Ob-Gyn Coding Alert

'Endometrial thickening' doesn't always mean you should report these codes.

If the thought of ICD-10 strikes fear, rest assured: often times, you will find simple one-to-one relationships between old and new codes. That's the case for hyperplasia -- but beware. You will still need to carry over the same coding conventions.

For instance, suppose your ob-gyn suspects hyperplasia. He detects and documents "endometrial thickening" during an ultrasound examination. What diagnosis should you report?

Just because your ob-gyn documents endometrial thickening does not mean the patient has endometrial hyperplasia (621.30, Endometrial hyperplasia, unspecified; or 621.31, Simple endometrial hyperplasia without atypia). Many coders make this mistake.

ICD-10 difference: You should remember this pitfall. That means if you encounter the same scenario in 2013, you should not necessarily report the straight forward hyperplasia equivalents N8500 (Endometrial hyperplasia, unspecified) and N8501 (Simple endometrial hyperplasia without atypia). Notice how these definitions are exactly the same.

Coder tips: Don't be swayed by "endometrial thickening." You should not code this as hyperplasia because physicians don't always consider the thickening of the uterus "abnormal;" in fact, it's just a monthly "ramp up" for all women, experts say. Do not report hyperplasia until the ob-gyn has performed a biopsy, and you have a pathology report that confirms this condition.

Real solution: Because you have no code to describe the patient's condition, you should report 793.5 (Nonspecific abnormal findings by ultrasound of genitourinary organs). Endometrial thickening is a finding -- not a diagnosis. Therefore, you should locate the diagnosis code in the signs and symptoms section of ICD-9. If you look under "thickened endometrium," this will lead you to 793.5.

In the ICD-10 alphabetic index, you'll not see "thickened endometrium" referenced at all so you would normally rely on the choices given by one of the equivalent tables that have been produced (such the ICD-10 Bridge found at https://www.aapc.com/codes/)  based on the ICD-9 code 793.5. Beware: If you look up 793.5's ICD-10 equivalent, you'll find that the National Center for Health Statistics still lists R93.4 (Abnormal findings on diagnostic imaging of urinary organs), which is incorrect because the uterus is not a urinary organ. The Ob-gyn Coding Alert's consulting editor has been in contact with the NCHS and proposed they add a reference for "endometrial thickening" to guide coders to R93.8 (Abnormal findings on diagnostic imaging of other specified body structures) instead. They will consider doing this at their March 19 meeting agenda, but currently, R93.4 stands.