Ob-Gyn Coding Alert

PMDD Tops List of Ob-Gyn ICD-9 Changes for Fall

With four significant changes and dozens of minor alterations, the new ICD-9 codes, effective Oct. 1, will affect reporting for peripartum cardiomyopathy, pelvic adhesions and contraception, among others.

When looking strictly at the Genitourinary System and Pregnancy, Childbirth, and Puerperium ICD-9 code revisions and additions, there are exactly four. The new ICD-9 will include the term "premenstrual dysphoric disorder (PMDD)" in 625.4 (Premenstrual tension syndromes), and PMDD will be directly referenced in the alphabetic index. This clearly indicates that PMS and PMDD are related conditions and would be coded the same.

For obstetric changes beginning Oct. 1, ICD-9 adds a new code for peripartum cardiomyopathy, 674.5x. This condition refers to cardiac failure caused by heart muscle disease in the period before, during or after delivery. As with all obstetric chapter codes, this one will require a fifth digit of 0 (unspecified as to episode of care or not applicable), 1 (delivered, with or without mention of antepartum condition), 2 (delivered, with mention of postpartum complication), 3 (antepartum condition or complication), or 4 (postpartum condition or complication). The inclusion term listed with the code refers to postpartum cardiomyopathy, but you may use this code when the patient has this condition during the antepartum period as well. Note that you formerly would reference postpartum cardiomyopathy with 674.8x. So you may have to revise practice encounter forms to capture the new diagnosis.

And for those coders who were wondering which ICD-9 code to assign to a pregnant patient with pelvic peritoneal adhesions, the alphabetic index will specifically reference 648.9x (Other current conditions in the mother classifiable elsewhere, but complicating pregnancy, childbirth, or the puerperium).

Finally, ICD-9 adds two codes that will alleviate several coding headaches. The first new code removes decreased libido from the mental-health chapter. You will be able to assign 799.81 for visits associated with complaints of decreased libido or sexual desire. The second new code, V25.03, is for encounters for emergency or postcoital contraception or counseling. "The V25.03 code has been long awaited and will be perfect for those 'morning after' pill situations," says Jaime Darling, CPC, a certified coder with Graybill Medical Group in Southern California.

Other miscellaneous code additions and revisions that may interest ob-gyn practices include:

Severe acute respiratory syndrome (SARS) reporting. Beginning in October,
you should report 079.82 for SARS-associated coronavirus, use 480.3 for pneumonia due to SARS-associated coronavirus, and submit V01.82 if the patient is exposed to SARS-associated coronavirus. If a pregnant patient is exposed to SARS and is being monitored for the condition, the codes would be V22.2 (Pregnant state, incidental), plus V01.82. If the physician tests the patient for the SARS virus, you would code V73.89 (Special screening examination for other specified viral diseases). You would not report an ob chapter ICD-9 code unless the patient developed SARS or SARS-like symptoms.

Obesity. The new ICD-9 adds the inclusion term "severe obesity" to the existing code 278.01 (Morbid obesity).

Factor V Leiden mutation. As of Oct. 1, you can report this condition using the new code 289.81 (Primary hypercoagulable state).

Urgency of urination. This symptom is common, but not the same thing as urge incontinence. To report urgency of urination, the patient must have only an intense feeling of having to urinate. Urge incontinence, on the other hand, is the intense feeling of having to urinate but not being able to make it to the bathroom. Because of this difference, the American Urological Association requested and was granted the new code 788.63 (Urgency of urination). "This code will be especially useful in ob-gyn offices for those patients who are experiencing urgency but have not yet had a definitive diagnosis for the condition, such as a urinary tract infection or incontinence," Darling says.

Abnormal glucose. In 1997, the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus released new recommendations that included a new stage of impaired glucose condition called impaired fasting glucose (IFG). Therefore, the group requested a new code to help identify these patients. The old code 790.2 has been expanded to three codes: 790.21 (Impaired fasting glucose), 790.22 (Impaired glucose tolerance test) and 790.29 (Other abnormal glucose). This last code will include an abnormal nonfasting glucose result. Because the old code is frequently found on practice encounter forms, coding and billing staff should make special note of this change because the four-digit code will become invalid after Oct. 1.

Injury. ICD-9 increases the old code category 959.1 to several fifth-digit codes to capture specific sites of injury to the trunk. You will report 959.11 for injuries to the breast, 959.12 for injuries to the abdomen, 959.14 for injuries to the external genitalia (also referred to as the vulva, which includes the mons pubis, the labia majora and minora, the clitoris, the vestibule of the vagina and its glands, and the opening of the urethra and of the vagina), and 959.19 (Other injury of other site of trunk NOS) for injuries to the groin, buttock or perineum.

Need for prophylactic vaccination. The new ICD-9 expands V04.8 to three new codes, and you will report one of those codes, V04.81, for patients who receive the influenza vaccine.

Long-term current drug use. As of October, ICD-9 adds several new codes to the V58.6 code category. You will assign V58.63 for use of antiplatelets or antithrombotics, V58.64 covers the use of nonsteroidal anti-inflammatories (NSAIDs), and V58.65 is for long-term steroid use.

Converted procedures. ICD-9 expands the old code V64.4 (Laparoscopic surgical procedure converted to open procedure) to include other closed surgical procedures converted to open procedures. Consequently, to report the converted laparoscopy, you will need to report V64.41.

Other persons seeking consultation. ICD-9 expands V65.1 (Person consulting on behalf of another person) to two codes. You will use V65.11 to denote a visit to the pediatrician by the pregnant mother and V65.19 for all other situations when the person consulting with the physician is not the patient and the patient is not present. "One situation when V65.19 may come in handy could be if the father has some concerns and speaks with the ob-gyn when the patient is not actually present for the visit," Darling says.

What You Can Do Now

Although the new ICD-9 codes don't take effect until Oct. 1, start updating your encounter forms to make sure you capture the proper diagnoses as soon as possible.

"Also check your updates to your electronic coding systems to be sure they will include these codes in the update," Darling says. Have a meeting with your physicians to review the new codes, she suggests. "That way, everyone is on the same page."

In addition, you should contact carriers and update them on the new codes, says Brenda Rush, CPC, associate consultant at RSM McGladrey Inc. in Kansas City, Mo. "In my experience, most insurance companies are unaware of the new code changes, and the end result is a delay in the claim."

Some payers may take as long as six months or longer to implement new diagnostic codes. So check with your payers to find out when they plan to implement the new and revised codes to avoid those "invalid diagnosis" explanation of benefits messages and denials.