ICD 10 Coding Alert

Cardiovascular system changes and more will impact your practice.

After a five-year code freeze to ease transitioning to ICD-10 CM, you can expect to see the first set of annual updates this Oct. 1. The Centers for Disease Control and Prevention (CDC) has posted a preliminary list of ICD-10-CM changes for what will become ICD-10-CM 2017.

With the release of 1,943 new codes, “Change seems to be the name of the game,” says Duane C. Abbey, PhD, president of Abbey and Abbey Consultants Inc., in Ames, IA. Read on to see which changes you can expect to impact your general surgery practice.

Be warned: The list is not yet final. The CDC will post the final addendum in June.

Look for Vascular System Changes

ICD-10-CM will likely offer a couple of new options that will allow you to be more specific in your artery aneurysm coding:

• I72.5 — Aneurysm of other precerebral arteries
• I72.6 — Aneurysm of vertebral artery.

Artery dissection will probably see more specific options in October, as well, with the following additions to I77.7- (Other arterial dissection):

• I77.70 — Dissection of unspecified artery
• I77.75 — Dissection of other precerebral arteries
• I77.76 — Dissection of artery of upper extremity
• I77.77 — Dissection of artery of lower extremity.

You also can expect a revision to “other” code I77.79:

• 2016: I77.79 — Dissection of other artery
• 2017: I77.79 — Dissection of other specified artery.

You can also anticipate new options to report vascular stent stenosis for non-coronary vessels with the new codes listed below. “This should be a useful addition,” says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department.

• T82.856A — Stenosis of peripheral vascular stent, initial encounter
• T82.856D — Stenosis of peripheral vascular stent, subsequent encounter
• T82.856S — Stenosis of peripheral vascular stent, sequela.

To make way for these additions, the existing stenosis codes will add the term “other.”

• 2016: T82.858- — Stenosis of vascular prosthetic devices, implants and grafts …
• 2017: T82.858- — Stenosis of other vascular prosthetic…

Pick Up on Subtle Postprocedural Updates

You can expect to see patterns in the revisions to postprocedural complication codes.

First, watch for changes to postprocedural hemorrhage and hematoma codes, with ICD-10-CM 2017 providing distinct options for each condition within each organ system.

For example, note the changes to these digestive system procedure codes:

• 2016: K91.840 — Postprocedural hemorrhage and hematoma of a digestive system organ or structure following a digestive system procedure
• 2017: K91.840 — Postprocedural hemorrhage of a digestive system organ or structure following a digestive system procedure
• 2017: new code K91.870 — Postprocedural hematoma of a digestive system organ or structure following a digestive system procedure.

You’ll find similar changes to provide separate codes for postprocedural hemorrhage or hematoma in the circulatory system, endocrine system, and skin and subcutaneous tissue chapters, to name a few that may impact general surgery.

Brace for Digestive System Changes

When your surgeons treat patients with intestinal inflammation, you can expect a big change in how you code in 2017, such as the following changes:

• Delete K522 — Allergic and dietetic gastroenteritis and colitis

Add the following new codes:

• K52.21 — Food protein-induced enterocolitis syndrome
• K52.22 — Food protein-induced enteropathy
• K52.29 — Other allergic and dietetic gastroenteritis and colitis
• K52.831 — Collagenous colitis
• K52.832 — Lymphocytic colitis
• K52.838 — Other microscopic colitis
• K52.839 — Microscopic colitis, unspecified
• K55.30 — Necrotizing enterocolitis, unspecified
• K55.31 — Stage 1 necrotizing enterocolitis
• K55.32 — Stage 2 necrotizing enterocolitis
• K55.33 — Stage 3 necrotizing enterocolitis
• K58.1 — Irritable bowel syndrome with constipation
• K58.2 — Mixed irritable bowel syndrome
• K58.8 — Other irritable bowel syndrome.

You’ll also change how you report intestinal vascular disorders, as follows:

• Delete K55.0 — Acute vascular disorders of intestine

Add these more-specific codes:

• K55.011 — Focal (segmental) acute (reversible) ischemia of small intestine
• K55.012 — Diffuse acute (reversible) ischemia of small intestine
• K55.019 — Acute (reversible) ischemia of small intestine, extent unspecified
• K55.021 — Focal (segmental) acute infarction of small intestine
• K55.022 — Diffuse acute infarction of small intestine
• K55.029 — Acute infarction of small intestine, extent unspecified
• K55.031-K55.049 repeats the same series as K55.011-K55.029, except for large intestine
• K55.051-K55.069 repeats the same series as K55.011-K55.029, except for intestine, part unspecified.

Your surgeons will also have a new group of codes to report gastrointestinal stromal tumor by site — C49.A0- C49.A9 for unspecified site, esophagus, stomach, small intestine, large intestine, rectum, or other sites.

Check Out Other Relevant Changes

ICD-10 2017 deletes the following pancreatitis codes:

• K85.0 — Idiopathic acute pancreatitis
• K85.1 — Biliary acute pancreatitis
• K85.2 — Alcohol induced acute pancreatitis
• K85.3 — Drug induced acute pancreatitis
• K85.8 — Other acute pancreatitis
• K85.9 — Acute pancreatitis, unspecified

Instead, ICD-10 2017 replaces the codes with more specific codes requiring a fifth character to distinguish infection and necrosis, such as:

• K85.00 — … without necrosis or infection
• K85.01 — … with uninfected necrosis
• K85.02 — … with infected necrosis

You’ll also find changes for reporting enlarged prostate that makes ICD-10 similar to how you reported the condition under ICD-9. For instance, N400 and N4001 change from “enlarged prostate” to “benign prostatic hyperplasia” with or without Lower Urinary Tract Symptoms (LUTS).

ICD-10 2017 also adds specificity for prostate dysplasia by deleting N42.3 (Dysplasia of prostate) and replacing it with these more specific codes:

• N42.30 — Unspecified dysplasia of prostate
• N42.31 — Prostatic intraepithelial neoplasia
• N42.32 — Atypical small acinar proliferation of prostate
• N42.39 — Other dysplasia of prostate.

Resource: To review the complete list, head to ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2017/NewICD10CMCodes_FY2017.txt.