General Surgery Coding Alert

COVID-19 and GI changes top the list.

Don’t miss out on diagnosis coding updates — your successful claims payment could depend on accurately documenting medical necessity using new codes.

With nearly 160 ICD-10-CM 2022 code changes, let our experts help you zero in on the revisions that could affect your general surgery practice. There’s no time to waste because the changes are effective Oct. 1.

Dial In Coding for COVID-19 Symptoms and Sequalae

To acknowledge the many “long hauler” COVID-19 cases, ICD-10-CM provides new code U09.9 (Post COVID-19 condition, unspecified) in Chapter 22, Codes for Special Purposes. The instructions clarify that reporting U09.9 allows clinicians to establish a link to COVID-19, but that you should code first the related condition (symptom), if known, using one of the following codes:

• J96.1- (Chronic respiratory failure)
• R43.0 (Anosmia)
• R43.8 (Other disturbances of smell and taste)
• M35.81 (Multisystem inflammatory syndrome)
• I26.- (Pulmonary embolism)
• J84.10 (Pulmonary fibrosis, unspecified)

Key: Don’t report U09.9 for active COVID-19 cases unless it is a re-infection case that occurs with a condition related to prior COVID-19 infection. In that case, correct coding includes U07.1 (COVID-19), the symptom code, and U09.9.

Get specific with coughs: Often a symptom of COVID-19 and many other conditions, reporting a cough with a simple R05 (Cough) is out the window on Oct. 1. In fact, R05 is one of several 2022 ICD-10-CM codes that have been “converted to parents to help increase specificity,” says Kristen Taylor, CPC, CHC, CHIAP, Associate Partner at Pinnacle Enterprise Risk Consulting Services in Columbia, South Carolina. That means R05 now requires you to report a fourth character for one of the following expanded codes:

• R05.1 (Acute cough)
• R05.2 (Subacute cough)
• R05.3 (Chronic cough)
• R05.4 (Cough syncope)
• R05.8 (Other specified cough)
• R05.9 (Cough, unspecified)

The codes now give you three levels of severity, from acute through subacute to chronic, the last of which also has three synonyms: persistent cough, refractory cough, and unexplained cough. For instance, you might see R05.4 to document cough syncope, a condition where a patient loses consciousness after a coughing bout.

Tip: You should avoid the unspecified code, R05.8 whenever possible “in favor of a code with greater specificity,” says Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement.

Exclusion Notes: The new R05 codes come with instructions that smoker’s cough (J41.0) and paroxysmal cough due to Bordetella pertussis (A37.0-) are Excludes1 codes. However, R04.2 (Cough with hemorrhage) is now an Excludes2 code.

Seize Specific System Codes for General Surgery

Surgeons need to know new codes across multiple ICD-10-CM chapters that will require more specific reporting of certain conditions such as some gastrointestinal, skin, and musculoskeletal disorders.

Chapter 11: Diseases of the Digestive System offer up these new codes you should know for esophageal conditions:

• K22.1 (Esophageal polyp)
• K22.82 (Esophagogastric junction polyp)
• K22.89 (Other specified disease of esophagus (hemorrhage of the esophagus NOS))

You’ll also find new subcategory K31.A- (Gastric intestinal metaplasia) with the following 10 specific codes that will require documentation of the anatomic site and presence of dysplasia:

• K31.A0 (… unspecified)
• K31.A11 (… without dysplasia, involving the antrum)
• K31.A12 (… without dysplasia, involving the body (corpus))
• K31.A13 (… without dysplasia, involving the fundus)
• K31.A14 (… without dysplasia, involving the cardia)
• K31.A15 (… without dysplasia, involving multiple sites)
• K31.A19 (… without dysplasia, unspecified site)
• K31.A21 (… with low grade dysplasia)
• K31.A22 (… with high grade dysplasia)
• K31.A29 (… with dysplasia, unspecified)

Chapter 12: Diseases of the Skin and Subcutaneous Tissue brings eight new codes under two new subcategories for irritant contact dermatitis:

• Under L24.A- (Irritant contact dermatitis due to friction or contact with body fluids), the 2022 code set adds four new codes to identify the type of fluid.
• Under L24.B- (Irritant contact dermatitis related to stoma or fistula), you’ll find four new codes that specify the type of stoma or fistula, such as digestive, respiratory, fecal/urinary.

Chapter 13: ICD-10-CM adds numerous codes to category M45.- (Ankylosing spondylitis) to describe inflammatory spinal arthritis that isn’t visible on x-ray. Existing fourth characters 0-9 specify the involved site, so the following new codes are under new subcategory M45.A- (Non-radiographic axial spondyloarthritis):

• M45.A0 (… of unspecified sites in spine)
• M45.A1 (… of occipito-atlanto-axial region)
• M45.A2 (… of cervical region)
• M45.A3 (… of cervicothoracic region)
• M45.A4 (… of thoracic region)
• M45.A5 (… of thoracolumbar region)
• M45.A6 (… of lumbar region)
• M45.A7 (… of lumbosacral region)
• M45.A8 (… of sacral and sacrococcygeal region)
• M45.AB (… of multiple sites in spine)

Detail Other Factors Influencing Health

You’ll have a host of new “Z” codes in the Chapter 21 update to describe “Factors Influencing Health Status and Contact With Health Services.”

To document immunization safety counseling or vaccine product safety counseling, you can report Z71.85 (Encounter for immunization safety counseling) beginning Oct. 1. If an immunization occurs, you should also report Z23 (Encounter for immunization), but if it does not occur, you should note Z28.- (Immunization not carried out and underimmunization status).

Several Z-code updates relate to social determinants of health, such as the following:

• Add Z55.5 (Less than High School Diploma)
• Add Z58.6 (Inadequate drinking-water supply)

Expand: Z59.0- (Homelessness) to allow specification of sheltered or unsheltered

Expand Z59.4 (Lack of food) to account for food insecurity and other situations

Expand Z59.8- (Other Problems Related to Housing and Economic Circumstances) to document details of housing instability

Resource: Find the full list of added, revised, and deleted 2022 ICD-10-CM codes at www.cdc.gov/nchs/icd/icd10cm.htm. Click on the ICD-10-CM FY 2022 Addenda PDF 2022 link to download the Table and Index zip files.