Ob-Gyn Coding Alert

Four scenarios show you where to brush up before Oct. 1 hits.

October 1 means it's time to apply the new 2011 diagnosis codes affecting your obgyn practice, which include new uterine anomaly, placenta, personal history, and fecal incontinence diagnoses. Are you ready? Take this challenge to find out.

Add Uterine Anomalies to Your Diagnosis Arsenal

Scenario 1: Your ob-gyn will find uterine anomalies difficult to determine, because women  with some of these conditions are asymptomatic. The patient won't know she has an anomaly until she has a problem with conception or maintenance of a pregnancy. Which of the following are new uterine anomaly codes for ICD-9 2011?

A) 752.31

B) 752.33

C) 752.35

D) None of the above.

E) All of the above.

Solution 1: E. The American Society of Reproductive Medicine (ASRM) identified seven types of uterine anomalies: agenesis, unicornuate, didelphus, bicornuate, septate, arcuate, and DES related anomalies. Of these, only didelphus and DES related anomalies have unique ICD-9 codes prior to Oct. 1: 752.2 and 760.76, respectively. For the other anomalies, you have no specific diagnosis recourse.

However, as of Oct. 1, you'll be able to differentiate between these different types, and payers will translate these codes into specific gynecologic and obstetric implications and management. They are:

• 752.31 -- Agenesis of uterus
• 752.32 - Hypoplasia of uterus
• 752.33 -- Unicornuate uterus
• 752.34 -- Bicornuate uterus
• 752.35 -- Septate uterus
• 752.36 -- Arcuate uterus
• 752.39 -- Other anomalies of uterus.

Multiple Placentae? Make Use of New Dx

Scenario 2: The ob-gyn delivers dichorionic/diamniotic twins vaginally. After October 1, how should you report this?

A) 59400, 59409-51, 651.01, V91.00, V27.2

B) 59400, 59409-51, 651.01, V91.01, V27.2

C) 59400, 59409-51, 651.01, V91.02, V27.2

D) 59400, 59409-51, 651.01, V91.03, V27.2

E) 59400, 59409-51, 651.01, V91.09, V27.2

Solution 2: D. You would report 59400 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care) for the first baby and 59409-51 (Vaginal delivery only [with or without episiotomy and/or forceps]; Multiple procedures) for the second. To support these CPT codes, you'd link each to 651.01 (Twin pregnancy; delivered) and add a secondary diagnoses of V91.03 (Twin gestation, dichorionic/diamniotic [two placentae, two amniotic sacs]) and the outcome code V27.2 (Twins, both liveborn).

Did you know? You'll find similar V codes for triplet gestations (V91.10-V91.19), quadruplet gestations (V91.20-29), and other unspecified multiple gestations (V91.91- V91.99).

Get Specific with Personal History Codes

Scenario 3: A patient presents on September 30 for a follow-up to a bicornuate uterus, which the ob-gyn corrected surgically six months ago. What should you report?

A) 99211-99215, V13.62

B) 99211-99215, V67.09

C) 99211-99215, V13.23

D) 99211-99215, V13.24

Solution 3: B. Trick question.

Had this visit occurred after October 1, then you would have made a different selection.

In other words, because the patient is no longer in the postoperative period and she is not presenting for aftercare, new code V13.62 (Personal history of other [corrected] congenital malformations of genitourinary system) would adequately explain the reason for the visit (99211-99215, Office or other outpatient visit for an established patient ...). But this visit took place prior to October 1. Therefore, you can report only V67.09 (Follow-up examination; following other surgery), which is not as specific.

Pick the Deleted Fecal Incontinence Code

Scenario 4: You have new fecal incontinence codes to start using as of October 1 which will replace a current code. Which code will not appear in your ICD-9 2011 books?

A) 787.6

B) 787.60

C) 787.61

D) 787.62

E) 787.63

Solution 4: A. When Oct. 1 rolls around, you'll no longer be able to report 787.6 (Incontinence of feces). ICD-9 will delete it. Instead, you'll use one of the following new codes:

• 787.60 -- Full incontinence of feces
• 787.61 -- Incomplete defecation
• 787.62 -- Fecal smearing
• 787.63 -- Fecal urgency.

Remember: Incomplete defecation is distinct from constipation and fecal impaction. Rectum and anal sphincter problems (including rectoceles) can cause these problems, but currently, you don't have a way to specify these symptoms.

Not so when Oct. 1 rolls around.

However, just because you have these new codes to use doesn't mean you're suddenly going to get paid by payers who didn't pay you before. "Right now, even with the current 560.39 (Other impaction of the intestine) diagnosis code, we tend to run into some insurance carriers who do not view this as something that is medically necessary to remove," says Melanie Cramer, CMRS, a lead accounts receivable representative for a practice in Bedford, N.H. "Whether the old code or new code for fecal impaction is used, usefulness doesn't really apply when you have insurance companies who do not see eye-to-eye on the medical necessity of removing it."

Know more: For a full listing of new ICD-9 2011 codes that will affect your practice, go to the Ob-gyn Coding Alert, volume 13, number 5, and check out the article entitled "ICD-92011: Begin Prepping for New Placenta, Dysplasia, and Uterine Anomaly Diagnoses."