General Surgery Coding Alert

Start using new and revised codes Oct. 1, 2019.

From history of cancer to cardiovascular diagnoses, you’ll find plenty for your general surgery practice to master in the 2020 ICD-10-CM update.

Let our experts guide you through the top codes you should know out of the 273 additions, 21 deletions, and 30 revisions coming your way.

Remember: Medicare quality reporting programs rely on appropriate diagnosis coding to evaluate appropriate procedures — so missing the boat now could impact your bottom line later.

Specify Vein Disease Anatomic Site

Your general surgeons need to be familiar with many changes to the “Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified” (I80-I89) group of codes. In particular, note additions such as the following that allow you to pinpoint conditions in the peroneal and calf muscle veins:

• I80.24- (Phlebitis and thrombophlebitis of peroneal vein)
• I80.25- (Phlebitis and thrombophlebitis of calf muscular vein)
• I82.45- (Acute embolism and thrombosis of peroneal vein)
• I82.46- (Acute embolism and thrombosis of calf muscular vein)
• I82.55- (Chronic embolism and thrombosis of peroneal vein)
• I82.56- (Chronic embolism and thrombosis of calf muscular vein).

“Until now, coders could only report such conditions with other and unspecified codes,” says Sheri Poe Bernard, CPC, CRC, CDEO, CCS-P, author of the AMA book, Risk Adjustment Documentation and Coding.

As with all the other codes in this section, you will need to add a sixth digit to specify right (1), left (2), bilateral (3), or unspecified (9).

Also in the I80-I89 section, “you should note the changes in the inclusion terms to both the new and existing codes,” Bernard adds. These include adding specific site information, such as anterior or posterior tibial vein, and external or internal iliac vein.

Learn New Pressure Ulcer Detail

Under L89 (Pressure Ulcer), ICD-10-CM 2020 adds 25 new codes to distinguish pressure-induced deep tissue damage of various sites. If your surgeon treats pressure ulcers, you should be familiar with the following new site-specific codes for Pressure-induced deep tissue damage of …:

• L89.0-6 (… elbow)
• L89.1-6 (… back)
• L89.2-6 (… hip)
• L89.3-6 (… buttock)
• L89.46 (… contiguous site of back, buttock, and hip)
• L89.5-6 (… ankle)
• L89.6-6 (… heel)
• L89.816 (… head)
• L89.896 (… other site)
• L89.96 (… unspecified site).

The fifth digit for many of these codes indicates laterality as unspecified (0), right (1), or left (2).

Update Congenital Abnormality Coding

You’ll find a vast number of Chapter 17 (Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)) changes that practices should review, according to Donelle Holle, RN, a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana.

For instance: ICD-10 2020 has pluralized the code for Ehlers-Danlos syndrome, Q79.6- (Ehlers-Danlos syndrome) to reflect variants of this connective-tissue disorder with the following new codes:

• Q79.60 (Ehlers-Danlos syndrome, unspecified)
• Q79.61 (Classical Ehlers-Danlos syndrome)
• Q79.62 (Hypermobile Ehlers-Danlos syndrome)
• Q79.63 (Vascular Ehlers-Danlos syndrome)
• Q79.69 (Other Ehlers-Danlos syndromes).

Patients with this syndrome may require surgery for blood vessels or joints damaged by the condition.

More: “ICD-10 has removed Prader-Willi syndrome from the synonyms for Q87.1 (Congenital malformation syndromes predominantly associated with short stature) and given it its own code, Q87.11, while all other synonyms are now defined as ‘Other’ under Q87.19,” notes Jan Blanchard, CPC, CPMA, consultant at Vermont-based PCC.

ICD-10-CM 2020 also expands Q66.- (Congenital deformities of feet) “for reporting of laterality,” explains Heidi Stout, BA, CPC, COSC, PCS, CCS-P, with Coder on Call, Inc., in Milltown, New Jersey.

Refresh Breast-Lump Coding

When your surgeon excises breast tissue, correct diagnosis coding has demanded specific anatomic-site specificity based on laterality and breast quadrant since ICD-10-CM added N63.- details two years ago.

For 2020, you have the following two, new, specific codes for cases involving a breast lump that doesn’t conform to existing codes because it overlaps quadrants:

• N63.15 (Unspecified lump in the right breast, overlapping quadrants)
• N63.25 (Unspecified lump in the left breast, overlapping quadrants).

Upgrade Personal History Choices

Starting Oct. 1, clinicians have a host of new personal-history codes your surgeon might use when a patient presents with a lesion that requires a procedure such as biopsy. Get familiar with the following new codes:

• Z86.15 (Personal history of latent tuberculosis infection)
• Z11.7 (Encounter for testing for latent tuberculosis infection)
• Z22.7 (Latent tuberculosis)
• Z86.002 (Personal history of in-situ neoplasm of other and unspecified genital organs)
• Z86.003 (… of oral cavity, esophagus and stomach)
• Z86.004 (… of other and unspecified digestive organs)
• Z86.005 (… of middle ear and respiratory system)
• Z86.007 (… of skin)
• Z86.006 (Personal history of melanoma in-situ).

You’ll typically use these codes as secondary diagnoses following either the code for the presenting symptoms or the definitive diagnosis. But if they’re the only codes in the chart, it may be possible to report them as primary codes, depending on your insurer. “Z codes may be used as either a first-listed (principal diagnosis code in the inpatient setting) or secondary code, depending on the circumstances of the encounter,” the ICD-10 manual says.

Get the Last Word

“I encourage coders to get in there and review these changes personally. No one knows your practice like you do, so you should look through the addenda for those special items you alone will notice,” advises Blanchard.

Pro tip: “With … any diagnosis selection, be sure to pay attention to the details,” says Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fl. “When I’m auditing codes, many of the mistakes I see are based on the coder not paying attention to the slight differences between code descriptors.”

To view the entire 2010 ICD-10-CM Addenda, go to www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-CM.html and download the zip file labeled 2020 Addenda.