General Surgery Coding Alert

Apply these ICD-10-CM coding changes beginning October 1

With nearly 250 new ICD-10-CM codes and many deletions and revisions going into effect on Oct. 1, 2024, you need to get ready for the changes that will impact your general surgery practice. Understanding these changes is essential for maintaining compliance, ensuring accurate reimbursement, and providing a clear and concise picture of a patient’s medical condition and the care they have received.

We’re here to assist you by providing the essential information you need for submitting error-free surgical claims using the most up-to-date and precise diagnosis codes.

Remember: Medicare quality reporting initiatives also depend on correct diagnosis coding to assess suitable procedures. Any oversight now could potentially affect your payouts in the future.

Changes to Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E00-E89)

You will see some big changes when it comes to diabetic status coding. When a patient with diabetes comes in for an office visit, the coding process can be influenced in a variety of ways. The ICD-10-CM codes for diabetes, E11 for Type 2 and E10 for Type 1, are typically used alongside the code for the office visit, providing a comprehensive view of the patient’s health status. Prior to operating, it’s important for any surgeon to know a patient’s diabetic status. Look at a few of those codes that you’ll see updated:

• Z79.85- (Use Additional injectable non-insulin antidiabetic drugs)
• E16.A- (Use Additional code for hypoglycemia level, if applicable)
• E10.A- (Type 1 diabetes mellitus, presymptomatic)
• E10.A0- (Type 1 diabetes mellitus, presymptomatic, unspecified)
• E10.A1- (Type 1 diabetes mellitus, presymptomatic, Stage 1)
• E10.A2- (Type 1 diabetes mellitus, presymptomatic, Stage 2)

According to Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, product manager, MRO, in Philadelphia, “Proper diabetes coding is one of those code sets where good surgeon documentation in the assessment portion of the notes is so essential. Adding this new level of specificity, ‘pre-symptomatic’, better describes the condition of the patient.”

A big change is also coming for body mass/weight from how it was previously handled

• Revise from code to identify body mass index (BMI), if known (Z68.-)
• Revise to code to identify body mass index (BMI), if known, for adults (Z68.1- Z68.45) or pediatrics(Z68.5-)

New codes have been created which refer to “obesity class.” These new codes allow for greater specificity in coding for obesity and obesity-related conditions. The classes are organized using the following BMI parameters:

• E66.81- (Obesity class)
• E66.811- (Obesity, class 1) now used for patients with a BMI 30.0 to 34.9
• E66.812- (Obesity, class 2) now used for patients with a BMI 35.0 to 39.9
• E66.813- (Obesity, class 3) now used for patients with a BMI 40.0 and above
• E66.89- (Other obesity not elsewhere classified)

Updates to Chapter 11, Diseases of the Digestive System (K00-K95)

General surgeons play a crucial role in the treatment of conditions related to anal fissures. In some instances, they may need to perform extensive procedures such as the excision of an anal fistula. These fistulae, or abnormal passageways, often form when a perirectal abscess, caused by an infected crypt or blind pit, drains into the skin. In these cases, the surgeon may carry out a fistulectomy, a procedure that involves removing the roof of the fistula along with the patient’s internal and/or external hemorrhoids. If an anal fissure is present, this would also be addressed at the time of surgery. This comprehensive approach ensures that all related conditions are treated simultaneously, providing the patient with thorough care and potentially reducing the need for additional surgeries.

Beginning October 1, you’ll have new, more specific codes for reporting digestive system diagnosis coding. The updates to Chapter 11 are extensive, but here is an abbreviated list:

• K60.31- (Anal fistula, simple)
• K60.311- (Anal fistula, simple, initial)
• K60.312- (Anal fistula, simple, persistent)
• K60.313- (Anal fistula, simple, recurrent)
• K60.319- (Anal fistula, simple, unspecified)
• K60.32- (Anal fistula, complex)
• K60.321- (Anal fistula, complex, initial)
• K60.322- (Anal fistula, complex, persistent)
• K60.323- (Anal fistula, complex, recurrent)
• K60.329- (Anal fistula, complex, unspecified)

Changes to Chapter 19, Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88)

Keeping abreast of new injury codes is also crucial in the field of general surgery. Here is a list of new injury codes to choose from beginning October 1:

• T81.320- (Disruption or dehiscence of gastrointestinal tract anastomosis, repair, or closure)
• T81.321- (Disruption or dehiscence of closure of internal operation (surgical) wound of abdominal wall muscle or fascia)
• T81.328- (Disruption or dehiscence of closure of other specified internal operation(surgical) wound)
  o Disruption or dehiscence of closure of muscle or muscle flap (other than abdominal wall muscle)
  o Disruption or dehiscence of closure of ribs or rib cage
  o Disruption or dehiscence of closure of skull or craniotomy
  o Disruption or dehiscence of closure of sternum or sternotomy
  o Disruption or dehiscence of closure of tendon or ligament
  o Disruption or dehiscence of closure of superficial or muscular fascia (other than abdominal wall fascia)
• T81.329- (Deep disruption or dehiscence of operation wound, unspecified)

“Often in general surgery coding and documentation, we’re focused more on the surgical diagnosis and less so on underlying or related conditions,” says Joy. “As we continue to refine ICD-10-CM coding to tell the patient’s story, it’s important to keep up education and communication about these supporting conditions,” she says.

For more information on ICD-10-CM coding updates and 2025 changes, check out the full list.