Anesthesia Coding Alert

Keep your providers abreast of details that help avoid denials.

As an anesthesia coder, you’re accustomed to searching throughout ICD-10 for diagnosis codes that apply to virtually any type of procedure. With new ICD-10 diagnosis codes becoming effective in October, here’s a quick look at some of the changes that might affect your claims.

Pay Attention to Appendicitis Expansion

The proposed ICD-10 list includes potential codes that would allow additional specificity in appendicitis coding. If confirmed, the codes open up the options for reporting appendicitis with peritonitis depending on whether or not the patient had an abscess, perforation, or gangrene. The changes, proposed by the American Association for the Surgery of Trauma, include eight new codes and almost as many revisions to codes and subcategories in the K35 (Acute appendicitis …) range.

For instance: The proposed changes would 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 — Acute appendicitis with generalized peritonitis, with abscess
• K35.30 — Acute appendicitis with localized peritonitis, without perforation or gangrene
• K35.891 — Other acute appendicitis without perforation, with gangrene.

If the ICD-10 Committee approves the new codes, doctors will need to be increasingly specific in their documentation so coders know when appendicitis patients have peritonitis, abscess, perforation, or gangrene, because the coding choice will depend upon those facts.

“These would typically be details, if available, providers would mention,” advises Sarah Todt, RN, CPMA, CPC, CEDC, director of provider education and audit with LogixHealth in Bedford, Mass. Therefore, if these codes are adopted, you’ll need to ensure that your physicians document these details in the notes.

Cholelithiasis Series Could See New Note

The proposed ICD-10 updates include a suggestion to add “if applicable” to certain codes in the “Disorders of the Gallbladder and Biliary Tract” section of the diagnosis coding manual.

The American Association for the Surgery of Trauma requested that some ICD-10 codes under the categories for cholelithiasis (K80), cholecystitis (K81), and Other diseases of gallbladder (K82) be clarified “to allow characterization of the severity of cholecystitis,” according to the meeting agenda document.

Therefore, under codes such as K80.1 (Calculus of gallbladder with other cholecystitis) and K80.4 (Calculus of bile duct with cholecystitis), the committee has suggested that the note following the code should say “Use additional code if applicable for associated gangrene of gallbladder.” The bolded “if applicable” is the possible new part.

In addition, the committee has proposed adding a new subcategory and two new codes to refer to gallbladder disorders, as follows:

• K82.A —  Disorders of gallbladder in diseases classified elsewhere

                  o K82.A1 — Gangrene of gallbladder in cholecystitis o K82.A2 — Perforation of gallbladder in cholecystitis.

If these codes are expanded as such, you’ll need to scrutinize the medical record so you can apply the accurate ICD-10 codes, says Rose B. Moore, CMC, CMCO, CMIS, CMOM, CCP, PCS, CEC, CMA-ophth, president and CEO of Medical Consultant Concepts, LLC.

“Coders would need to pay attention to the documentation so that the correct medical necessity is made clear,” Moore says. “Lack of specificity would create delay or denial of claims by making the codes invalid. As we continue to move towards severity of illness measures for the payment of claims, we have to look for our codes to cover these conditions.”

Check for Tiny Details Shifts in Revised Codes

While some ICD-10 updates will be obvious to see, others will be subtler. For example, you’ll find five revisions to urology-related diagnoses, each with only one- or two-word changes in the revised descriptors. They are:

• Revise Q64.12 (Cloacal extrophy of urinary bladder) to “Cloacal exstrophy of urinary bladder”
• Revise Q82.2 (Mastocytosis) to “Congenital cutaneous mastocytosis”
• Revise N991.11 (Postprocedural bulbous urethral stricture) to “Postprocedural bulbous urethral stricture, male”
• Revise N991.12 (Postprocedural membranous urethral stricture) to “Postprocedural membranous urethral stricture, male”
• Revise N991.13 (Postprocedural anterior bulbous urethral stricture) to “Postprocedural anterior bulbous urethral stricture, male.”

What it means: “Typically, anesthesia coders do not get a lot of the detailed information and are stuck applying an ‘unspecified’ code,” says Kelly D. Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla. “Watch for denials and let the clinical staff know when additional information is necessary to help avoid denials in the future.