ICD-10 Code Specialty Round-Up

Written by on February 2, 2012 in Features, Practice tips - 1 Comment

By Suzanne Leder, BA, M. Phil., CPC, COBGC, certified AHIMA ICD-10 trainer

Part of your 2012 New Year’s resolution should be preparing for International Classification of Diseases 10th Revision (ICD-10). Centers for Medicare and Medicaid Services (CMS) has not instituted any delay or elimination of ICD-10, which means you’ll need to be ready to use the new code set by Oct. 1, 2013 – less than two years away.

Rule of thumb: You should search for specificity whenever possible, which means expanding your documentation in certain situations. Examine these top diagnoses for cardiology, oncology, orthopedics, general surgery, ob-gyn and radiology and how they change in ICD-10.

Cardiology: Check Out Your New DVT Choices For 2013

An embolism is the obstruction of a vessel by a clot or foreign substance (such as plaque or fatty deposits). Thrombosis is obstruction by a blood clot. The codes featured here are specific to deep vessels and are appropriate for deep vein thrombosis (DVT). The codes are also specific to acute cases, as opposed to chronic. Coding for DVT will become more detailed under ICD-10, the following is what you can expect.

ICD-9-CM 2011 code:

  • 453.42, Acute venous embolism and thrombosis of deep vessels of distal lower extremity

ICD-10-CM 2011 codes:

  • I82.441, Acute embolism and thrombosis of right tibial vein
  • I82.442, Acute embolism and thrombosis of left tibial vein
  • I82.443, Acute embolism and thrombosis of tibial vein, bilateral
  • I82.449, Acute embolism and thrombosis of unspecified tibial vein
  • I82.491, Acute embolism and thrombosis of other specified deep vein of right lower extremity
  • I82.492, Acute embolism and thrombosis of other specified deep vein of left lower extremity
  • I82.493, Acute embolism and thrombosis of other specified deep vein of lower extremity, bilateral
  • I82.499, Acute embolism and thrombosis of other specified deep vein of unspecified lower extremity
  • I82.4Z1, Acute embolism and thrombosis of unspecified deep veins of right distal lower extremity
  • I82.4Z2, Acute embolism and thrombosis of unspecified deep veins of left distal lower extremity
  • I82.4Z3, Acute embolism and thrombosis of unspecified deep veins of distal lower extremity, bilateral
  • I82.4Z9, Acute embolism and thrombosis of unspecified deep veins of unspecified distal lower extremity

ICD-10 expands your options dramatically, creating codes that differ based on if the diagnosis involves the right leg, the left leg, both legs or an unspecified leg. You also must choose among codes that differ based on whether the vein involved is the tibial, another specified vein or is not specified.

Takeaway: Your documentation must be clear about the vessel(s) and limb(s) involved for you to choose the most appropriate ICD-10 code. Remember that “other” means you documented the type, but ICD-10 doesn’t offer a code specific to the documented type. “Unspecified” means you did not document the required information.

Coder tips: The codes shown here are specific to acute, deep vein and distal lower extremity diagnoses. You’ll see similarly detailed coding options for chronic and proximal lower extremity diagnoses, as well as diagnoses specific to other anatomic features, such as thoracic or upper extremity vessels. If these are diagnoses you see in your practice, take the time to review those new code ranges.

Oncology: Get Specific With Unspecified Non-Hodgkin Lymphomas

When you start using ICD-10 in 2013, the new code set won’t always offer a simple one-to-one relationship to the old codes. Often, you’ll have additional options that may require tweaking the way your physician documents a service and the way your coder reports it.
Right now, your go-to code for unspecified non-Hodgkin lymphoma (NHL) is 202.8x (other lymphomas). So 202.8x serves as both a not elsewhere classifiable/other specified (NEC) and not otherwise specified/unspecified (NOS) code.

ICD-10-CM change: ICD-10 does this differently, offering one code range for NHL NEC and another for NHL NOS.

NEC: ICD-10 2011 includes C85.8- (other specified types of non-Hodgkin lymphoma) for reporting NHL when you document the type, but ICD-10 doesn’t offer a more specific code appropriate for that diagnosis. To start preparing to use this code range, take a close look at the ICD-10 codes available for specified types of NHL. That way, you’ll be able to identify more quickly when you document a type that doesn’t match available specific codes. And, just as with ICD-9, be sure to start your ICD-10 code search in the index for terms that match your documentation. That will help you identify the most specific code for your case.

NOS: ICD-10 2011 includes C85.9- (non-Hodgkin lymphoma, unspecified) for when you document NHL without stating the specific type.

Keep in mind; the NHL codes require a fifth digit to be complete. The fifth digit sub-classification is based on the lymph nodes involved. The ICD-10 and ICD-9 options are similar, with one important difference. You will have separate ICD-10 options for unspecified site (0) and extranodal and solid organ sites (9). In ICD-9, the two are both reported using fifth digit (0).

Orthopedics: Pay Attention to Laterality When Reporting Meralgia Paresthetica

Meralgia paresthetica may be a diagnosis you encounter frequently in your orthopedic practice; under ICD-10, you’ll need to look specifically for laterality details to accurately code this condition.

Code 355.1 (Meralgia paresthetica) in ICD-9 expands into three options in ICD-10, as of Oct. 1, 2013:

  • G57.10 Meralgia paresthetica, unspecified lower limb
  • G57.11 Meralgia paresthetica, right lower limb
  • G57.12 Meralgia paresthetica, left lower limb)

Meralgia paresthetica means the patient is experiencing numbness or pain in the outer thigh that is not caused by an injury to the thigh but an injury to the sensory nerve supplying that region. This nerve, called the lateral femoral cutaneous nerve, extends from the spinal column to the thigh. The cause of the numbness or pain is usually an entrapment or compression of the nerve. The pain may be acute, severe and may radiate distantly into the groin or ribs.
You’ll choose these codes based on if the complaints are in the right or left lower limb. You do have an unspecified option, but payers will want the highest specificity: either right or left. Make sure you clearly specify which side was affected.

Takeaway: You probably already documented the patient has meralgia paresthetica in the right or left lower limb, but in ICD-10-CM, you have a new way to reflect that.

General Surgery: Apply These New Appendicitis Additions

When you remove an appendix, you’ll have more specific diagnosis code choices under ICD-10.

Coding for acute appendicitis will change as follows, from ICD-9 to ICD-10:

  • 540.0 (Acute appendicitis with generalized peritonitis) becomes K35.2 with an identical definition.
  • 540.1 (Acute appendicitis with peritoneal abscess) becomes K35.3 (acute appendicitis with localized peritonitis).
  • 540.9 (Acute appendicitis without peritonitis) leads to two possible ICD-10 codes: K35.80 (unspecified acute appendicitis) or K35.89 (other acute appendicitis).

ICD-10 provides a similar distinction between “other” and “unspecified” for the following ICD-9 to ICD-10 crosswalks:

  • 541 (Appendicitis unqualified) becomes K37 (unspecified appendicitis).
  • 542 (Other appendicitis) becomes K36 (other appendicitis).

Note: Although you’ll find a one-to-one crosswalk for appendix hyperplasia (543.0, hyperplasia of appendix [lymphoid] to K38.0, hyperplasia of appendix), ICD-10 provides many more specific codes for other conditions.

Instead of ICD-9’s 543.9 (other and unspecified diseases of appendix), you’ll choose one of the following codes starting Oct. 1, 2013:

  • K38.1  Appendicular concretions
  • K38.2 Diverticulum of appendix
  • K38.3 Fistula of appendix
  • K38.8 Other specified diseases of appendix
  • K38.9 Disease of appendix, unspecified.

Takeaway: You should be ultra specific when documenting a patient’s appendicitis.

Ob-gyn: Your Leukorrhea Code Will Become a General One

If a patient has leukorrhea, she has whitish, yellowish or greenish discharge from the vagina. The discharge can be normal or the sign of an infection.

Right now, you should report this condition with 623.5 (leukorrhea not specified as infective). When you switch to ICD-10, you should report N98.8 (other specified noninflammatory disorders of vagina) instead. These two codes have a one-to-one correlation, but you should examine how the descriptors differ.

Takeaway: You should turn to code N89.8 when documenting leukorrhea. If you document leukorrhea NOS, you’ll still turn to N89.8 because this term appears as an explanatory term under N89.8.

Radiology: N20.2 Adds Option to Kidney and Ureter Calculus Coding

Kidney stone sufferers number in the millions each year. Because those numbers are on the rise, the diagnosis code for this ailment is sure to still rank among your commonly used codes when the transition to ICD-10 occurs in 2013.

Good news: For “calculus of kidney and ureter” codes, you’ll find almost a one-to-one code correspondence between ICD-9 2011 and ICD-10 2011.

The major difference is that ICD-10 offers a code (N20.2) that is appropriate when the patient has calculi of both the kidney and the ureter. Under ICD-9, you would report the same diagnosis using two codes (592.0 and 592.1).

Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update

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Suzanne Leder, M.Phil., CPC, COBGC, certified AHIMA ICD-10 trainer
can answer your ICD-10 coding questions. In addition to being ICD-10 trainer certified by the American Health Information Management Association (AHIMA), Suzanne is a Certified Obstetrics Gynecology Coder (COBGCTM). She has been the Ob-gyn Coding Specialty Alert editor for six years and counting. During her coding writing career, she has covered cardiology, gastroenterology, neurology, neurosurgery, orthopedics, otolaryngology, and physical medicine and rehab. Suzanne has a bachelor of arts degree from North Carolina State University and an international Master’s degree (M. Phil) from Trinity College Dublin. She became a Certified Professional Coder® (CPC®) through the American Academy of Professional Coders (AAPC) in 2004.

One Comment on "ICD-10 Code Specialty Round-Up"

  1. obgyn coding April 3, 2012 at 8:35 am · Reply

    An informative post…. The system used by the ICD-10 allows the medical coder to review the list of diagnoses and match the procedure and diagnosis codes based on medical necessity. This manual also is available as a book or for online viewing… obgyn coding

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