General Surgery Coding Alert

Update skin cancer dx and more with CMS's final proposed change to ICD-9-CM code set.

General surgery practices will need to know four new codes to report complications of gastric band or bariatric procedures beginning Oct. 1 if the proposed ICD-9 codes become final. You'll find 539.xx (Complications of bariatric surgery and gastric band procedures) and other new, invalid, and revised codes that will impact your practice recently posted on the CMS Website.

Capture Bariatric Infection, Other Complications

Bariatric surgery or gastric band procedure complications are currently indexed to 997.4 (Digestive system complications). "This is a case where we simply index the complication to a generic code ... and we actually don't have any secondary code to use," noted National Center for Health Statistics (NCHS)'s Amy Blum at the ICD-9-CM Coordination and Maintenance Committee meeting (proposals, summaries, and presentation slides available at www.cdc.gov/nchs/icd/icd9cm_maintenance.htm).

All that will change Oct. 1, 2011 if the proposed codes become final. Then you'll start to report bariatric/gastric band complications with one of the following codes:

• 539.01 - Infection due to gastric band procedure
• 539.09 -- Other complications of gastric band procedure
• 539.81 -- Infection due to other bariatric procedure
• 539.89 -- Other complications of other bariatric procedure.

ICD-9 adds an "excludes" note to 997.4 directing coders to the new codes.

Advantages: Code 997.4 doesn't distinguish digestive system complications from bariatric or gastric band surgeries fromcomplications due to any other procedures or conditions. The new codes allow better data collection for complications of bariatric and gastric band procedures.

Get Ready for Skin Cancer Details

The latest ICD-9 proposed changes will expand 10 current codes (173.x, Other malignant neoplasm of skin) to 40 new codes (173.xx) that you'll have to use when your surgeon performs a skin excision.

Skin site distinguishes the 10 existing codes (173.0-173.9) that will become "invalid." The same site distinctions remain in the new codes, but ICD-9 2012 adds a fifth digit to each fourdigit code to differentiate cancer type, such as basal cell or squamous cell carcinoma.

Break it down: The new "other malignant neoplasm of skin" codes (that require a fifth digit) are as follows:

• 173.0x -- Skin of lip
• 173.1x -- Eyelid, including canthus
• 173.2x -- Skin of ear and external auditory canal
• 173.3x -- Skin of other and unspecified parts of face
• 173.4x -- Scalp and skin of neck
• 173.5x -- Skin of trunk, except scrotum
• 173.6x -- Skin of upper limb, including shoulder
• 173.7x -- Skin of lower limb, including hip
• 173.8x -- Other specified sites of skin
• 173.9x -- Skin, site unspecified.

The following fifth digits distinguish each site-specific fourdigit code based on neoplasm details:

• 0 -- Unspecified malignant neoplasm of ...
• 1 -- Basal cell carcinoma of ...
• 2 -- Squamous cell carcinoma of ...
• 9 -- Other specified malignant neoplasm of ...

For example: If your surgeon removes a basal cell carcinoma from the patient's neck after Oct. 1, you'll assign 173.41 (Basal cell carcinoma of scalp and skin of neck) instead of invalid code 173.4 (Other malignant neoplasm of scalp and skin of neck).

Don't wait: With only a few months before implementation, the time to act is now, says Pamela Biffle, CPC, CPC-P, CPC-I, CCS-P, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Austin, Texas. "Coders will have to make sure their systems are updated with the new codes," she notes.

End Your Pelvic Circle Fracture Code Search

Proposals to update pelvic fracture codes also should create more precise coding under ICD-9 2012.

The new codes will be specific to "without disruption":

• 808.44 -- Multiple closed pelvic fractures without disruption of pelvic circle
• 808.54 -- Multiple open pelvic fractures without disruption of pelvic circle.

These codes will offer an alternative to "with disruption" codes 808.43 (Multiple closed pelvic fractures with disruption of pelvic circle) and 808.53 (Multiple open pelvic fractures with disruption of pelvic circle).

Term tip: In your documentation, physicians may refer to "ring" rather than "circle," Blum points out.