Coding Endometriosis With Improved Specificity

Coding Endometriosis With Improved Specificity

New ICD-10-CM codes allow healthcare providers to be clearer about the patient’s condition.

Coding endometriosis is changed for fiscal year (FY) 2023. After multiple requests, the American College of Obstetricians and Gynecologists (ACOG) and the American Association of Gynecologic Laparoscopists (AAGL), succeeded in getting the N80 code family expanded to allow providers to paint a clearer picture of what’s going on in the patient. “This will enable better tracking, measurement, and ultimately treatment for endometriosis,” the associations stated at the ICD-10 Coordination and Maintenance Committee Meeting, Sept. 14-15, 2021.

What Is Endometriosis?

Endometriosis occurs when the uterine lining, or endometrium, grows outside of the uterus, causing excessive menstrual cramps, heavy periods, and painful sexual intercourse. An estimated 2 to 10 percent of women in America between 25 and 40 years of age suffer from endometriosis.

This abnormal tissue growth typically occurs on the surface of the uterus and may extend to the fallopian tubes, uterosacral ligaments, pelvic cavity lining, and ovaries. Less often, the endometrial tissue may grow on or around the vagina, cervix, bladder, intestines, rectum, or stomach.

Endometrium tissue in the uterus sheds with each menstrual cycle, but when it grows outside of the uterus, it builds instead. Left untreated, this buildup can lead to inflammation, scarring, cysts, and other complications, including infertility.

Endometriosis is classified from stages 1 to 4 and measured in terms of tissue depth:

  • Superficial endometriosis: Ectopic growth of endometrial tissue extending 5 mm or less below the peritoneal surface.
  • Deeply infiltrating endometriosis: Ectopic growth of endometrial tissue that extends greater than 5 mm below the peritoneal surface.

Lesions can occur in either case, but the deeper the tissue growth, the worse they become.

Why Were More Codes for Endometriosis Needed?

The existing N80 codes, located in Chapter 14: Diseases of the Genitourinary System (N00-N99) of ICD-10-CM, only describe the location of the endometriosis, such as the uterus, ovary, fallopian tube, etc. The new codes provide details for laterality, depth of invasion, volume of disease, and whether specific organs are involved.

New five- and six-character codes greatly expand the existing code category. For example (new codes are green):

N80.0    Endometriosis of uterus

             N80.00       Endometriosis of the uterus, unspecified

             N80.01       Superficial endometriosis of the uterus

             N80.02       Deep endometriosis of the uterus

             N80.03       Adenomyosis of the uterus

N80.1    Endometriosis of ovary

             N80.10       Endometriosis of ovary, unspecified depth

              N80.101           Endometriosis of right ovary, unspecified depth

              N80.102           Endometriosis of left ovary, unspecified depth

              N80.103           Endometriosis of bilateral ovaries, unspecified depth

              N80.109           Endometriosis of ovary, unspecified side, unspecified depth

 N80.11  Superficial endometriosis of the ovary

               N80.111           Superficial endometriosis of right ovary

             N80.112           Superficial endometriosis of left ovary

              N80.113           Superficial endometriosis of bilateral ovaries

             N80.119           Superficial endometriosis of ovary, unspecified ovary

  N80.12 Deep endometriosis of ovary

               N80.121           Deep endometriosis of right ovary

               N80.122           Deep endometriosis of left ovary

               N80.123           Deep endometriosis of bilateral ovaries

               N80.129           Deep endometriosis of ovary, unspecified ovary

The remaining existing codes in this category are expanded similarly. For example, code N80.3 Endometriosis of pelvic peritoneum is expanded to include four- and five-character codes for the anterior and posterior cul-de-sac, pelvic sidewall, pelvic brim, and uterosacral ligament(s). And code N80.5 Endometriosis of intestine is expanded to include four- and five-character codes for the various sections of the intestines. This category is also expanded to include new codes for endometriosis of the bladder and ureters (N80.A-), cardiothoracic space (N80.B-), abdomen (N80.C-), and pelvic nerves (N80.D-).

These codes support the medical necessity of such diagnostic procedures as computed tomography (CT) of the abdomen and pelvis, ultrasound, and magnetic resonance imaging (MRI). Laparoscopy and biopsy also may be used to diagnose endometriosis. These codes would also support the medical necessity of common treatments for endometriosis such as laparoscopy or laparotomy, hormone treatments (e.g., luteinizing hormone-releasing hormone analogs), and hysterectomy.

Call to Action

Healthcare practitioners should be educated on the changes for coding endometriosis, and clinical documentation improvement is necessary to ensure the medical record contains the necessary information to capture these new codes for FY 2023. Additionally, make sure your electronic health record system is updated with the new codes and that practitioners are making the most of the available specificity to improve data measurement and patient care.


Resources:

Johns Hopkins Medicine: www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis

Centers for Disease Control and Prevention, National Center for Health Statistics. ICD-10-CM Coordination and Maintenance Committee: www.cdc.gov/nchs/icd/icd10cm_maintenance.htm

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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

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