General Surgery Coding Alert

Up your documentation ante to support new ‘fifth digits.’

You should be nearly three months into the brave new world of diagnosis coding using ICD-10-CM 2017, so now’s a good time to check in to ensure that you’ve tackled the changes you need to know for you general surgery practice.

We prepped you for the changes with an overview in “Get Ready for Dx Updates This October” (General Surgery Coding Alert Vol. 18 No.5). But now we have an in-depth analysis of some of the most complex and comprehensive changes you’ll need to use in your practice.

Focus on Intestinal Vascular Disorders

Your surgeons may perform procedures such as 44202 (Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosis) or 44204 (… colectomy, partial, with anastomosis) to treat intestinal infarcts or ischemia. That means you’ll need to embrace the explosion of codes to describe those conditions in the ICD-10 update.

Rationale for change: Previously, you had one solitary code — K55.0 (Acute vascular disorders of intestine) to report almost any type of fulminant ischemic colitis, intestinal infarction, ischemia, necrosis, or even mesenteric embolism. Not anymore.

In the 2017 diagnosis code update, you should “look for greater specificity on these types of conditions,” says Lisa Center, CPC, Physician Practice Manager, Via Christi Hospital Pittsburg, Inc. Pittsburg, Kan.

Now you have code subcategory K55.0-, (Acute vascular disorders of intestine…) with four new options that cater to the diagnosis of acute ischemia or infarction of small or the large intestines.

Coder tip: Ischemia describes a restriction of blood supply to tissues, while an infarction is the death of tissue due to complete loss of blood supply.

Here are the four new codes:

• K55.01- (Acute [reversible] ischemia of small intestine)
• K55.02- (Acute infarction of small intestine), which also describes gangrene or necrosis of the small intestine
• K55.03- (Acute [reversible] ischemia of large intestine) which includes acute fulminant ischemic colitis and subacute ischemic colitis
• K55.04- (Acute infarction of large intestine), which covers gangrene and necrosis of the large intestine, too.

Plus, each one of these five-digit codes comes with three new sixth character options:

• 1 (Focal segmental)
• 2 (Diffuse)
• 9 (Acute)

The result: One code becomes twelve, more-detailed codes in ICD-10 2017.

Example: To code for acute intestinal infarction of the large intestine, diffuse in nature, prior to October 2017, you would simply choose K55.0 (Acute vascular disorders of intestine). Now that the ICD-2017 update has taken effect, you have a very precise code for this condition — K55.042 (Diffuse acute infarction of large intestine).

Overhaul Pancreatitis Coding

When your surgeons perform pancreas procedures from drainage to pancreatectomy, such as 48000 (Placement of drains, peripancreatic, for acute pancreatitis) or 48155 (Pancreatectomy, total), you’ll need to accurately report the patient’s condition to indicate medical necessity for the procedure. That job just got easier, because ICD-10 2017 greatly enhances specificity for reporting pancreatitis (K85.--, Acute pancreatitis …).

The following codes were complete, four-digit codes prior to the 2017 update, but now you have a fifth digit to provide more specific diagnoses for these conditions:

• K85.0-, (Idiopathic acute pancreatitis…)
• K85.2-, (Alcohol induced acute pancreatitis…)
• K85.3-, (Drug induced acute pancreatitis…)
• K85.8-, (Other acute pancreatitis…)
• K85.9-, (Acute pancreatitis, unspecified…)

The fifth digit adds specificity to each of the above codes:

• 0 (… without necrosis or infection)
• 1 (…with uninfected necrosis)
• 2 (…with infected necrosis)

Note change: By bringing that specificity down to the individual code level, ICD-10 2017 removes the following conditions from the “includes” note following category K85:

• abscess of pancreas
• acute necrosis of pancreas
• gangrene of (gangrenous) pancreas
• hemorrhagic pancreatitis
• infective necrosis of pancreas
• suppurative pancreatitis

The “includes” note for category K85 still states “acute (recurrent) pancreatitis” and “subacute pancreatitis.”

By creating specific codes to report the pancreatic absence or presence of infected or uninfected necrosis, the revised code set gives you the freedom and precision of choosing from 15 new codes, for better accuracy.

With such a proliferation of codes, providers will need to be more vigilant in documenting details, to enable coders to reach a precise code for the diagnosis. We need to “focus the education on the physicians and the method of reporting these diagnoses,” says Michael Weinstein, MD, former representative of the AMA’s CPT® Advisory Panel. More detailed documentation will help you choose the exact code from the many options available.