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