General Surgery Coding Alert

Look for complication first in 2013.

You'll have three more hemorrhoid codes to choose from in ICD-10, 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.

Pay attention to hierarchy: 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/unspecified, and whether the patient exhibits specific complications. On the other hand, ICD-10 provides three subcategories (four digit codes) based on whether the hemorrhoids are thrombosed, have other complications, or have no complications, as follows:

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 455.8 (Unspecified hemorrhoids with other complications) under ICD-9. Notice that ICD-10 allows you to gain specificity by capturing "internal and external" hemorrhoids, and by identifying that the complication is "ulcerated." ICD-9 loses both of those pieces of information.