Medicare Compliance & Reimbursement

More than 300 additions are on the 2019 diagnosis code slate.

With 320 new diagnosis codes ready for release this fall— in addition to 172 code revisions — Medicare providers will have quite a few options in 2019. CMS published the full listing of new, deleted, and revised codes in mid-June.

“As in years past, 2019 will see a significant number of ICD-10 code changes,” says Amanda Corney, MBA, medical billing operations manager for Medical Resources Management in Rochester, New York. “On October 1st, 2018 coders need to be ready to incorporate both new and revised codes — as well as suspend the use of the deleted codes,” Corney relays.

Check out Post-Procedural Infection Codes

Effective Oct. 1, you’ll find coding updates that allow additional specificity in post-procedural infection coding. Three codes are scheduled for deletion in this category: T81.4XXA (Infection following a procedure, initial encounter), T81.4XXD (Infection following a procedure, subsequent encounter), and T81.4XXS (Infection following a procedure, sequela).

To replace these deleted codes, ICD-10 is going infinitely more granular. You’ll find more than 20 new codes that describe more specifics of the post-procedural infection or other condition, all of which fall under the following parent codes:

• T81.40 -- Infection following a procedure, unspecified
• T81.41 -- … superficial incisional surgical site
• T81.42 -- … deep incisional surgical site
• T81.43 -- … organ and space surgical site
• T81.44 -- Sepsis following a procedure 
• T81.49 -- Infection following a procedure, other surgical site

The above codes represent the primary new codes, each of which will expand out to additional characters to describe whether the encounter was initial, subsequent, or for sequela. An example from the T81.40 section follows:

• T81.40XA -- Infection following a procedure, unspecified, initial encounter
• T81.40XD -- Infection following a procedure, unspecified, subsequent encounter
• T81.40XS -- Infection following a procedure, unspecified, sequela

The additional codes in the series follow this lead, with the “A,” “D,” and “S” seventh character designations.

Check Out These Examples

Consider the following scenarios to see how you may encounter post-surgical infection billing:

Example 1: A patient was hospitalized for a pulmonary embolism, and a surgeon removed the clot and inserted a filter to prevent any future issues. The patient presents to your practice several weeks after the procedure for a planned transfer of care from the surgeon. The pulmonologist notices that the patient has swelling, pus, and inflammation at the surgical site. She asks the patient if he has shown the surgeon the issue and the patient says he cancelled his follow-up with the surgeon due to scheduling issues and planned to only continue follow-up with the pulmonologist.

Answer: A pulmonologist prescribes an antibiotic and contacts the surgeon’s office to arrange for a complete post-surgical follow-up later that day. The physician will link the visit to T81.41XA (Infection following a procedure, superficial incisional surgical site, initial encounter).

Example 2: The surgeon performs a partial colectomy with closure of the distal segment. Several days later, the patient presents to your practice and the surgical site shows swelling, pus, and inflammation. The physician incises the surgical wound and drains fluid from it and prescribes antibiotics.

Answer: For this situation, you will link the I&D code to T81.41XA (Infection following a procedure, superficial incisional surgical site, initial encounter).

Resource: To access the entire list of new, revised, and deleted ICD-10 codes, visit www.cms.gov/Medicare/Coding/ICD10/2019-ICD-10-CM.html.