ICD 10 Coding Alert

Obstetric surgical wound infection codes receive overhaul, too.

320 additions. 172 revised codes. Three deleted codes. The changes to the 2019 ICD-10 are not as extensive as they have been in previous years, but as always, the revisions will affect all medical specialties, especially ob-gyn.

So here are all the changes that will affect obstetric reporting beginning Oct. 1.

Manage These Multiple Gestation Additions

You’ll have a new series of multiple gestation codes.

Triplet pregnancies that are “trichorionic triamniotic” mean that each fetus has its own placenta and amniotic sac. You’ve got new ICD-10 codes to reflect this, based on trimester. They are:

• O30.131 — Triplet pregnancy, trichorionic/triamniotic, first trimester
• O30.132 — Triplet pregnancy, trichorionic/triamniotic, second trimester
• O30.133 — Triplet pregnancy, trichorionic/triamniotic, third trimester
• O30.139 — Triplet pregnancy, trichorionic/triamniotic, unspecified trimester.

You have similar codes for quadruplet pregnancy:

• O30.231 — Quadruplet pregnancy, quadrachorionic/quadra-amniotic, first trimester
• O30.232 — Quadruplet pregnancy, quadrachorionic/quadra-amniotic, second trimester
• O30.233 — Quadruplet pregnancy, quadrachorionic/quadra-amniotic, third trimester
• O30.239 — Quadruplet pregnancy, quadrachorionic/quadra-amniotic, unspecified trimester.

For other numbers of fetuses (such as quintuplets, sextuplets, or septuplets), check out O30.83- (Other specified multiple gestation, number of chorions and amnions are both equal to the number of fetuses). Underneath this code, you’ll see the following inclusion terms:

• Pentachorionic, penta-amniotic pregnancy (quintuplets)
• Hexachorionic, hexa-amniotic pregnancy (sextuplets)
• Heptachorionic, hepta-amniotic pregnancy (septuplets).

The required sixth character specifies the trimester (1, first trimester; 2, second trimester; 3, third trimester; 9, unspecified trimester). “While this specificity is valuable information for health information/statistics, unfortunately most physician coders do not get this much information when coding for professional services,” says Jan Rasmussen, PCS, CPC, ACS-GI, ACS-OB, owner/consultant of Professional Coding Solutions in Holcombe, Wis.

“In the case of triplets, we more likely will end up coding O30.10- (Triplet pregnancy, unspecified number of placenta and unspecified number of amniotic sacs) due to poor diagnostic information supplied by the physician even in the medical record.”

Succeed in New Surgical Wound Infection Diagnoses

Obstetric patients undergoing cesarean sections or perineal repairs may develop infections at the wound site. You currently have code O86.0 (Infection of obstetric surgical wound), but you will have the addition of an Excludes1 note stating: “complications of procedures, not elsewhere classified (T81.4-), postprocedural fever NOS (R50.82), postprocedural retroperitoneal abscess (K68.11).” Remember, an Excludes1 note means that these two codes can never be coded together, and you should code either one or the other, says Melanie Witt, RN, MA, an independent coding expert based in Guadalupita, New Mexico.

Expanding on O86.0, you will find six new additions, including O86.00 (Infection of obstetric surgical wound, unspecified) and O86.01 (Infection of obstetric surgical wound, superficial incisional site). Under this latter code, you’ll see the inclusion terminology stating, “Subcutaneous abscess following an obstetrical procedure” and “Stitch abscess following an obstetrical procedure.”

Similarly, you’ll find O86.02 (Infection of obstetric surgical wound, deep incisional site) along with the inclusion terminology of “Intramuscular abscess following an obstetrical procedure” and “Sub-fascial abscess following a procedure.”

New code O86.03 (Infection of obstetric surgical wound, organ and space site) features the following inclusion terminology: “Intraabdominal abscess following an obstetrical procedure” and “Subphrenic abscess following an obstetrical procedure.”

Code O86.04 (Sepsis following an obstetrical procedure) directs you to “Use Additional code to identify the sepsis.” “Keep in mind that the additional code they are asking for is the organism causing the sepsis, not puerperal sepsis (O85),” Witt says. “For example, A40.0 (Sepsis due to streptococcus, group A) or A40.1 (Sepsis due to streptococcus, group B).”

Finally, you also need to know O86.09 (Infection of obstetric surgical wound, other surgical site).

“These are great codes to have, as superficial wound infections may not require significant treatment whereas more significant surgical wound infections may allow for additional reimbursement using modifier 24 on an E/M service or an additional paid surgical procedure,” Rasmussen cheers.

Lastly, Check Out New Encounter Code, Plus One Revision

You have one additional new obstetric code, and that’s Z13.32 (Encounter for screening for maternal depression or Encounter for screening for perinatal depression).

You’ve also got one obstetric revision to note. The old description to O00.212 (Left ovarian pregnancy without intrauterine pregnancy) will become (Left ovarian pregnancy with intrauterine pregnancy) (Emphasis added).

To download the complete addenda to the 2019 ICD-10-CM, go to www.cms.gov/Medicare/Coding/ICD10/2019-ICD-10-CM.html