Ob-Gyn Coding Alert

Don’t forget: You’ll need to include an “x” placeholder for these T codes.

You’ve got a bunch of new gynecology diagnoses to learn — such as, N35.92 (Unspecified urethral stricture, female). The clock is already ticking, because these codes go into effect October 1, 2018. Read on to start learning what’s new for your gynecology claims.

Start Learning New Septate Uterus Diagnoses

A septate uterus is a congenital deformity that occurs during fetal development. A membrane called a septum divides the uterus either partially or completely, says Melanie Witt, RN, MA, an independent coding expert based in Guadalupita, New Mexico.

You currently have code Q51.2 (Other doubling of uterus) with inclusion terminology of “Septate uterus, complete or partial.” That terminology will be revised to say “septate uterus” because it’s expanding to four new codes based on whether the septum is partial or complete:

• Q51.20 (Other doubling of uterus, unspecified)
      Septate uterus, unspecified
• Q51.21 (Other complete doubling of uterus)
      Complete septate uterus
• Q51.22 (Other partial doubling of uterus)
      Partial septate uterus
• Q51.28 (Other doubling of uterus, other specified)
      Septate uterus, other specified

Assess These New Abnormal Urine Findings Options

You’ve got new abnormal urine finding options, as of October 1. Current code R82.99 (Other abnormal findings in urine) will expand to five new options:

• R82.991 (Hypocitraturia)
• R82.992 (Hyperoxaluria)
      Excludes1: Primary hyperoxaluria (E72.53)
• R82.993 (Hyperuricoscuria)
• R82.994 (Hypercalciuria)
      Idiopathic hypercalciuria
• R82.998 (Other abnormal findings in urine)
      Cells and casts in urine
      Crystalluria
      Melanuria

But don’t let these terms confuse you, Witt says. “Hypocitraturia signifies low urine citrate. Urinary citrate is important because it is the major inhibitor of kidney stone formation and low levels are considered a risk for kidney stones.”

“Hyperoxaluria refers to too much oxalate in the urine which in turn can cause kidney stones. This increase can be due to eating large quantities of foods high in oxalate such as spinach, bran flakes, rhubarb, beets, potato chips, french fries, and nuts and nut butters,” Witt says.

“Hyperuricoscuria refers to too much uric acid in the urine. This can occur with conditions such as gout, or kidney stones made of the acid, but may also be due to severe renal failure or possibly a complication with chemotherapy when tumor cells are killed off rapidly and their contents are excreted from the body via urine,” Witt says.

Finally, “Hypercalciuria means there is a higher level of calcium in the urine than is normal. This can occur due to taking too much calcium or may be the result of an overactive parathyroid gland,” Witt says.

You’ll also need to know R93.89 (Abnormal findings on diagnostic imaging of other specified body structures). The inclusion terms are:

            Abnormal finding by radioisotope localization of placenta
​            Abnormal radiological finding in skin and subcutaneous tissue
​            Mediastinal shift

Take the Initiative with T Codes

You’ve got a bunch of T codes to learn as of October 1. The new codes for exploitation are as follows:

• T74.5 (Forced sexual exploitation, confirmed)
• T74.51 (Adult forced sexual exploitation, confirmed)
• T74.52 (Child sexual exploitation, confirmed)
• T74.6 (Forced labor exploitation, confirmed)
• T74.61 (Adult forced labor exploitation, confirmed)
• T74.62 (Child forced labor exploitation, confirmed)
• T76.5 (Forced sexual exploitation, suspected)
• T76.51 (Adult forced sexual exploitation, suspected)
• T76.52 (Child sexual exploitation, suspected)
• T76.6 (Forced labor exploitation, suspected)
• T76.61 (Adult forced labor exploitation, suspected)
• T76.62 (Child forced labor exploitation, suspected).

Remember that these T codes require a final 7th character of A (Initial encounter), D (Subsequent encounter), or S (Sequela), so the letter “x” will need to be added as the 6th character.

Example: If you had a case where a new patient presents for confirmed adult sexual exploitation, you would report T74.51xA.

Those aren’t the only new T codes you need to learn. You currently have T81.4 (Infection following a procedure) but you’ll delete the Excludes1 note and add:

“Excludes2:

​            obstetric surgical wound infection (O86.0-)
​            postprocedural fever NOS (R50.82)
​            postprocedural retroperitoneal abscess (K68.11)”

You’ll then add on these additions:

• T81.40 (Infection following a procedure, unspecified)
• T81.41 (Infection following a procedure, superficial incisional surgical site)
      Subcutaneous abscess following a procedure 
      Stitch abscess following a procedure
• T81.42 (Infection following a procedure, deep incisional surgical site)
      Intra-muscular abscess following a procedure
• T81.43 (Infection following a procedure, organ and space surgical site)
      Intra-abdominal abscess following a procedure
      Subphrenic abscess following a procedure
• T81.44 (Sepsis following a procedure)
      Use Additional code to identify the sepsis
• T81.49 (Infection following a procedure, other surgical site).

Next, Move to the Z Codes

Your current code Z04.8 (Encounter for examination and observation for other specified reasons) has expanded to theseadditions:

• Z04.81 (Encounter for examination and observation of victim following forced sexual exploitation)
• Z04.82 (Encounter for examination and observation of victim following forced labor exploitation)
• Z04.89 (Encounter for examination and observation for other specified reasons).

Current code Z13.3 (Encounter for screening examination for mental health and behavioral disorders) will expand as well:

• Z13.30 (Encounter for screening examination for mental health and behavioral disorders, unspecified)
• Z13.31 (Encounter for screening for depression)
      Encounter for screening for depression, adult
      Encounter for screening for depression for child or adolescent
• Z13.32 (Encounter for screening for maternal depression)
      Encounter for screening for perinatal depression
• Z13.39 (Encounter for screening examination for other mental health and behavioral disorders)
      Encounter for screening for alcoholism
      Encounter for screening for intellectual disabilities

“I am very happy to see more specification in the screening for mental health and behavioral disorders as it will give better definition what exactly is being evaluated,” says Jan Rasmussen, PCS, CPC, ACS-GI, ACS-OB,  owner/consultant of Professional Coding Solutions in Holcombe, Wis. “Medicare specifically pays for depression screening and alcoholism so these codes will help support medical necessity for those services.”

You have a smattering of other Z codes to learn. For instance, you should add Z20.821 (Contact with and (suspected) exposure to Zika virus) to your coding arsenal. Check out the following new Z codes you should highlight:

• Z28.83 (Immunization not carried out due to unavailability of vaccine)
      Delay in delivery of vaccine
      Lack of availability of vaccine
      Manufacturer delay of vaccine
• Z62.813 (Personal history of forced labor or sexual exploitation in childhood)
• Z83.430 (Family history of elevated lipoprotein(a))
      Family history of elevated Lp(a)
• Z83.438 (Family history of other disorder of lipoprotein metabolism and other lipidemia)
      Family history of familial combined hyperlipidemia
• Z91.42 (Personal history of forced labor or sexual exploitation).

Don’t Overlook These Revisions

Often, subtle revisions can make the difference between a clean claim and a denial. Check out these subtle T code revisions:

You’ll have the addition of inclusion terms under T74.3 (Psychological abuse, confirmed):

​            Bullying and intimidation, confirmed
​            Intimidation through social media, confirmed

You’ll also have the addition of inclusion terms under T76.3 (Psychological abuse, suspected):

​            Bullying and intimidation, suspected
​            Intimidation through social media, suspected.