Anesthesia Coding Alert

Tip: Look for complication first before coding in 2013.

You'll need to compare your anesthesiologist's notes with those of the surgeon even more often when coding for hemorrhoid cases, effective Oct. 1, 2013. That's because the new code set adds codes for "internal and external" in addition to codes for internal, unspecified, or external hemorrhoids. But that's not the only change you'll see when you go to choose a hemorrhoid diagnosis in ICD-10.

Hierarchy counts: ICD-9 has 10, four digit codes under category 455 (Hemorrhoids). The fourth digit 0-9 distinguishes each code based on whether the hemorrhoids are internal, external, or unspecified, and whether the patient exhibits specific complications. By comparison, ICD-10 provides three subcategories (four digit codes) based on whether the hemorrhoids are thrombosed, have other complications, or have no complications:

• I84.0 -- Thrombosed hemorrhoids
• I84.1 -- Hemorrhoids with other complications
• I84.2 -- Hemorrhoids without complication.

Show location with fifth digit: ICD-10 uses the fifth digit to show hemorrhoid location as follows:

• 0 -- Unspecified
• 1 -- Internal
• 2 -- External
• 3 -- Internal and external.

Specify complication: Once you've narrowed your selection to the correct five-digit code, you'll need to add specificity if the patient has one of the "other" complications. For subcategory I84.1x, choose from the following sixth digits:

• 1 -- bleeding
• 2 -- prolapsed
• 3 -- strangulated
• 4 -- ulcerated.

Example: For a patient with internal and external ulcerated hemorrhoids, you'd report I84.134 (Internal and external ulcerated hemorrhoids) in ICD-10. For the same condition, you'd have to choose a more general code under ICD-9 that could represent any number of complications (such as bleeding, prolapsed, strangulated, or ulcerated). ICD-10 allows you to gain specificity by capturing "internal and external" hemorrhoids, and by identifying that the complication is "ulcerated."