General Surgery Coding Alert

You just studied tips for accurate ICD-9 coding in "3 Steps Focus Diagnosis Coding for Your Surgical Claims." Now you can practice those skills with the following example:

Scenario: Your general surgeon excises an external thrombosed hemorrhoid (46320, Excision of thrombosed hemorrhoid, external) in a patient at 28 weeks gestation. What ICD-9 code should you use?

Solution: If you selected 455.4 (External thrombosed hemorrhoids) because you checked only the alphabetic index, you would be wrong. Once you turn to the tabular list, you'll see that category 455 (Hemorrhoids) excludes "that complicating pregnancy, childbirth, or the puerperium (671.8)."

When you look up 671.8 (Other venous complications), you'll read that the code lists "Hemorrhoids" as an example of this condition. You'll also notice that ICD-9 lists the code with a red dot -- meaning you'll need to add a digit.

Final answer: In this case, you should choose 671.83 to indicate that this is an antepartum condition or complication.