Ob-Gyn Coding Alert

ICD-10-CM Coding Quiz:

Oct. 1 Approaches — Are You Prepared for All the Ob-Gyn Changes?

Tip: Be careful when it comes to acute vs. chronic conditions.

Your ICD-10-CM ob-gyn diagnoses expanded by leaps and bounds for late 2022, and the Ob-gyn Coding Alert volume 25 number 8 described them in the article, “Get Ready: Your Endometriosis Code Options Will Explode As of Oct. 1.” Now that you’ve had a chance to learn what’s changed, test your readiness with this coding quiz.

Question 1: Your ob-gyn documents “endometriosis of the ovary, right side” and does not specify depth. How should you report this?

A) N80.1

B) N80.11

C) N80.101

D) N80.011

Answer 1: C. You should report N80.101 (Endometriosis of ovary, unspecified depth; right side). Remember, you do have options for “superficial” and “deep” endometriosis of the ovary, so if your ob-gyn provides more information about depth, you will choose one of those codes.

Question 2: When you choose a 6th character of “2” for endometriosis of the posterior cul de-sac (N80.32-), what does it represent?

A) Second removal

B) Left side

C) Superficial

D) Deep

Answer 2: D. This endometriosis diagnois follow a different pattern from many of the others because the anatomy lacks two sides. You’ll see a pattern where the 6th character represents superficial (1), deep (2), and unspecified depth (3).

Question 3: How should you report “Endometriosis of the anterior abdominal wall, subcutaneous tissue?”

A) N80.C10

B) N80.C11

C) N80.C12

D) N80.C19

Answer 3: A. You should report N80.C10. Although many of the endometriosis codes follow an understandable pattern, endometriosis codes like N80.C10 follow no pattern at all. For those, you must rely on your anatomical and ICD-10-CM knowledge.

Bottom line: Remind your ob-gyn that their documentation needs to be specific about the endometriosis anatomic location and, in some cases, the side(s) or depth.

Question 4: Your ob-gyn sees a patient for the fourth time this year for vaginal candidiasis. How should you report this?

A) B37.3

B) B37.31

C) B37.32

D) B37

Answer 4: C. Because this is the fourth time your ob-gyn has seen the patient for this condition, you can characterize it as “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.”

Question 5: Can non-pregnant patients experience an isthmocele?

A) No. This condition is for pregnant patients only.

B) Yes, but there is no way to report it, even after Oct. 1, 2022.

C) Yes, and you will be able to report it with N85.

D) Yes, and you will be able to report it with N85.A.

Answer 5: D. An 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. Non-pregnant patients with this condition may experience “pelvic pain, abnormal uterine bleeding, secondary infertility, vaginal discharge, postmenstrual spotting, dyspareunia and dysmenorrhea,” the ICD-10 Committee Notes explains. As of Oct. 1, you are able to use N85.A (Isthmocele) for non-pregnant patients, who may undergo a hysteroscopy or laparoscopy to repair the defect.

Be sure you review all the ob-gyn related ICD-10-CM changes to avoid denials.

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