ICD-10cm – 2017 Genitourinary and Gynecology Diagnosis Update! (Part 1)

ICD-10cm – 2017 Genitourinary and Gynecology Diagnosis Update!  (Part 1)

October 22, 2016

As you may be aware, the ICD-10CM code set used within the United States is maintained by the ICD Coordination and Maintenance Committee.  It is this organization that is responsible for putting for the additions, deletions, and updates to ICD-10-cm code set on a yearly basis.  This committee includes representatives from the National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS). 

The ICD-10cm guidelines,  as well as the actual numeric code set, should be reviewed frequently and used as a vital companion reference when coding for diagnosis in physician based and clinical diagnosis services.  As a coding procedure, it is necessary to review all sections of the guidelines to fully understand all of the rules, procedural  and instructional processes needed to code clinical documentation presented in the medical records properly. 

The complete ICD-10cm guidelines can be found at the beginning of your ICD-10cm 2017 book and/or e-files.   The new updates for the ICD-10 code set for 2017 actually went into effect on 10/01/2017.  If you haven’t downloaded the new codes, or purchased your books yet, you really need to!  Access to the new updates and revisions is an essential tool for coders and clinical providers.

As we look at some of the codes that affect Gynecology coding, the sepsis “A” codes had verbiage revision, and also, had some additions and deletions that are important to review.

No Change Other bacterial diseases (A30-A49)

No Change           A40 Streptococcal sepsis

No Change         Code first

Revise from   postprocedural streptococcal sepsis (T81.4)

Revise to       postprocedural streptococcal sepsis (T81.4-)

No Change           A41 Other sepsis

No Change         Code first

Revise from  postprocedural sepsis (T81.4)

Revise to      postprocedural sepsis (T81.4-)

Delete  Excludes1: sepsis NOS (A41.9)

The Zika virus that made news this year was also revised to make it easier to code out for the actual virus itself, not for “screening of”  for Zika Virus. 

 No Change A92 Other mosquito-borne viral fevers

Add A92.5 Zika virus disease

Add Zika virus fever

Add Zika virus infection

Add Zika NOS

If the patient has had an exposure to the Zika Virus you would want to code that diagnosis with Z20.828 - Contact with and (suspected) exposure to other viral communicable diseases.   As a coder, be sure that the documentation is clearly reflecting the difference of an “exposure to” the Zika virus or if the patient currently “has” the Zika virus infection.  

In the Neoplasms codeset, ICD-10cm made a minor change within the D27 code set – Benign Neoplasm of Ovary.   Even though there was not any major changes, the “excludes 2” notes have verbiage revision within them and that you should  review carefully when appending this diagnosis to a claim.   

No ChangeD27 Benign neoplasm of ovary

No Change Excludes 2 note:

Revise from corpus albicans cyst (N83.2)

Revise to corpus albicans cyst (N83.2-)
 

Revise from corpus luteum cyst (N83.1)

Revise to corpus luteum cyst (N83.1-)

Revise from follicular (atretic) cyst (N83.0)

Revise to follicular (atretic) cyst (N83.0-)

Revise from graafian follicle cyst (N83.0)

Revise to graafian follicle cyst (N83.0-)

Revise from ovarian cyst NEC (N83.2)

Revise to ovarian cyst NEC (N83.2-)

Revise from ovarian retention cyst (N83.2)

Revise to ovarian retention cyst (N83.2-)

As we move forward through these updates, the “N” codes associated with the genito-urinary systems include both male and female gender codes.  The male gender codes will be addressed in part 2.  Even though we think of the “N” codes as primarily genito-urinary, some of the breast codes are also within the “N” code-set and affect both male and female gender.  Be aware that some carriers have edits in place, that some of these codes were tagged as only “female” codes, when in fact they should be for both gender.  If you are getting denials for an inappropriate gender, be sure to appeal, or contact the carrier/payer so the edit can be corrected. 

The codes in N61 and N64 had some minor changes.  ICD-10cm 2017 added

Add N61.0 Mastitis without abscess

Add Infective mastitis (acute) (nonpuerperal) (subacute)

Add Mastitis (acute) (nonpuerperal) (subacute) NOS

Add Cellulitis (acute) (nonpuerperal) (subacute) of breast NOS

Add Cellulitis (acute) (nonpuerperal) (subacute) of nipple NOS

Add N61.1 Abscess of the breast and nipple

Add Abscess (acute) (chronic) (nonpuerperal) of areola

Add Abscess (acute) (chronic) (nonpuerperal) of breast

Add Carbuncle of breast

Add Mastitis with abscess

These codes were expanded from the N61 category of inflammatory disorders of the breast.  However,  take note that the mastitis code set N61 denotes “nonpuerperal” within it.  If it is a puerperal mastitis, those diagnoses are found in the “O” codes under the code set of O91 - Infections of breast associated with pregnancy, the puerperium and lactation. 

The N64 category only had a minor change in the revision from a 5-character code to a 6-character code.

No Change N64.1 Fat necrosis of breast
No Change Code first

  Revise from:  breast necrosis due to breast graft (T85.89)

  Revise to: breast necrosis due to breast graft (T85.898)

The N83 code set included a number of changes, in that the code set was expanded to include codes for an unspecified side, left and right side laterality codes throughout the N83 code set.  The laterality notation for the N83 code set includes the ovary, fallopian tube and broad ligament.  These changes are:  

N83.0 Follicular cyst of ovary

·         Add N83.00 Follicular cyst of ovary, unspecified side

·         Add N83.01 Follicular cyst of right ovary

·         Add N83.02 Follicular cyst of left ovary

N83.1 Corpus luteum cyst

·         Add N83.10 Corpus luteum cyst of ovary, unspecified side

·         Add N83.11 Corpus luteum cyst of right ovary

·         Add N83.12 Corpus luteum cyst of left ovary

N83.20 Unspecified ovarian cysts

·         Add N83.201 Unspecified ovarian cyst, right side

·         Add N83.202 Unspecified ovarian cyst, left side

·         Add N83.209 Unspecified ovarian cyst, unspecified side

o   Add Ovarian cyst, NOS

N83.29 Other ovarian cysts

·         Add N83.291 Other ovarian cyst, right side

·         Add N83.292 Other ovarian cyst, left side

·         Add N83.299 Other ovarian cyst, unspecified side

N83.31 Acquired atrophy of ovary

·         Add N83.311 Acquired atrophy of right ovary

·         Add N83.312 Acquired atrophy of left ovary

·         Add N83.319 Acquired atrophy of ovary, unspecified side

o   Add Acquired atrophy of ovary, NOS

N83.32 Acquired atrophy of fallopian tube

·         Add N83.321 Acquired atrophy of right fallopian tube

·         Add N83.322 Acquired atrophy of left fallopian tube

·         Ad N83.329 Acquired atrophy of fallopian tube, unspecified side

o   Add Acquired atrophy of fallopian tube, NOS

N83.33 Acquired atrophy of ovary and fallopian tube

·         Add N83.331 Acquired atrophy of right ovary and fallopian tube

·         Add N83.332 Acquired atrophy of left ovary and fallopian tube

·         Add N83.339 Acquired atrophy of ovary and fallopian tube, unspecified side

o   Add Acquired atrophy of ovary and fallopian tube, NOS

N83.4 Prolapse and hernia of ovary and fallopian tube

·         Add N83.40 Prolapse and hernia of ovary and fallopian tube, unspecified side

o   Add Prolapse and hernia of ovary and fallopian tube, NOS

·         Add N83.41 Prolapse and hernia of right ovary and fallopian tube

o   Add N83.42 Prolapse and hernia of left ovary and fallopian tube

N83.51 Torsion of ovary and ovarian pedicle

·         Add N83.511 Torsion of right ovary and ovarian pedicle

·         Add N83.512 Torsion of left ovary and ovarian pedicle

·         Add N83.519 Torsion of ovary and ovarian pedicle, unspecified side

o   Add Torsion of ovary and ovarian pedicle, NOS

N83.52 Torsion of fallopian tube

·         Add N83.521 Torsion of right fallopian tube

·         Add N83.522 Torsion of left fallopian tube

·         Add N83.529 Torsion of fallopian tube, unspecified side

o   Add Torsion of fallopian tube, NOS

In the next series of code set changes that present some terrific updates for gynecologic coding is the updates for the hypertrophy of vulva in code set N90.6.    The addition/expansion of these codes was a nice surprise to see added for 2017.  In the past the hypertrophy vulva/labia was very generic in the code set.  In 2017 these codes have been added and now have given us three much more diagnostically driven diagnoses.  We still have an “unspecified” code, but we now have the option to code as CALME (Childhood Asymmetric Labium Majus Enlargement) or utilize the newly added “other specified” hypertrophy. 

·         Add N90.60 Unspecified hypertrophy of vulva

o   Add Unspecified hypertrophy of labia

·         Add N90.61 Childhood asymmetric labium majus enlargement

o   Add CALME

·         Add N90.69 Other specified hypertrophy of vulva

o   Add Other specified hypertrophy of labia

ICD-10cm has also given the gynecology codes an expansion for the diagnosis of dyspareunia.  For patients who have been a diagnosed with dyspareunia, payers oftentimes been view or tag in the edits as an inconsequential, or not medically relevant diagnosis to many surgical cases performed in gynecology.   The definition of dyspareunia is painful sexual intercourse due to medical or psychological causes.  Patients describe the pain location as primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix.  It has also been noted to affect a small portion of the vulva or vagina.  There have also been notations that it is felt all over the genital areas both inside and out.  As a coder, it is our responsibility to ensure that we communicate to the providers to give us better clinical documentation for the diagnosis of dyspareunia.  If it is clinically documented more clearly, it will help ensure clearer medical necessity for our insurance claims.

The code set for the diagnosis of dyspareunia has now been taken from a simple code of N94.1 to the expanded code set seen below.

·         Add  N94.10 Unspecified dyspareunia

·         Add  N94.11 Superficial (introital) dyspareunia

·         Add  N94.12 Deep dyspareunia

·         Add  N94.19 Other specified dyspareunia

The last area of review for ICD-10 pertaining to gynecology, is the verbiage revision(s) to the N99.82X and an addition of N99.84X code sets based upon the verbiage revision.  These codes were revised and added to separate out terms that were previously combined.  In N99.92 it states “Postprocedural hemorrhage and hematoma” and this was revised to simply be “post procedural” hemorrhage.  ICD-10 then included expansion for a 6^th character for added specificity.   The verbiage removal of “hematoma” was then added to seroma and added to the code set N99.84, with the expansion of the 6^th character for increased specificity. 

·         Revise from: N99.82 Postprocedural hemorrhage and hematoma of a genitourinary system organ or structure following a procedure

·         Revise to:  N99.82 Postprocedural hemorrhage of a genitourinary system organ or structure following a procedure

o   Revise from N99.820 Post procedural hemorrhage and hematoma of a genitourinary system organ or structure following a genitourinary system procedure

o   Revise to N99.820 Postprocedural hemorrhage of a genitourinary system organ or structure following a genitourinary system procedure

o   Revise from N99.821 Postprocedural hemorrhage and hematoma of a genitourinary system organ or structure following other procedure

o   Revise to N99.821 Postprocedural hemorrhage of a genitourinary system organ or structure following other procedure

·         Add N99.84 Postprocedural hematoma and seroma of a genitourinary system organ or structure following a procedure

o   Add N99.840 Postprocedural hematoma of a genitourinary system organ or structure following a genitourinary system procedure

o   Add N99.841 Postprocedural hematoma of a genitourinary system organ or structure following other procedure

o   Add N99.842 Postprocedural seroma of a genitourinary system organ or structure following a genitourinary system procedure

o   Add N99.843 Postprocedural seroma of a genitourinary system organ or structure following other procedure

As ICD-10cm continues to be improved, we should also remember the goal of working hand in hand with the clinical providers of care to ensure that the clinical documentation of the patient record is clearly reflected by the procedure and diagnosis codes chosen and billed to the insurance payers.  The patients’ medical record documentation is essential for determining the most appropriate codes and reimbursement.  Failing to provide clear, concise and accurate documentation can lead to incorrect and/or inaccurate medical care and diagnosis; inappropriate or incorrect claims for services; claim denials or the worst case scenario of allegation of fraud/abuse.    The verbiage revisions,  added codes and expanded code set characters within ICD-10cm in 2017 is a welcome addition to making our job as coders that much better.

Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC and ICD10 cm/pcs Ambassador/trainer is an E&M, and Procedure based Coding, Compliance, Data Charge entry and HIPAA Privacy specialist, with over 20 years of experience.  Lori-Lynne’s coding specialty is OB/GYN office & Hospitalist Services, Maternal Fetal Medicine, OB/GYN Oncology, Urology, and general surgical coding.  She can be reached via e-mail at webbservices.lori@gmail.com or you can also find current coding information on her blog site: http://lori-lynnescodingcoachblog.blogspot.com/.