Gastroenterology Coding Alert

Appendicitis gets additional specificity effective Oct. 1.

The ICD-10 Committee debuted more codes for GI practices beyond those described in our cover story. You’ll also find additional diagnosis codes for conditions such as appendicitis and post-procedural infections. Read on for the scoop.

Check out New Appendicitis Codes

Effective Oct. 1, you’ll find new codes that allow additional specificity in appendicitis coding. 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, which were actually proposed last year 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 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 — 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

Thanks to the new codes, gastroenterologists and surgeons 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.

This change is significant enough to warrant coders to speak with their physicians about it in-depth, because specifying the appendicitis to this level of clinical detail is not always a part of the documentation or is only apparent in the pathology report.

Check out Post-Procedural Infection Codes

Effective Oct. 1, you’ll also find coding updates that allow additional specificity in post-procedural infection coding. Three codes are scheduled for deletion at that point: T81.4XXA (Infection following a procedure, initial encounter), T81.4XXD (Infection following a procedure, subsequent encounter), and T81.4XXS (Infection following a procedure, sequela).

To replace these deleted codes, ICD-10 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 -- Infection following a procedure, superficial incisional surgical site
• T81.42 -- Infection following a procedure, deep incisional surgical site
• T81.43 -- Infection following a procedure, 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 -- Infection following a procedure, unspecified, subsequent encounter
• T81.40XS -- Infection following a procedure, unspecified, sequela

The additional codes in the series follow this lead, with the “A,” “D,” and “S” seventh character designations.

Check This Example

Consider the following example to see how you may encounter postsurgical infection billing:

The surgeon performs a partial colectomy with closure of the distal segment. Several days later, the patient presents to your practice and the surgical site shows swelling, pus and inflammation. The physician incises the surgical wound and drains fluid from it and prescribes antibiotics. For this situation, you will link the I&D code to T81.41XA (Infection following a procedure, superficial incisional surgical site, initial encounter).

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