General Surgery Coding Alert

Start using new codes Oct. 1.

Now’s the time for your general surgery practice to solidify diagnosis coding changes that could impact your bottom line. Starting Oct. 1, you’re facing 490 code additions, 58 deletions, and 47 revisions to the ICD-10-CM code set.

Key: Medicare claims processing, audits, and quality reporting programs rely on proper diagnosis coding to demonstrate medical necessity for procedures your surgeons perform.

“Keeping abreast of [ICD-10-CM] changes can be important to the bottom line, and ensures that the most accurate information is being passed on to decision-makers of all types,” says Melanie Witt, RN, MA, an independent coding consultant from Guadalupita, New Mexico.

Read on for a quick overview of diagnosis code changes that could impact your general surgery practice.

Greet Digestive System Additions

The 2021 code set extends the following codes to a fifth digit to distinguish “with” or “without” bleeding, which you must document when you report these conditions starting Oct. 1:

• K20.80 (Other esophagitis without bleeding)
• K20.81 (… with bleeding)
• K20.90 (Esophagitis, unspecified without bleeding)
• K20.91 (… with bleeding)
• K21.00 (Gastro-esophageal reflux disease with esophagitis, without bleeding)
• K21.01 (… with bleeding)

These changes are the result of stakeholder requests to rectify the problem of ICD-10-CM not including combination codes that reflect bleeding with these conditions. For instance, “in ICD-9-CM, there was a unique code for esophageal hemorrhage,” explained Shannon McConnell-Lamptey, of the ICD-10-CM Coordination and Maintenance Committee (ICMC) during the meeting that considered these changes.

In addition to the bleeding specification codes, general surgeons will also benefit from two new options under K59.8 (Other specified functional intestinal disorders):

• K59.81 (Ogilvie syndrome)
• K59.89 (Other specified functional intestinal disorders)

“Ogilvie syndrome is a rare, acquired disorder characterized by abnormalities affecting the involuntary, rhythmic muscular contractions within the colon,” McConnell-Lamptey said when initially proposing the new codes. Also referred to as “acute colonic pseudo-obstruction,” Ogilvie can mimic the symptoms of mechanical blockage of the colon when no physical obstruction is present.

Finally, the 2021 code set expands K74.0 (Hepatic fibrosis) with the following new codes based on the stage of the condition:

• K74.00 (Hepatic fibrosis, unspecified)
• K74.01 (… early fibrosis)
• K74.02 (… advanced fibrosis)

Expand Laterality Choices

An important change in ICD-10-CM 2021 “involves instances where codes are altered to add a fifth or sixth digit to reflect specific body areas and laterality,” says Barbara Hays, CPC, CPCO, CPMA, CRC, CPC-I, CEMC, CFPC, medical review supervisor, special investigations, at GEHA in Lee’s Summit, Missouri. You should review these changes, “especially if you need to code for anatomical reference,” she says.

For instance: General surgeons who perform procedures such as breast biopsies should be familiar with the new code family N61.2- (Granulomatous mastitis) that requires a fifth character: 0 (unspecified breast), 1 (right breast), 2 (left breast), or 3 (bilateral breast).

Granulomatous mastitis is a “rare, chronic, inflammatory condition of the breast,” according to the ICD-10-CM proposal for these codes. The condition can clinically mimic carcinoma, so surgeons may encounter these codes with various excision procedures.

For surgeons treating thorax injuries, you should be aware of 54 new codes in Chapter 19. The codes add specificity for the anatomic location of superficial thorax injuries for codes in the families S20.2 (Contusion of thorax) and S20.3 (Other and unspecified superficial injuries of front wall of thorax). Existing codes have a sixth digit “1” for right, “2” for left, and “0” for unspecified. The changes add sixth digits: “3” for bilateral and “4” for middle. Each of the codes also reports to a seventh character “A” for initial encounter, “D” for subsequent encounter, and “S” for sequela.

You’ll also find many codes in Chapter 13 for the musculoskeletal system that have expanded codes for site specificity and laterality.

Remember COVID-19

In case you encounter a patient who tests positive for COVID-19, you need to remember to use U07.1 (COVID-19). The code first appears in the 2021 ICD-10-CM code book, although it has been official since April due to the pressing need to monitor the spread of the pandemic.

“The new code, U07.1, was initially assigned by the World Health Organization. Usually it requires at least a one-year process to get a new code adopted, but this went through with exceptional speed,” said Betty Ann Price, BSN, RN, president and founder of Professional Reimbursement and Coding Strategies, and AHIMA-approved ICD-10-CM trainer.

The early adoption of U07.1 was necessary, to “fulfill the imperative need to track the diagnosis of this condition as well as its subsequent treatment,” explains Gregory Przybylski, MD, at New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey.

Resource: To read the entire new ICD-10-CM code set, visit the CMS website at www.cms.gov/medicare/icd-10/2021-icd-10-cm.