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 using this code has been revised. "Conditions classifiable to 614-615" has been more clearly spelled out as including only 614.0-614.5, 614.7-614.9 and 615. "Code 614.6, pelvic peritoneal adhesions, is no longer referenced under this pregnancy code because adhesions are not considered to be an infection, but rather the late result of one," Witt says.
674.1x An "excludes" note has been added for this code, disruption of cesarean wound. "Do not report this code if the patient has uterine rupture before the onset of labor (665.0x) or uterine rupture during labor (665.1x)," Witt cautions.
V49.81 The descriptor was revised to include the
term "asymptomatic" postmenopausal status as a counterpart to the changes to 627.2 and 627.4 discussed above.
V58.83 A new note has been added for encounters for therapeutic drug monitoring that instructs coders also to report a second code to indicate any associated long-term, current drug use (V58.61-V58.69).
New Codes
The revisions add 31 new codes that will assist ob/gyns who struggle with medical justification for care, tests and procedures. "The new codes," Witt says, "provide sharper diagnostic tools. They pinpoint specific disorders and will help to prove medical necessity to skeptical carriers."
040.82 Toxic shock syndrome: A new code was added in recognition of toxic shock syndrome's symptoms, which are often severe. Previously, toxic shock had been assigned as an inclusion term to 040.89 (Other specified bacterial diseases). "When assigning this code, use an additional code to identify the organism involved," Witt says.
454.8 Varicose veins of the lower extremities, with other complications: This new code fills the gap between varicose veins with ulcer or inflammation and asymptomatic varicose veins. "Report this code if there is a finding of edema, swelling or pain with the varicose veins," Witt says.
633 Ectopic pregnancy: The codes in this category have been expanded to a fifth digit to describe an ectopic pregnancy by site with or without the presence of an intrauterine pregnancy. The new codes are:
633.00 Abdominal pregnancy without intrauterine pregnancy
633.01 with intrauterine pregnancy
633.10 Tubal pregnancy without intrauterine pregnancy
633.11 with intrauterine pregnancy
633.20 Ovarian pregnancy without intrauterine pregnancy
633.21 with intrauterine pregnancy
633.80 Other ectopic pregnancy without intrauterine pregnancy
633.81 with intrauterine pregnancy
633.90 Unspecified ectopic pregnancy without intrauterine pregnancy
633.91 with intrauterine pregnancy.
795.0 Nonspecific abnormal Papanicolaou smear of cervix: This code has been expanded to four codes with the addition of a fifth digit. The changes were made to more closely match current Bethesda Pap interpretation language.
Note: In the definitions below, the bolded italics include the primary definition.
The new codes are:
795.00 Nonspecific abnormal Papanicolaou smear of cervix, unspecified
795.01 Atypical squamous cell changes of undetermined significance favor benign (ASCUS favor benign)
Atypical glandular cell changes of undetermined significance favor benign (AGCUS favor benign)
795.02 Atypical squamous cell changes of undetermined significance favor dysplasia (ASCUS favor dysplasia)
Atypical glandular cell changes of undetermined significance favor dysplasia (AGCUS favor dysplasia)
795.09 Other nonspecific abnormal Papanicolaou smear of cervix
Benign cellular changes
Unsatisfactory smear
795.3 Nonspecific positive culture findings: This code has been expanded to two codes with the addition of a fifth digit. The first new code was needed because of recent anthrax cases and the possibility of future outbreaks. The second code is used for positive culture samples taken from the nose, throat, a wound or sputum.
795.31 Nonspecific positive findings for anthrax
Positive findings by nasal swab
795.39 Other nonspecific positive culture findings
998.3 Disruption of operation wound: This code has been expanded to two codes with the addition of a fifth digit. "The new codes allow you to differentiate between an external or internal wound dehiscence. An example of an external wound would be one from abdominal surgery; an example of an internal wound might be vaginal cuff sutures. If the surgeon does not specify which, default to the external wound code," Witt says.
998.31 Disruption of internal operation wound
998.32 Disruption of external operation wound
Disruption of operation wound NOS
V01.8 Contact with or exposure to communicable diseases: This code has been expanded to two new codes, once again because of current events. These codes are:
V01.81 Anthrax
V01.89 Other communicable diseases
V13.2 Other genital system and obstetric disorders: This code has been expanded to two codes with the addition of a fifth digit. ACOG presented this proposal with the one below to capture information about women with preterm labor histories that predispose them to complications of future pregnancies. Note that V13.21 is used to indicate a patient who is not currently pregnant. Code V13.29 is now used to indicate a past personal history of, for example, dysplasia when the current or last few Paps were normal.
V13.21 Personal history of pre-term labor
V13.29 Personal history of other genital system and obstetric disorders
V23.4 Pregnancy with other poor obstetric history: As with V13.2, this code has been expanded to two codes. They are used with a current pregnancy only. The new code, V23.49, is for a history of conditions classifiable to 630-643 and 645-676.
V23.41 Pregnancy with history of pre-term labor
V23.49 Pregnancy with other poor obstetric history
V58.42 Aftercare following surgery for neoplasm: This code is used when the surgery involves neoplasms classifiable to diagnostic codes 140-239. "When reporting it, you will need to use another aftercare code to fully identify the reason for the aftercare encounter. For instance, was the purpose of the visit chemotherapy after surgery (V58.1), or was it planned for attention to surgical dressings (V58.3)?" Witt says.
V58.7 Aftercare following surgery to specified body systems, not elsewhere classified: This new subcategory was added along with eight fifth-digit codes. As with the aftercare code for neoplasm surgery, these new codes also require the use of a more specific aftercare code to identify the reason for the encounter. Of these eight new codes, the following may be useful to ob/gyns. Note that V58.76 excludes aftercare following sterilization reversal (V26.22).
V58.76 Aftercare following surgery of the genitourinary system, NEC
Conditions classifiable to 520-579
V58.77 Aftercare following surgery of the skin and subcutaneous tissue, NEC
Conditions classifiable to 680-709
V83.8 Other genetic carrier status: This new subcategory was added with two new fifth-digit codes. This code category can only be used when the patient can pass the disease on genetically. They are not intended for patients who might develop the disease.
V83.81 Cystic fibrosis gene carrier
V83.89 Other genetic carrier status
Note: A complete listing of the code changes is in the May 9, 2002, Federal Register (Vol. 67, No. 90, pp. 31627-31631). To download a copy go to http://www.access. gpo.gov/su_docs/fedreg/a020509c.html and scroll down until you come to the pages cited above. The file is available in text and PDF formats (Adobe 5.0).
