ICD 10 Coding Alert

The 2021 ICD-10-CM updates, which were released recently and go into effect Oct. 1, 2020, may not appear to affect ob-gyn practices as much as other years. But some code updates will bring about useful changes, like helping ob-gyns track data about granulomatous mastitis and defects due to previous cesareans.

“This year seems to bring the fewest changes to codes that might be reported by ob-gyn practices, but like it or not, if you fail to take note of them, it could have an impact on establishing medical necessity for testing or management options,” says Melanie Witt, RN, MA, independent coding consultant from Guadalupita, New Mexico. “Keeping abreast of even minor changes can be important to the bottom line and ensures that the most accurate information is being passed on to decision-makers of all types,” she adds.

One example: You may use code Z33.1 (Pregnant state, incidental) all the time. Now, in the moments when you question whether to use this code for simple “pregnancy,” (as in, when the physician hasn’t otherwise specified other details), ICD-10-CM will now include the inclusion term “Pregnancy NOS.”

Note New Mastitis Codes

If your documentation says the patient has “mastitis,” then you’ll need to query for more information. That’s because mastitis can be granulomatous mastitis, as of Oct. 1.

Background: Granulomatous mastitis is a “rare, chronic, inflammatory condition of the breast,” according to the ICD-10-CM proposal. You may not report this often, but you should know that this condition has a “progressive clinical course with multiple recurrences.” This condition may pose diagnostic and therapeutic challenges for your ob-gyns, which means that the ability to track these cases can help by giving “providers/researchers access to incidence and prevalence data.”

You’ll report this condition with the following codes:

• N61.2 (Granulomatous mastitis)
  • N61.20 (Granulomatous mastitis, unspecified breast)
  • N61.21 (Granulomatous mastitis, right breast)
  • N61.22 (Granulomatous mastitis, left breast)
  • N61.23 (Granulomatous mastitis, bilateral breast)

Example: If your ob-gyn treats a patient with granulomatous mastitis of the left breast, you’d report N61.22.

Check Out New Codes for Previous Caesarean Defects

First of all, if your ob-gyn encounters a patient who had a previous cesarean section and has a mid-transverse T incision, you may have wondered how to report this. Previous code O34.21 (Maternal care for scar from previous cesarean delivery) remains the same, but you’ll shift to new code O34.218 (Maternal care for other type scar from previous cesarean delivery) for this type of incision.

Additionally, your ob-gyn may encounter an isthmocele which is “the result of incomplete healing of the isthmic myometrium after a low transverse uterine incision performed for cesarean section,” according to the ICD-10-CM proposal. This can cause a litany of conditions, such a menstrual abnormalities like postmenstrual spotting, chronic pelvic pain, or secondary infertility. Obstetric complications can include scar tissue dehiscence, scar pregnancy, and abnormally adherent placenta, the ICD-10-CM proposal goes on. Ob-gyns will typically perform repairs using hysteroscopy and laparoscopy. Therefore, you’ll see an expansion to O34.2- (Maternal care due to uterine scar from previous surgery). The new code will be O34.22 (Maternal care for cesarean scar defect (isthmocele)).

Report Postpartum Depression Like This

You know you should report O99.34 (Other mental disorders complicating pregnancy, childbirth, and the puerperium) for postpartum depression. However, as of Oct. 1, you will no longer see the reference to code F53.

This fits with the advice from the AHA Coding Clinic, which states you should report a F53 code with O99.345 (because this is the code for a mental disorder in the puerperium). The range F01-F09, F20-F52, and F54-F99 would inclusive to conditions specifically pertaining to the O99.34 category but would not need to be reported in addition, unless desired, Witt says.

You’ll see the revision, stating from “Conditions in F01-F09, F20-F99 and F54-F99” to “F01-F09, F20-F52 and F54-F99.”

Expand Use of O99.89 Beginning Oct. 1

The American Congress of Obstetricians and Gynecologists (ACOG) requested the expansion of O99.89 (Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium) to allow ob-gyns and coders to “quickly identify the obstetric-related stage of the patient, e.g. pregnancy, childbirth, puerperium.”

Therefore, you’ll see no change to possible inclusive conditions reported with O99.89 (Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium), but you will see an expansion of this code to include:

• O99.891 (Other specified diseases and conditions complicating pregnancy)
• O99.892 (Other specified diseases and conditions complicating childbirth)
• O99.893 (Other specified diseases and conditions complicating puerperium).

Get More Specific With Q51.2-

You’ll tweak how you report the doubling of uterus as of Oct. 1. You won’t change the category code Q51.2- (Other doubling of uterus), but you will delete Q51.20 (Other doubling of uterus, unspecified).

You’ll then revise Q51.21 from (Other complete doubling of uterus) to (Complete doubling of uterus). Notice the deletion of the word “Other” from the code descriptor. You’ll also see a similar revision to Q51.22 (Partial doubling of uterus), deleting the word “Other” from the old descriptor.

The inclusion note under Q51.28 (Other and unspecified doubling of uterus) will be revised from “Septate uterus, other specified” to “Septate uterus NOS.”

Beware These Excludes1 Changes

As of Oct. 1, you’ll delete the Excludes2 note under category Z79 stating “long term (current) use of oral antidiabetic drugs (Z79.84)” and “long term (current) use of oral hypoglycemic drugs (Z79.84)” and move these same notes into an Excludes1 note under Z79.4 (Long term (current) use of insulin).

Remember: An Excludes1 note means “NOT CODED HERE,” whereas an Excludes2 note means “Not included here.” A patient may have those two conditions at the same time.