General Surgery Coding Alert

Don’t forget ‘X’ place holder.

With 320 new and 170 revised diagnosis codes in ICD-10-CM 2019, you have a lot to learn.

“On October 1st, 2018 coders need to be ready to incorporate both new and revised codes — as well as suspend the use of the deleted codes,” says Amanda Corney, MBA, medical billing operations manager for Medical Resources Management in Rochester, New York.

Help is here: We’ve reviewed the full list to identify changes most relevant to your general surgery practice. Read on for a brief introduction to how you’ll report certain conditions beginning this fall.

Zero-In on These Eyelid Neoplasm Changes

You’ll face nearly 50 code changes related to eyelid neoplasms. But before you worry too much, you should notice a pattern — that many new codes have “the addition of seventh character extensions,” says Angie Paine, COC, CPC, CPCO, CPB, CPMA, CPPM, CRC, CPC-I, CEMC, CRHC, consultant for Pinnacle Enterprise Risk Consulting Services located in Centennial, Colorado.

For starters, the code set includes a new code family to describe sebaceous carcinoma of the eyelid: C44.13 (Sebaceous cell carcinoma of skin of eyelid, including canthus). The new family includes the following codes:

• C44.131 (Sebaceous cell carcinoma of skin of unspecified eyelid, including canthus)
• C44.132- (… right eyelid, including canthus)
• C44.1321 (… right upper eyelid, including canthus)
• C44.1322 (… right lower eyelid, including canthus)
• C44.139- (… left eyelid, including canthus)
• C44.1391 (… left upper eyelid, including canthus)
• C44.1392 (… left lower eyelid, including canthus)

Similar: You’ll notice that the new code family follows the pattern of the existing codes for eyelid tumors, starting with unspecified eyelid (C44.131), then right eyelid (C44.132-), then left eyelid (C44.139-).

Different: You’ll also notice that the new code family includes an extra, final character for right and left eyes — “1” for upper eyelid, and “2” for lower eyelid. The Oct. 1 ICD-10-CM update also makes this change for all other eyelid neoplasm codes, adding 38 new codes with a “1” or “2” as the final character to indicate upper or lower eyelid.

For example: ICD-10-CM adds two codes under C43.11-

• C43.111 (Malignant melanoma of right upper eyelid, including canthus)
• C43.112 (… right lower eyelid, including canthus)

and two codes under C43.12-:

• C43.121 (Malignant melanoma of left upper eyelid, including canthus)
• C43.122 (… left lower eyelid, including canthus)

The other codes with a final character “1” or “2” to indicate upper or lower lid of the right and left eyes include the following:

• C4A.11- and C4A.12- for Merkel cell carcinoma
• C44.102- and C44.109- for unspecified malignant neoplasm
• C44.112- and C44.119- for basal cell carcinoma
• C44.122- and C44.129- for squamous cell carcinoma
• C44.192- and C44.199- for other specified malignant neoplasm
• D03.11- and D03.12- for melanoma in situ
• D04.11- and D04.12- for carcinoma in situ
• D22.11- and D22.12- for melanocytic nevi
• D23.11- and D23.12- for other benign neoplasm

Heads up: With the addition of the new codes and final character extensions, many existing codes will be invalid as “truncated” codes. For instance, you can no longer report C43.11 beginning Oct. 1, because you must report either C43.111 or C43.112.

Remember: As a surgery coder, you should wait for the pathology report, if possible, so that you can assign the most specific code. You should look up the histologic term for the neoplasm, such as “sebaceous carcinoma,” in the Alphabetic Index and note the code and any other instructions. Then when you check the Neoplasm Table, you’ll know which column is appropriate for the patient’s diagnosis. That’s why you should always check the Alphabetical Index first, according to Lisa Selman-Holman, JD, BSN, RN, COS-C, HCS-D, HCS-O, with Selman-Holman & Associates, LLC, and CoDR in Denton, Texas.

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: T81.4XXA (Infection following a procedure, initial encounter), T81.4XXD (… subsequent encounter), and T81.4XXS (… 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- (… superficial incisional surgical site)
• T81.42- (… deep incisional surgical site)
• T81.43- (… 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 (… subsequent encounter)
• T81.40XS (… sequela).

“These additions offer further specificity regarding the location of the infection, as well as provide information related to the stage of treatment (initial, subsequent or sequela),” says Leah Fuller, CPC, associate consultant, Pinnacle Enterprise Risk Consulting Services, LLC, in Colorado.

Coder tip: Remember to add a placeholder of “X” before you add the A,” “D,” and “S” seventh character designations.

Example: 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).

Don’t Miss New Appendicitis Codes

Changes to appendicitis coding in ICD-10-CM 2019 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 (… 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, 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.

Resources: This space couldn’t hold all the changes to ICD-10-CM that will impact surgery coders. Stay tuned to future issues of General Surgery Coding Alert for more news on 2019 diagnosis coding changes you’ll need to know. Also, to access the entire list of new, revised, and deleted ICD-10-CM codes, visit the CMS website at www.cms.gov/Medicare/Coding/ICD10/2019- ICD-10-CM.html.