Pathology/Lab Coding Alert

Remember the ‘X’ placeholder.

If you code for a pathology practice or clinical laboratory, you know that just about any diagnosis might cross your desk. That’s because the testing your clinicians perform might aid in the identification of myriad medical conditions.

Hopefully you read last month’s “Mark Changes for Coding Neoplasms, Metabolic Disorders, and More” in Pathology/Lab Coding Alert Vol. 19, No. 9, but this month we cover additional ICD-10-CM changes you need to know.

“On October 1st, 2018 coders need to be ready to incorporate both new and revised codes — as well as suspend the use of the deleted codes,” says Amanda Corney, MBA, medical billing operations manager for Medical Resources Management in Rochester, New York.

Check Out Post-Procedural Infection Codes

ICD-10-CM expands T81.4 (Infection following a procedure), which you’ll need to know if your lab performs testing to identify infectious agents.

The Oct. 1 update includes the deletion of three codes: T81.4XXA (Infection following a procedure, initial encounter), T81.4XXD (… subsequent encounter), and T81.4XXS (… sequela).

To replace these deleted codes, ICD-10-CM is going infinitely more granular. You’ll find over 20 new codes that describe more specifics of the post-procedural infection or other condition, all of which fall under the following parent codes:

• T81.40- (Infection following a procedure, unspecified)
• T81.41- (… superficial incisional surgical site)
• T81.42- (… deep incisional surgical site)
• T81.43- (… organ and space surgical site)
• T81.44- (Sepsis following a procedure)
• T81.49- (Infection following a procedure, other surgical site).

The above codes represent the primary new codes, each of which will expand out to additional characters to describe whether the encounter was initial, subsequent, or for sequela. An example from the T81.40 section follows:

• T81.40XA (Infection following a procedure, unspecified, initial encounter)
• T81.40XD (… subsequent encounter)
• T81.40XS (… sequela).

“These additions offer further specificity regarding the location of the infection, as well as provide information related to the stage of treatment (initial, subsequent or sequela),” says Leah Fuller, CPC, Associate Consultant, Pinnacle Enterprise Risk Consulting Services, LLC, Connecticut.

Coder tip: Remember to add a placeholder of “X” before you add the A,” “D,” and “S” seventh character designations. This recalls the eyelid neoplasm code changes described in last month’s Pathology/Lab Coding Alert, in which many of the new codes have the addition of seventh character extensions, according to Angie Paine, COC, CPC, CPCO, CPB, CPMA, CPPM, CRC, CPC-I, CEMC, CRHC, consultant for Pinnacle Enterprise Risk Consulting Services located in Centennial, Colorado.

Lab tip: Directions for using the infection-following-a-procedure codes instructs, “Use additional code to identify infection.” This note means that you should report an additional code to identify the specific organism, if known. The ordering clinician should supply the diagnosis code or narrative for the condition (such as T81.41XA), and the lab that performs the test, such as a culture, will provide the organism identification. Report the organism with a code from the range B95-B97 for bacterial and viral infectious agents.

Don’t Miss New Appendicitis Codes

Changes to appendicitis coding in ICD-10-CM 2019 include eight new codes and almost as many revisions to codes and subcategories in the K35 (Acute appendicitis) range.

For instance: The changes expand the current appendicitis codes out to a fifth, and sometimes sixth, character, including the following, among others:

• K35.20 (Acute appendicitis with generalized peritonitis, without abscess)
• K35.21 (… with abscess)
• K35.30 (Acute appendicitis with localized peritonitis, without perforation or gangrene)
• K35.891 (Other acute appendicitis without perforation, with gangrene).

Thanks to the new codes, clinicians will need to be increasingly specific in their documentation so coders know when appendicitis patients have peritonitis, abscess, perforation, or gangrene. Pathologists examining an appendix specimen may identify some of the conditions (such as abscess), but some of the information not evident in the specimen will come from the ordering clinician (such as generalized peritonitis).

Find New Gallbladder, Cholecystitis Codes

Paralleling changes to appendicitis codes, you’ll also see some new choices for cholecystitis in ICD-10-CM 2019 that allow for documenting abscess, perforation, or gangrene.

For instance, you’ll find the following new codes to refer to gallbladder disorders:

• K82.A1 (Gangrene of gallbladder in cholecystitis)
• K82.A2 (Perforation of gallbladder in cholecystitis).

You’ll also find two new codes for cholangitis, which is currently covered under the catch-all code K83.0 (Cholangitis). But starting Oct. 1, you can get more specific with the following choices:

• K83.01 (Primary sclerosing cholangitis)
• K83.09 (Other cholangitis).

Because primary sclerosing cholangitis is a complex chronic liver condition that usually involves non-surgical management, the new code will help demonstrate medical necessity for involved services, particularly imaging such as MRCP, interventions by ERCP or other encounters to manage the medical aspects of the condition, says Glenn D. Littenberg, MD, MACP, FASGE, AGAF, a physician and former CPT^® Editorial Panel member in Pasadena, California.

Resources: To access the entire list of new, revised, and deleted ICD-10-CM codes, visit the CMS website at www.cms.gov/Medicare/Coding/ICD10/2019-ICD-10-CM.html.