Gastroenterology Coding Alert

Changes for GIs to postprocedural hematoma, Hodgkin’s lymphomas, and more.

Sorting through the CMS final update for the ICD-10-CM codes can be a daunting task, with over 1,900 new codes, 400-plus revised codes, and 300-plus codes to go obsolete. As for the new final codeset, “…these 2017 ICD-10-CM codes are to be used for discharges occurring from October 1, 2016 through September 30, 2017,” says CMS.

In the previous issue, we covered the ICD-10 proposed updates for gastroenterology, dividing them into seven broad areas. However, there are more updates (in their final updated version) that deserve your attention.

Explore More Options for Intraprocedural Bleeding

The existing codes for gastrointestinal intraoperative/intraprocedural bleeding have been updated to have separate codes for hematoma and hemorrhage. These codes may not apply to colonoscopy procedures specifically, says Michael Weinstein, MD, former representative of the AMA’s CPT^® Advisory Panel. However, it’s important to know the changes, lest you may handle a postprocedural bleeding.

• Revise K91.84 (Postprocedural hemorrhage and hematoma of a digestive system organ or structure following a procedure) to (Postprocedural hemorrhage of a digestive system organ or structure following a procedure)
• Revise K91.840 (Postprocedural hemorrhage and hematoma of a digestive system organ or structure following a digestive system procedure    ) to (Postprocedural hemorrhage of a digestive system organ or structure following a digestive system procedure)
• Revise K91.841 (Postprocedural hemorrhage and hematoma of a digestive system organ or structure following other procedure) to (Postprocedural hemorrhage of a digestive system organ or structure following other procedure).

Plus: You have four new codes to specifically report postprocedural hematomas, and seromas of the digestive system organ or structure:

• K91.87 (Postprocedural hematoma and seroma of a digestive system organ or structure following a procedure)
• K91.870 (Postprocedural hematoma of a digestive system organ or structure following a digestive system procedure)
• K91.871 (Postprocedural hematoma of a digestive system organ or structure following other procedure)
• K91.872 (Postprocedural seroma of a digestive system organ or structure following a digestive system procedure)
• K91.873 (Postprocedural seroma of a digestive system organ or structure following other procedure).

Don’t Miss Out On These GI Updates From a Mixed Bag

Unless someone specifically points these out to you, it is very likely you may miss out on these gastroenterology updates, scattered here and there in a mixed bag of updates from all the systems.

Drop the Word “Classical” In Hodgkin’s Lymphoma Codes

The word “classical” has been dropped from the code descriptors of all of the fifty-plus codes related to Hodgkin’s lymphoma. You have this revision to note for the different types of Hodgkin’s lymphomas, affecting the intra-abdominal lymph nodes:

• You will revise C81.13 (Nodular sclerosis classical Hodgkin lymphoma, intra-abdominal lymph nodes) to (Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes).
• Revise C81.23 (Mixed cellularity classical Hodgkin lymphoma, intra-abdominal lymph nodes) to (Mixed cellularity Hodgkin lymphoma, intra-abdominal lymph nodes).
• Revise C81.33 (Lymphocyte depleted classical Hodgkin lymphoma, intra-abdominal lymph nodes) to (Lymphocyte depleted Hodgkin lymphoma, intra-abdominal lymph nodes).
• Revise C81.43 (Lymphocyte-rich classical Hodgkin lymphoma, intra-abdominal lymph nodes) to (Lymphocyte-rich Hodgkin lymphoma, intra-abdominal lymph nodes).
• Revise C81.73 (Other classical Hodgkin lymphoma, intra-abdominal lymph nodes) to (Other Hodgkin lymphoma, intra-abdominal lymph nodes).

Viral hepatitis simplified: In the final list of ICD-10-CM codes released in June, the diagnosis codes for a carrier of viral hepatitis stand deleted from October onwards. In the future, a carrier of viral hepatitis will be accounted for within the codes for chronic viral hepatitis, as depicted below:

Other new additions that may interest a gastroenterology coder are:

• Z05.5 (Observation and evaluation of newborn for suspected gastrointestinal condition ruled out)
• Z53.31 (Laparoscopic surgical procedure converted to open procedure)
• Z53.39 (Other specified procedure converted to open procedure).

Final takeaway: The final code list is a bit different and more evolved from the proposed changes we have been sifting through for familiarity’s sake since April. You will need to take some time and take in other significant shifts in codes, within the time you have in hand, until the final ICD-10 update is published in October.