Anesthesia Coding Alert

Caveat: Your provider will still need detailed documentation for you to code correctly.

The newest changes to ICD-10 go into effect on Oct. 1, and you won’t want to miss some of the updates. Of the hundreds of additions, quite a few could come in handy when you’re documenting the patient’s status in relation to your anesthesia provider’s work.

Appendicitis Coding Gets Much More Specific

ICD-10 will add eight new diagnoses related to appendicitis, specifying whether the patient has complications such as an abscess or perforation. They are:

• K35.20 – Acute appendicitis with generalized peritonitis, without abscess
• K35.21 – Acute appendicitis with generalized peritonitis, with abscess
• K35.30 – Acute appendicitis with localized peritonitis, without perforation or gangrene
• K35.31 – Acute appendicitis with localized peritonitis and gangrene, without perforation
• K35.32 – Acute appendicitis with perforation and localized peritonitis, without abscess
• K35.33 – Acute appendicitis with perforation and localized peritonitis, with abscess
• K35.890 – Other acute appendicitis without perforation or gangrene
• K35.891 – Other acute appendicitis without perforation, with gangrene.

“Keep in mind that coders may need to educate their clinical staff to provide more than just ‘appendicitis’ as a diagnosis,” says Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I,  owner of Perfect Office Solutions in Leesburg, Fl. “I see this issue very often.”

New gallbladder diagnoses also highlight complications:

• K82.A – Disorders of gallbladder in diseases classified elsewhere
• K82.A1 – Gangrene of gallbladder in cholecystitis
• K82.A2 – Perforation of gallbladder in cholecystitis
• K83.01 – Primary sclerosing cholangitis
• K83.09 – Other cholangitis.

Reminder: Cholangitis is an infection of the bile duct system, usually associated with a bacterial infection.

Watch for Urethral Stricture Additions

Also pay attention to new urology diagnoses, most of which you’ll find in the N35 (Urethral stricture) code family.

Several new codes will serve a general role for “other” urethral stricture conditions:

• N35.81 – Other urethral stricture, male
• N35.811 – Other urethral stricture, male, meatal
• N35.812 – Other urethral bulbous stricture, male
• N35.813 – Other membranous urethral stricture, male
• N35.814 – Other anterior urethral stricture, male, anterior
• N35.816 – Other urethral stricture, male, overlapping sites
• N35.819 – Other urethral stricture, male, unspecified site
• N35.82 – Other urethral stricture, female.

Take note: If the etiology or cause of the urethral stricture is unknown (as secondary to post procedural, post infective, or post traumatic), you may report one of the above “other” specific location codes, according to Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stony Brook.

One goal of ICD-10 is specificity so that providers can be as accurate in their diagnosis assignment as possible. There are, however, still times when coders must resort to “unspecified” diagnoses because they do not have all the supporting details for another option.

The new edition of ICD-10 will add eight more “unspecified” choices to your urethral stricture coding arsenal:

• N35.91 – Urethral stricture, unspecified, male
• N35.911 – Unspecified urethral stricture, male, meatal
• N35.912 – Unspecified bulbous urethral stricture, male
• N35.913 – Unspecified membranous urethral stricture, male
• N35.914 – Unspecified anterior urethral stricture, male
• N35.916 – Unspecified urethral stricture, male, overlapping sites
• N35.919 – Unspecified urethral stricture, male, unspecified site
• N35.92 – Unspecified urethral stricture, female.

Having these options can come in handy, but Ferragamo reminds that you should rarely need to use “unspecified” diagnostic codes, due to the sheer numbers of more specific codes available. However, as an anesthesia coder, you might sometimes have to resort to “unspecified” if the surgeon’s records don’t include adequate details for you to code from.

Documenting Complicated Deliveries Just Got Easier

Coding for obstetrical cases can be tricky from an anesthesia perspective since circumstances can quickly change and lead to a different anesthesia plan for your provider. The 2019 edition of ICD-10 introduces new diagnoses for multiple gestation pregnancies and post-op wound infections that could send the patient back to the OR.

Triplet pregnancies that are “trichorionic triamniotic” mean that each fetus has its own placenta and amniotic sac. You’ve got new ICD-10 codes to reflect this, based on trimester. They are:

• O30.13- – Triplet pregnancy, trichorionic/triamniotic, …
• O30.23- – Quadruplet pregnancy, quadrachorionic/quadra-amniotic …

The required sixth character specifies the trimester (1, first trimester; 2, second trimester; 3, third trimester; 9, unspecified trimester). “While this specificity is valuable information for health information/statistics, unfortunately most physician coders do not get this much information when coding for professional services,” says Jan Rasmussen, PCS, CPC, ACS-GI, ACS-OB, owner/consultant of Professional Coding Solutions in Holcombe, Wis. From an anesthesia perspective, you could find yourself relying on the “9” for “unspecified trimester” most often.

There’s more: For other numbers of fetuses (such as quintuplets, sextuplets, or septuplets), check out O30.83- (Other specified multiple gestation, number of chorions and amnions are both equal to the number of fetuses). Underneath this code, you’ll see the following inclusionterms:

• Pentachorionic, penta-amniotic pregnancy (quintuplets)
• Hexachorionic, hexa-amniotic pregnancy (sextuplets)
• Heptachorionic, hepta-amniotic pregnancy (septuplets).

Obstetric patients undergoing cesarean sections or perineal repairs may develop infections at the wound site. You currently have code O86.0 (Infection of obstetric surgical wound), but you will have the addition of an Excludes1 note stating: “complications of procedures, not elsewhere classified (T81.4-), postprocedural fever NOS (R50.82), postprocedural retroperitoneal abscess (K68.11). “Remember, an Excludes1 note means that these two codes can never be coded together, and you should code either one or the other,” says Melanie Witt, RN, MA, an independent coding expert based in Guadalupita, N.M.

Beginning in October, you’ll have six new options to further explain obstetric surgical wound infections:

• O86.00 – Infection of obstetric surgical wound, unspecified
• O86.01 – Infection of obstetric surgical wound, superficial incisional site
• O86.02 – Infection of obstetric surgical wound, deep incisional site
• O86.03 – Infection of obstetric surgical wound, organ and space site
• O86.04 – Sepsis following an obstetrical procedure
• O86.09 – Infection of obstetric surgical wound, other surgical site.

Know the Encounter for Sepsis Coding

The potential for sepsis is a concern for any surgical procedure. If you find yourself coding for a patient who goes back into surgery to treat sepsis following a procedure, you have four new codes to describe the encounter:

• T81.44 – Sepsis following a procedure
• T81.44XA – Sepsis following a procedure, initial encounter
• T81.44XD – Sepsis following a procedure, subsequent encounter
• T81.44XS – Sepsis following a procedure, sequela.

This edition of ICD-10-CM will be effective from Oct. 1, 2018, until Sept. 30, 2019.