General Surgery Coding Alert

OB infections are different.

With so many new diagnosis codes that could impact your general surgery practice, we’re serving up “round 2” to make sure you’re ready for the Oct. 1 ICD-10-CM 2019 implementation date.

Hopefully you read last month’s “Embrace New Dx Coding Options For Your Surgery Practice” in General Surgery Coding Alert Vol. 20, No. 9. This month we cover additional ICD-10-CM changes you need to know.

Focus Obstetric Surgical Wound Infection Diagnoses

Although last month you read about more than 20 new post procedural infection codes under T81.4-, you shouldn’t use any of those codes if you’re reporting a surgical-wound infection for an obstetric surgical case.

Instead, you would currently turn to O86.0 (Infection of obstetric surgical wound) for patients undergoing cesarean sections or perineal repairs who develop infections at the wound site. Beginning Oct. 1, you’ll have the addition of an Excludes1 note stating: “complications of procedures, not elsewhere classified (T81.4-), postprocedural fever NOS (R50.82), postprocedural retroperitoneal abscess (K68.11).”

Remember, an Excludes1 note means that these two codes can never be coded together, and you should code either one or the other, says Melanie Witt, RN, MA, an independent coding expert based in Guadalupita, New Mexico.

ICD-10-CM 2019 also expands 086.0 to include the following six new codes:

• O86.00 (Infection of obstetric surgical wound, unspecified)
• O86.01 (… superficial incisional site)
• O86.02 (… deep incisional site)
• O86.03 (… organ and space site)
• O86.04 (Sepsis following an obstetrical procedure)
  A note following this code directs you to “Use Additional code to identify the sepsis.” “Keep in mind that the additional code they are asking for is the organism causing the sepsis, not puerperal sepsis (O85),” Witt says. “For example, use A40.0 (Sepsis due to streptococcus, group A) or A40.1 (… group B).”
• O86.09 (… other surgical site).

“These are great codes to have because superficial wound infections may not require significant treatment, whereas more significant surgical wound infections may allow for additional reimbursement using modifier 24 on an EM service or an additional paid surgical procedure,” says Jan Rasmussen, PCS, CPC, ACS-GI, ACS-OB, owner/consultant of Professional Coding Solutions in Holcombe, Wisconsin.

Tackle Non-Pressure Chronic Ulcer Revisions

If you report non-pressure chronic ulcers, you may recall that ICD-10 2018 added 45 new non-pressure chronic ulcer options. Now, with ICD-10 2019, you will see revisions that will add the words “of skin” to descriptors in some codes from category L98.49- (Non-pressure chronic ulcer of skin of other sites). Take a look at the revisions (emphasis added):

• L98.495 (Non-pressure chronic ulcer of skin of other sites with muscle involvement without evidence of necrosis)
• L98.496 (… of skin of other sites with bone involvement without evidence of necrosis)
• L98.498 (… of skin of other sites with other specified severity).

Don’t miss: As you can see by looking at other options in category L98.49-, codes like L98.491 (Non-pressure chronic ulcer of skin of other sites limited to breakdown of skin) already include the words “of skin.” So, these new revisions will help the descriptors of the newer codes stay consistent with the older ones.

When reading the code descriptors for L98.495 and L98.496, you will see the word “necrosis,” and you may wonder what this means. Basically, necrosis refers to how healthy a wound is, explains Jordan Meyers, DPM, consultant at Treace Medical Concepts, Inc. in Raleigh, North Carolina. Necrosis is a sign that there is likely inadequate perfusion to the wound.

Caution: Watch out for the key descriptor terms “with bone involvement” versus “with muscle involvement.” This distinction helps define the depth of the wound and how much treatment may be involved, according to Meyers. The deeper the wound, the deeper the problem and the higher risk of infection or need for surgery.

Check Out New Abscess Codes

Ever since ICD-10 debuted, you’ve had access to several codes that describe GI abscesses under the K61 (Abscess of anal and rectal regions) heading. However, although the section is robust, it has never represented every potential condition that can occur, and some coders have been eager for expanded opportunities for coding these conditions.

The 2019 edition of ICD-10 delivers, with several new codes debuting Oct. 1 to represent the following diagnoses:

• K61.31 (Horseshoe abscess)
• K61.39 (Other ischiorectal abscess)
• K61.5 (Supralevator abscess).

You previously reported horseshoe abscess with K61.1 (Rectal abscess), but that code doesn’t fully capture the condition, since a horseshoe abscess can be quite deep and can spread throughout the rectum and sphincter. The new code is expected to provide more clarity when surgeons perform more invasive procedures than what is usually required of a rectal abscess.

The K61.5 code offers you a location-specific option when the patient’s abscess is specifically in the supralevator space within the patient’s rectum. And new code K61.39 appears to build on the current description for K61.3 (Ischiorectal abscess), which has a note indicating that it covers “abscess of ischiorectal fossa.” In cases when the patient has an ischiorectal abscess that lies outside of that descriptor, K61.39 will be the right code to report.

Find New Gallbladder, Cholecystitis Codes

This year’s crop of new ICD-10 codes includes the following new codes to refer to gallbladder disorders:

• K82.A (Disorders of gallbladder in diseases classified elsewhere)
• K82.A1 (Gangrene of gallbladder in cholecystitis)
• K82.A2 (Perforation of gallbladder in cholecystitis).

You’ll also find two new codes for cholangitis, which is currently covered under the catch-all code K83.0 (Cholangitis). Under the 2019 update, you can now get more specific with the following:

• K83.01 (Primary sclerosing cholangitis)
• K83.09 (Other cholangitis).

Because primary sclerosing cholangitis is a complex chronic liver condition that usually involves non-surgical management, the new code will help demonstrate medical necessity for involved services, particularly imaging such as MRCP, interventions by ERCP or other encounters to manage the medical aspects of the condition, says Glenn D. Littenberg, MD, MACP, FASGE, AGAF, CPT^® Editorial Panel member in Pasadena, California.