Ob-Gyn Coding Alert

It's time to revise your patient encounter forms to reflect the upcoming ICD-9 changes, many of which will affect ob/gyn practices. Revisions and additions to the manual take effect Oct. 1, 2002, and last through Sept. 30, 2003. However, because many payers will wait until Jan. 1, 2003, before processing claims with the new codes, be sure to ask your payers when they will begin accepting them.

"The changes," says Melanie Witt, RN, CPC, MA, an independent coding consultant and educator based in Fredericksburg, Va., "clarify language, which in some cases was cloudy. The new codes also bring more definitive diagnosis options to the physician." For instance, ICD-9-CM has added the terms HGSIL and LGSIL to the code for cervical dysplasia to match more closely what coders see on the path report using the Bethesda system. In addition, there are new codes to report abnormal Pap results based on the Bethesda system, which will allow the physician to be more specific about results than ever before. ICD-9 Adds New Sequencing Instruction Ob/gyn practices need to look out for these three instructional changes: 1. "Code, if applicable, any causal condition first." You may use any code with this new note as a principal diagnosis if no causal condition is applicable or known. "For instance, because this new note appears after code category 788.3x (Incontinence of urine), you would first report the cause of the incontinence," Witt says. If the patient's genital prolapse is causing the incontinence, one of the genital prolapse codes (618.0-618.9) would appear first on the claim. If the cause is not known, 788.3 is sufficient. 2. The condition artificial menopause (627.4) has been deleted from the "excludes" note that accompanies 256.2 (Postablative ovarian failure). "If the patient complains of symptoms related to artificial menopause, then report 627.4 with the code for postab-lative ovarian failure," Witt advises. 3. Instructions following 256.3x (Other ovarian failure) that direct using an additional code associated with artificial menopause have been changed to read, "associated with natural menopause (627.2)." Code Revisions Below are explanations of the code revisions: 454.9 The descriptor has been changed from "varicose veins of lower extremities, without mention of ulcer of inflammation" to "asymptomatic varicose veins." 622.1 This change adds some terms to the inclusion list that follows the code number. Reference is now made to cervical intraepithelial neoplasia I and II, high-grade squamous intraepithelial dysplasia (HGSIL) and low-grade squamous intraepithelial dysplasia (LGSIL) as qualifying for 622.1. 627.2 and 627.4 These codes describe menopausal states natural or artificial. ICD-9 has added the term "symptomatic" to differentiate them from asympt-omatic menopause. 646.6x The note following this code for infections of the genitourinary tract in pregnancy that specifies the conditions that qualify for [...]