New ICD-9 Codes for OB/GYN - ACOG

ACOG reports on the new ICD-9-CM Codes: Effective October 1, 2011

ACOG just posted that these are the codes that will be changing in the OB/GYN sections. If you want to view – please follow this link… http://www.acog.org/departments/dept_notice.cfm?recno=6&bulletin=5356

Following are the new, expanded, and revised ICD-9-CM codes that are of interest to obstetricians and gynecologists. These codes will take effect October 1, 2011. HIPAA requires providers to use the medical code set that is valid at the time the service is provided. Therefore, physicians must cease using discontinued codes for services after the new codes become effective October 1.

INFLAMMATORY DISEASE OF CERVIX, VAGINA, AND VULVA
The code description for code 616 was revised to expand the categories of organisms. Prior to this change, the code description for code 616.10 (Vaginitis and vulvovaginitis, unspecified) included instructions for identifying the organisms, however, the code categories for the organisms now require a 5th digit assignment.

616 Inflammatory disease of cervix, vagina, and vulva
616.1 Vaginitis and vulvovaginitis
616.10 Vaginitis and vulvovaginitis, unspecified
Delete Use additional code to identify organism, such as
Escherichia coli [E. coli] (041.4), Staphylococcus (041.1), or
Streptococcus (041.0)

Add Use additional code to identify organism, such as:
Escherichia coli [E. coli] (041.41-041.49)
Staphylococcus (041.10-041.19)
Streptococcus (041.00-041.09)

PROLAPSE OF VAGINAL WALLS WITHOUT MENTION OF UTERINE PROLAPSE
Code 618 was revised to include a comment regarding reporting an additional code for any associated fecal incontinence.

618 Genital prolapse
618.0 Prolapse of vaginal walls without mention of uterine prolapse
618.04 Rectocele
Revise Use additional code for any associated
fecal incontinence (787.60-787.63)

OTHER DISORDERS OF FEMALE GENITAL TRACT
Code 629 was expanded to include a new subcategory that provides coding instructions for reporting erosion and exposure of vaginal mesh. Previous coding advice was to assign code 996.76, (Other complications due to genitourinary device, implant, and graft) for the erosion and/or code 996.65, (Infection and inflammatory reaction due to other genitourinary device, implant and graft) if an infection occurred from the mesh.

629 Other disorders of female genital organs
New
subcategory 629.3 Complication of implanted vaginal mesh and
other prosthetic materials

New code 629.31 Erosion of implanted vaginal mesh and other
prosthetic materials to surrounding organ or tissue
Erosion of implanted vaginal mesh and other
prosthetic materials into pelvic floor muscles

New code 629.32 Exposure of implanted vaginal mesh and other
prosthetic materials into vagina
Exposure of vaginal mesh and other prosthetic
materials through vaginal wall

OTHER ABNORMAL PRODUCT OF CONCEPTION
Code 631 has been expanded to address coding for what is referred to imprecisely as a false positive pregnancy, a chemical pregnancy, or a biochemical pregnancy. This would be reported in cases where a woman’s pregnancy test comes back as positive, indicating serum hCG levels, but when followed up with ultrasound, no fetus is present.

631 Other abnormal product of conception
Delete Blighted ovum
Delete Mole:
Delete NOS
Delete carneous
Delete fleshy
Delete stone

New code 631.0 Inappropriate change in quantitative human chorionic
gonadotropin (hCG) in early pregnancy
Biochemical pregnancy
Chemical pregnancy
Inappropriate level of quantitative human chorionic
gonadotropin (hCG) for gestational age in early pregnancy
Excludes: blighted ovum (631.8)
molar pregnancy (631.8)

New code 631.8 Other abnormal products of conception
Blighted ovum

MISSED ABORTION
The description of the exclusion term for code 632 was revised and updated to reference new code 631.8 (Other abnormal products of conception).

632 Missed abortion
Revise Excludes: that with abnormal product of conception (630, 631)
hydatidiform mole (630)

Add that with other abnormal products of conception (631.8)

LIVER DISORDERS IN PREGNANCY
Code 646.7 was revised to add biliary tract disorders to the code description.

646 Other complications of pregnancy, not elsewhere classified
Revise 646.7 Liver and biliary tract disorders in pregnancy

OTHER CONDITIONS OR STATUS OF THE MOTHER COMPLICATING PREGNANCY, CHILDBIRTH, OR PUERPERIUM
Hospitals and accreditation bodies are currently reviewing elective cesarean deliveries performed before 39 weeks gestation as a quality indicator. Code 649 was expanded to add a new subcategory, 649.8, to identify when onset of labor begins. Coding instructions include using an additional code to specify the reason for the planned c-section.

649 Other conditions or status of the mother complicating pregnancy,
childbirth, or the puerperium
NewSubcategory 649.8 Onset (spontaneous) of labor after 37 completed weeks of
[1-2] gestation but before 39 completed weeks gestation,
with delivery by (planned) cesarean section
Delivery by (planned) cesarean section occurring after 37
completed weeks of gestation but before 39 completed
weeks gestation due to (spontaneous) onset of labor

649.81 Onset (spontaneous) of labor after 37 completed weeks of gestation but before 39 completed weeks gestation, with delivery by (planned) cesarean section, delivered, with or without mention of antepartum condition

649.82 Onset (spontaneous) of labor after 37 completed weeks of gestation but before 39 completed weeks gestation, with delivery by (planned) cesarean section, delivered, with mention of postpartum condition
Use additional code to specify reason for planned cesarean section
such as:
cephalopelvic disproportion (normally formed fetus) (653.4)
previous cesarean delivery (654.2)

SUPPLEMENTARY CLASSIFICATION
The title of the supplementary classification (V-codes) was revised to correctly report code series V91 as the final set of codes in this section. V91 codes were added to ICD-9-CM in October of 2010.

Revise SUPPLEMENTARY CLASSIFICATION OF FACTORS
INFLUENCING HEALTH STATUS AND CONTACT WITH
HEALTH SERVICES (V01- V91)


ENDOCRINE, METABOLIC, AND IMMUNITY DISORDERS
Code V12.2 was expanded to add codes for personal history of gestational diabetes and personal history of other endocrine, metabolic, and immunity disorders.

V12 Personal history of certain other diseases
V12.2 Personal history endocrine, metabolic, and immunity disorders

New code V12.21 Gestational diabetes

New code V12.29 Other endocrine, metabolic, and immunity disorders

SUPERVISION OF HIGH-RISK PREGNANCY
Two codes were expanded in this code section. Code V23.4 was expanded to add coding for pregnancy (current) with history of ectopic pregnancy. Code V23.8 was expanded to add coding for pregnancy with inconclusive fetal viability.

V23 Supervision of high-risk pregnancy
V23.4 Pregnancy with other poor obstetric history
New code V23.42 Pregnancy with history of ectopic pregnancy

V23.8 Other high-risk pregnancy
New code V23.87 Pregnancy with inconclusive fetal viability
Encounter to determine fetal viability
of pregnancy

ICD-9/ICD-10 CODE FREEZE

Changes to ICD-9-CM on October 1, 2011, represent the last regular annual update to the ICD-9 CM code set prior to the ICD-10 implementation in 2013. There will be limited ICD-9 and ICD-10 code updates in 2012 and 2013 to capture new technology and new diseases:

Oct 1, 2012 - limited code updates to both ICD-9 CM and ICD-10 code sets
Oct 1, 2013 - limited updates to ICD-10 code set
Oct 1, 2014 - regular updates to ICD-10 will begin, ending the freeze