Ob-Gyn Coding Alert
Get Ready: Your Endometriosis Code Options Will Explode As of Oct. 1
These other gyn-related diagnoses focus on acute vs. chronic conditions. If your ob-gyn frequently sees patients with endometriosis, you will need to be hypervigilant about checking the documentation. That’s because ICD-10-CM takes your handful of current coding options and expands them by anatomic location, depth, and side(s). Check out what you need to know before these diagnoses go into effect — which is Oct. 1, 2022 — so that your gynecology claims won’t fall into limbo land. Endometriosis Goes From 9 to 127 Possible Codes Coding for endometriosis just got a lot more difficult and specific. That’s because ICD-10 expanded all of the current four-character codes to five- and six- character codes under the existing sites for endometriosis and added several new locations in the process. “Before October 1, you have only 9 codes to choose from. After October 1, that number increases to 127 codes,” says Melanie Witt, MA, RN, an ob-gyn coding expert based in Guadalupita, New Mexico. “Provider documentation will be the key to coding to the highest level of specificity.” According to the ICD-10 Committee Meeting Notes, “current ICD-10 codes for endometriosis do not provide details in terms of laterality, location, depth of invasion, volume of disease, and specific organ(s) involved. The addition and use of these proposed codes to specifically describe the type and location of endometriosis will have direct implications on disease management and clinical outcomes.” For instance, under N80.0- (Endometriosis of uterus), you will find more specific codes: Under N80.1- (Endometriosis of ovary), you’ll find N80.10- (Endometriosis of ovary, unspecified depth) with expanded 6th character options for right (1), left (2), bilateral (3), and unspecified (4). This means, if an ob-gyn treats endometriosis of the ovary with unspecified depth on both sides, you’ll only report one diagnosis code, which is N80.103 (Endometriosis of bilateral ovaries, unspecified depth). Codes N80.11- (Superficial endometriosis of the ovary) and N80.12- (Deep endometriosis of ovary) follow the same pattern. You’ll find similar 6th character options for right (1), left (2), bilateral (3), and unspecified (4) for the following endometriosis codes: Other endometriosis diagnoses follow a different pattern because the anatomy lacks two sides. For some of these diagnoses, you’ll see a pattern where the 5th or 6th character represents superficial (1), deep (2), and unspecified depth (3). Those codes are for the endometriosis of: Don’t miss: Although the above endometriosis codes follow an understandable pattern, you still have other new endometriosis codes that follow no pattern at all. For those, you must rely on your anatomical and ICD-10-CM knowledge. Those codes include: Bottom line: Your ob-gyn’s documentation needs to be specific about the endometriosis anatomic location and, in some cases, the side(s) or depth. New Gyn Diagnoses Don’t Stop There If you’re still reeling from the news about the endometriosis ICD-10-CM codes, you need to prepare yourself for even more new gynecological-related codes — but don’t worry. These additions are far less expansive. If you try to use B37.3 (Candidiasis of vulva and vagina) after October 1, you may face a denial. That’s because you will have two new codes, which are B37.31 (Acute candidiasis of vulva and vagina) and B37.32 (Chronic candidiasis of vulva and vagina). Notice the difference between “acute” and “chronic.” According to the ICD-10 Committee Notes, “recurrent vulvovaginal candidiasis” is “defined as 3-4 or more episodes of symptomatic infection within one year.” Also, if your ob-gyn treats a patient with Fournier disease, you’ll currently report N76.89 (Other specified inflammation of vagina and vulva). After Oct. 1, 2022, you should start using new code N76.82 (Fournier disease of vagina and vulva). Fournier disease is often a diabetic complication. Finally, you’ll have a new code for an isthmocele in a gynecologic setting. “The term isthmocele (also known as cesarean scar defect or niche) describes a dehiscence at the incision site of a previous cesarean section,” according to the ICD-10 Committee Meeting Notes. Although this can cause complications for a pregnant patient, you did not have a way to capture this issue for non-pregnant patients, who may experience “pelvic pain, abnormal uterine bleeding, secondary infertility, vaginal discharge, postmenstrual spotting, dyspareunia and dysmenorrhea,” the ICD-10 Committee Notes explains. As of October 1, you will be able to use N85.A (Isthmocele) for non-pregnant patients, who may undergo a hysteroscopy or laparoscopy to repair the defect.
Related Articles
Ob-Gyn Coding Alert
- ICD-10-CM 2023 Update:
Get Ready: Your Endometriosis Code Options Will Explode As of Oct. 1
These other gyn-related diagnoses focus on acute vs. chronic conditions. If your ob-gyn frequently sees [...] - ICD-10-2023 Update:
Category O35 Describes More Detail for Fetal Anomalies
You also have 3 obstetric guideline changes to adopt. For obstetric patients, you have new [...] - E/M:
Can You Answer These Inpatient E/M Coding FAQs?
Hint: Don’t forget modifier AI when necessary. Whether your ob-gyn is seeing hospital patients following [...] - You Be the Coder:
Find the Correct Comparison Code for This Scenario
Question: My ob-gyn had a woman with 15-16 week fetal demise in the left nondominant uterine [...] - Reader Questions:
Patient’s Employer Requesting Labs? Look to These Z Codes
Question: What diagnosis code would I use if the patient is requesting labs for work? [...] - Reader Questions:
All O Codes Will Require Gestational Age
Question: If a patient says she has a complete AB, do we need to list the [...] - Reader Questions:
Try Your Hand at Toxoplasmosis Screening Code
Question: I was wondering if someone could help. We have a newly pregnant patient who works [...] - Reader Questions:
Disagreements With Your Physician? Do This
Question: I have a doctor that wants to see in writing where they have to document [...]
