General Surgery Coding Alert

Don’t miss these new GI tumor codes.

As a general surgery coder, you know you have to be familiar with CPT^® codes for procedures involving many body systems.

The same is true for diagnosis coding, especially now that ICD-10-CM provides the first set of annual updates, effective Oct. 1, after a five-year code freeze.

We’ve already covered many changes you can expect in General Surgery Coding Alert vol. 18 no. 6 (“ICD-10: Get Ready for Dx Updates This October”) — specifically lots of vascular-system and a few gastrointestinal (GI) changes.

Now let’s look at some more code updates that might show up on your general surgery claims starting this fall.

Get Specific for GI Tumors

If you’ve had problems in the past finding a code to match the array of GI tumors your surgeon might remove, expect some new options come Oct. 1.

Stromal tumor: “You’ve got some great additions, especially the stromal tumor codes,” says Jan Rasmussen, CPC, PCS, ACS-GI, ACS-OB, owner/consultant of Professional Coding Solutions, Holcombe, Wisc., such as the following:

• C49.A0 — Gastrointestinal stromal tumor, unspecified site
• C49.A1 — … of esophagus
• C49.A2 — … of stomach
• C49.A3 — … of small intestine
• C49.A4 — … of large intestine
• C49.A5 — … of rectum
• C49.A9 — … of other sites.

Malignant carcinoid tumor: You also have the following minor revisions for carcinoid tumors:

• Revise C7A.094 - C7A.096 (Malignant carcinoid tumor of … NOS) to (Malignant carcinoid tumor …, unspecified).
• Revise D3A.094 - D3A.096 (Benign carcinoid tumor … NOS) to (Benign carcinoid tumor … unspecified).

Each of these series of three codes lists the specific sites — foregut, midgut, and hindgut — for the malignant or benign tumors. That doesn’t change in ICD-10-CM 2017, but all six codes drop the terminology “NOS” (not otherwise specified) in favor of “unspecified.”

Highlight These Updates to Distinguish Hemorrhage, Hematoma

You will also need to implement both revisions and additions for spleen complications when the update goes into effect on Oct. 1. For instance, the following two codes remove “and hematoma” from the code definitions:

• D78.21 — Postprocedural hemorrhage and hematoma of the spleen following a procedure on the spleen
• D78.22 — Postprocedural hemorrhage and hematoma of the spleen following other procedure

ICD-10-CM 2017 also adds these two codes:

• D78.31 — Postprocedural hematoma of the spleen following a procedure on the spleen
• D78.32 —Postprocedural hematoma of the spleen following other procedure.

“These [changes] are useful for post-colonoscopy complications,” says Michael Weinstein, MD, former representative of the AMA’s CPT^® Advisory Panel.

Add Granularity to Enterocoloitis Claims

When your surgeon performs a diagnostic procedure or excision for a patient with some type of enterocoloitis, you’ll have many changes in ICD-10-CM 2017 for more specific code choices.

The 2017 code set deletes K52.2 (Allergic and dietetic gastroenteritis and colitis) in favor of three new more specific codes:

• K52.21 — Food protein-induced enterocolitis syndrome
• K52.22 — Food protein-induced enteropathy
• K52.29 — Other allergic and dietetic gastroenteritis and colitis.

You’ll also find new codes in the family K52.8 (Other specified noninfective gastroenteritis and colitis), as follows:

• K52.831 — Collagenous colitis
• K52.832 — Lymphocytic colitis
• K52.838 — Other microscopic colitis
• K52.839 — Microscopic colitis, unspecified.

Also look for new codes in code family K55 (Vascular disorders of intestine) to describe necrotizing enterocoloitis:

• K55.30 — Necrotizing enterocolitis, unspecified
• K55.31 — Stage 1 necrotizing enterocolitis
• K55.32 — Stage 2 necrotizing enterocolitis
• K55.33 — Stage 3 necrotizing enterocolitis

Finally, look for three new codes to improve specificity when reporting Irritable Bowel Syndrome (IBS), as follows:

• K58.1 — Irritable bowel syndrome with constipation
• K58.2 — Mixed irritable bowel syndrome
• K58.8 — Other irritable bowel syndrome.