Ob-Gyn Coding Alert

Coders, beware. The latest round of ICD-9 will have you scrambling to apply numerous new codes for both obstetric and gynecological conditions -- unless you begin learning them now. Prepare for the mental shift on Oct. 1 by poring over these updates, and you-ll be ahead of the game.

Heads up: "Keep a close watch on fifth digits, the includes/excludes notes, and the NEC (Not elsewhere classifiable) and NOS (Not otherwise specified) codes -- you want to avoid them if possible,"says Dianne Wilkinson, RHIT, compliance auditor with West Tennessee Healthcare in Jackson.

You-ve got five new changes heading your way that will help specify ob conditions.

1. Suspected conditions: Maternal-fetal specialists often see patients for detailed ultrasounds when an initial screening indicates a possible abnormality. However, sometimes the detailed ultrasound shows no abnormality, and the maternal-fetal specialist might face problems getting reimbursed for this service.

Therefore, you now have codes for the following suspected conditions:

- V89.01 -- Suspected problem with amniotic cavity and membrane not found

- V89.02 -- Suspected placental problem not found

- V89.03 -- Suspected fetal anomaly not found

- V89.04 -- Suspected problem with fetal growth not found

- V89.05 -- Suspected cervical shortening not found

- V89.09 -- Other suspected maternal and fetal condition not found.

2. Cervical shortening: Women undergo cervix shortening when their bodies prepare for labor, but sometimes this can indicate an impending premature birth -- but not absolutely. Now you might reflect this condition with 654.5x (Cervical incompetence), 654.6x (Other congenital or acquired abnormality of cervix), or 644.1x (Other threatened labor). But Oct. 1 ushers in the more precise code of 649.7 [0, 1, 3] (Cervical shortening).

Remember: You-ll need one of the fifth digits indicated in the brackets (0, Unspecified as to episode of care or not applicable; 1, Delivered, with or without mention of antepartum condition; 3, Antepartum condition or complication), says Melanie Witt, RN, CPC-OGS, MA, an independent ob-gyn coding consultant in Guadalupita, N.M.

3. Pregnancy: You-ll have two new V codes to describe the patient's pregnancy: V23.85 (Pregnancy resulting from assisted reproductive technology) and V23.86 (Pregnancy with history of in utero procedure during previous pregnancy).

4. Screenings: You have three new V codes that may assist you when the ob-gyn screens a pregnant patient: V28.81 (Encounter for fetal anatomic survey), V28.82 (Encounter for screening for risk of pre-term labor), and V28.89 (Other specified antenatal screening). If your ob-gyn performs nuchal scans, you-ll use V28.89.

"Although the list of new codes published in the Federal Register gives only the code titles, this test will be listed as an -inclusion- term," Witt says.

You-ll also see a revision to V28.3 to say "Encounter for routine screening for malformation using ultrasonics."

5. Complications: You will have a specific code when a patient has fetal conjoined twins (678.1 [0, 1, 3]). Also, you can specify fetal hematologic conditions with new code 678.0 [0, 1, 3]. "Use 678.0x to report twin-twin transfusion," Witt says. Complications derived from in utero procedures will have two new codes: 679.0 [0-4] (Maternal complications from in utero procedure) and 679.1 [0-4] (Fetal complications from in utero procedures).

Remember: With these last two codes, you also have a fifth digit option of 2 (Delivered, with mention of postpartum complication) or 4 (Postpartum condition or complication).

Ob conditions aren't the only new changes. You have five gynecological condition additions as well.

1. Hematuria and urinary incontinence: If the patient has blood in the urine, or "hematuria," you have three new codes to represent this condition: 599.70 (Hematuria, unspecified), 599.71 (Gross hematuria), and 599.72 (Microscopic hematuria).

Note: If your encounter form now lists 599.7 as an option, you will start getting denials after Oct. 1 unless you remember to list one or more of the now five-digit codes for this condition, Witt says.

You have a new code for urinary incontinence: 788.91 (Functional urinary incontinence). Functional urinary incontinence occurs when a patient has impairment of the ability to control her bladder function.

ICD-9 also adds 788.99 (Other symptoms involving urinary symptoms).

2. Vulvar conditions: "Vulvodynia" literally means pain in the vulva, while vulvar vestibulitis is vulvodynia in the vestibular region. You-ll reflect this condition with new codes 625.70 (Vulvodynia, unspecified), 625.71 (Vulvar vestibulitis), and (625.79, Other vulvodynia).

3. Breast disorders: You-ve got new codes for breast conditions such as ptosis (611.81, Ptosis of breast), hypoplasia (611.82, Hypoplasia of breast), capsular contracture of breast implant (611.83), and other specified disorders of the breast (611.89). Also, be on the look out for 612.0 (Deformity of reconstructed breast) and 612.1 (Disproportion of reconstructed breast).

4. Wound disruption: This condition (also known as "wound dehiscence") means the patient has a physical separation of a surgical wound. This is a potentially serious complication. Under current ICD-9 guidelines, your ob-gyn has to specify "external" or "internal" wound dehiscence. Your new code is 998.30 (Disruption of wound, unspecified).

5. Tissue disorders: Patients with a large traumatic hematoma may develop a seroma (a small collection of fluid). However, nontraumatic hematomas also exist, so ICD-9 2009 qualifies this with 729.90 (Disorders of soft tissue, unspecified), 729.91 (Post-traumatic seroma), 729.92 (Nontraumatic hematoma of soft tissue), and 729.99 (Other disorders of soft tissue).

Revision: Code 998.31 will state: "Disruption of internal operation (surgical) wound" as of Oct. 1.

ICD-9 created a new V code to capture data on the many women who receive Tamoxifen and Raloxifene following breast cancer treatment. Then, they expanded this V code to include different classes of drugs used for this type of therapy. The new V codes are:

Note: From a guideline perspective, you can use the cancer code with one of these codes throughout the course of treatment, including during routine chemotherapy and radiation therapy. However, the long-term use of a drug falling under the V07.5x category wouldn't require the continued use of the cancer code.

Other V codes: ICD-2009 offers 11 new options to track a patient's history involving in utero procedures (V15.21-V15.22), fractures and musculoskeletal disorders (V13.51-V13.59, V15.51, V15.59), surgery (V15.29), and chemotherapy/drug therapy (V87.41-V87.49).

Want to learn these updates fast? "I display a list of the new ICD-9 codes that are pertinent to our specialty at my desk until I become familiar with them," says Donna Neuberger, CPC, coder at Kadlec Clinic/Associated Physicians for Women in Richland, Wash.

E-mail the editor at suzannel@eliresearch.com with "Ob-Gyn ICD-9 PDF" in the subject line for a free PDF of the ob-gyn-pertinent updates.