pit and fissureNew code 521.07 Dental caries of smooth surfaceNew code 521.08 Dental caries of root surface
Revise 521.1 Excessive attrition (approximalwear) (occlusal wear)
Delete Approximal wearDelete Occlusal wear
New code 521.10 Excessive attrition, unspecifiedNew code 521.11 Excessive attrition, limited to
enamelNew code 521.12 Excessive attrition, extending into
dentineNew code 521.13 Excessive attrition, extending into
pulp
PRACTICE MANAGEMENT
NOTESA Supplement to the AAOMS Today Newsletter July/August 2004
2 July/August 2004
New code 521.14 Excessive attrition, localizedNew code 521.15 Excessive attrition, generalized
521.2 Abrasion
New code 521.20 Abrasion, unspecifiedNew code 521.21 Abrasion, limited to enamelNew code 521.22 Abrasion, extending into dentineNew code 521.23 Abrasion, extending into pulpNew code 521.24 Abrasion, localizedNew code 521.25 Abrasion, generalized
521.3 Erosion
New code 521.30 Erosion, unspecifiedNew code 521.31 Erosion, limited to enamelNew code 521.32 Erosion, extending into dentineNew code 521.33 Erosion, extending into pulpNew code 521.34 Erosion, localizedNew code 521.35 Erosion, generalized
521.4 Pathological resorptionDelete Internal granuloma of pulpDelete Resorption of tooth or root
(external) (internal)
New code 521.40 Pathological resorption,unspecified
New code 521.41 Pathological resorption, internalNew code 521.42 Pathological resorption, externalNew code 521.49 Other pathological resorption
Internal granuloma of pulp
Revise 521.7 Intrinsic posteruptive colorchanges
Add Excludes: extrinsic color changes(523.6)
523 Gingival and periodontal diseases523.2 Gingival recession
Revise Gingival recession (generalized)(localized) (postinfective)(postoperative)
New code 523.20 Gingival recession, unspecifiedNew code 523.21 Gingival recession, minimalNew code 523.22 Gingival recession, moderateNew code 523.23 Gingival recession, severeNew code 523.24 Gingival recession, localizedNew code 523.25 Gingival recession, generalized
523.6 Accretions on teethAdd Extrinsic discoloration of teeth
Add Excludes: intrinsic discolorationof teeth (521.7)
524 Dentofacial anomalies, includingmalocclusion
524.0 Major anomalies of jaw size
New code 524.07 Excessive tuberosity of jaw
524.2 Anomalies of dental archrelationship
Delete Crossbite (anterior) (posterior)Disto-occlusionMesio-occlusionMidline deviationOpen bite (anterior) (posterior)Overbite (excessive):deephorizontalverticalOverjetPosterior lingual occlusion ofmandibular teethSoft tissue impingement
Add Excludes: soft tissue impingement(524.81-524.82)
New code 524.20 Unspecified anomaly of dentalarch relationship
New code 524.21 Angle’s class INeutro-occlusion
New code 524.22 Angle’s class IIDisto-occlusion Division IDisto-occlusion Division II
New code 524.23 Angle’s class IIIMesio-occlusion
New code 524.24 Open anterior occlusalrelationship
New code 524.25 Open posterior occlusalrelationship
New code 524.26 Excessive horizontal overlapNew code 524.27 Reverse articulation
Anterior articulationPosterior articulation
New code 524.28 Anomalies of interarch distanceExcessive interarch distanceInadequate interarch distance
New code 524.29 Other anomalies of dental archrelationship
AAOMS PRACTICE MANAGEMENT NOTES
July/August 2004 3
Revise 524.3 Anomalies of tooth position offully erupted teeth
Delete Crowding of tooth, teethDiastema of tooth, teethDisplacement of tooth, teethRotation of tooth, teethSpacing, abnormal, of tooth, teethTransposition of tooth, teethImpacted or embedded teeth withabnormal position of such teethor adjacent teeth
Add Excludes: impacted or embeddedteeth with abnormalposition of such teethor adjacent teeth (520.6)
New code 524.30 Unspecified anomaly of toothpositionDiastema of teeth NOSDisplacement of teeth NOSTransposition of teeth NOS
New code 524.31 Crowding of teethNew code 524.32 Excessive spacing of teethNew code 524.33 Horizontal displacement of teeth
Tipping of teethNew code 524.34 Vertical displacement of teeth
Infraeruption of teethSupraeruption of teeth
New code 524.35 Rotation of teethNew code 524.36 Insufficient interocclusal distance
of teeth (ridge)New code 524.37 Excessive interocclusal distance
of teethLoss of occlusal vertical dimension
New code 524.39 Other anomalies of tooth position
524.5 Dentofacial functionalabnormalities
Delete abnormal jaw closureDelete malocclusion due to:Delete abnormal swallowingDelete mouth breathingDelete tongue, lip, or finger habits
New code 524.50 Dentofacial functionalabnormality, unspecified
New code 524.51 Abnormal jaw closureDyskinesia
New code 524.52 Limited mandibular range ofmotion
New code 524.53 Deviation in opening and closingof the mandible
New code 524.54 Insufficient anterior guidanceNew code 524.55 Centric occlusion maximum
intercuspation discrepancy
New code 524.56 Non-working side interferenceNew code 524.57 Lack of posterior occlusal
supportNew code 524.59 Other dentofacial functional
abnormalitiesAbnormal swallowingMouth breathingSleep posturesTongue, lip, or finger habits
524.6 Temporomandibular jointdisorders
New code 524.64 Temporomandibular joint soundson opening and/or closing the jaw
524.7 Dentoalveolar anomalies
New code 524.75 Vertical displacement of alveolusand teethExtrusion of alveolus and teeth
New code 524.76 Occlusal plane deviation
524.8 Other specified dentofacialanomalies
New code 524.81 Anterior soft tissue impingementNew code 524.82 Posterior soft tissue impingementNew code 524.89 Other specified dentofacial
anomalies
525 Other diseases and conditions ofthe teeth and supporting structures
525.2 Atrophy of edentulous alveolar ridge
New code 525.20 Unspecified atrophy ofedentulous alveolar ridgeAtrophy of the mandible NOSAtrophy of the maxilla NOS
New code 525.21 Minimal atrophy of the mandibleNew code 525.22 Moderate atrophy of the
mandibleNew code 525.23 Severe atrophy of the mandibleNew code 525.24 Minimal atrophy of the maxillaNew code 525.25 Moderate atrophy of the maxillaNew code 525.26 Severe atrophy of the maxilla
528 Diseases of the oral soft tissues,excluding lesions specific forgingiva and tongue
528.6 Leukoplakia of oral mucosa,including tongue
4 July/August 2004
This is number 83 in a series of articles on practice management and marketing for oral and maxillofacial surgeons developedunder the auspices of the Committee on Practice Management (Larry J. Moore, chair, Robert W. Emery, Brent T. Garrison, JerryL. Halpern, Rickey L. Hurst, Donald P. Lewis, Jr., Robert T. Watts, Jr., and Robert L. Coles, consultant) and AAOMS staff.Complete sets of previously published Practice Management Notes are available online at aaoms.org.
All articles in Practice Management Notes are published only with the consent of the authors, who have expressly warrantedthat their works are original and do not violate copyright or trademark laws. AAOMS is not responsible for any violations ofcopyright/trademark law on the part of these authors.
Revise Excludes: leukokeratosis nicotinapalati (528.79)
528.7 Other disturbances of oralepithelium, including tongue
Delete Erythroplakia of mouth or tongueFocal epithelial hyperplasia ofmouth or tongueLeukoedema of mouth or tongueLeukokeratosis nicotina palati
New code 528.71 Minimal keratinized residualridge mucosa
New code 528.72 Excessive keratinized residualridge mucosa
New code 528.79 Other disturbances of oralepithelium, including tongueErythroplakia of mouth ortongueFocal epithelial hyperplasia ofmouth or tongueLeukoedema of mouth or tongueLeukokeratosis nicotina palate
529 Diseases and other conditions ofthe tongue
529.8 Other specified conditions of thetongue
Revise Excludes: erythroplasia of tongue(528.79)
718 Other derangement of jointRevise Excludes: jaw (524.60-524.69)
719 Other and unspecified disordersof joint
Revise Excludes: jaw (524.60-524.69)
719.8 Other specified disorders of jointRevise Excludes: temporomandibular
joint-pain-dysfunctionsyndrome [Costen’ssyndrome] (524.60)
Using current coding books is the “golden rule” of coding. With all of these changes, including the elimination of graceperiods, it is more important than ever to order your 2005 books early. PMIC (the Practice Management InformationCorporation) offers AAOMS members a 10% discount on anything they order. Beth Erlandson is ready to assist you at800/633-7467 x2547. So call today!
What else can you do? Participate in AAOMS Coding Courses! Where better to get the latest and greaest in codingchanges that affect your specialty? AAOMS offers three levels of coding resources; and in various formats too. To view abrochure, please visit our website, http://www.aaoms.org/Meetings/04Coding/04codingbrochure.pdf