Ob-Gyn Coding Alert

If you-re only looking at what codes are new, you-re missing vital information

Ob-gyn coders, prepare yourselves. You-ve got tons of new ob-gyn-related codes and revisions to learn for 2008. Prepare for the mental shift on Oct. 1 by pouring over these updates, and you-ll be ahead of the game.

Look at it this way: -Although most people think that with new codes comes new headaches, I feel that the more specific the codes are the easier it is in the long run,- says Kimberly Horn, CPC, BSHA, owner/operator of Village Coding in Village, Okla. -Hopefully, they will reduce the requests from insurance companies looking for medical records because they will have more specific information -- and that means sped-up payments for physicians.-

1. Get Specific With Carcinoma Diagnoses

When you look for a carcinoma -in situ- of a female genital organ, you will find more options to choose from, thanks to ICD-9 2008. Remember, in situ describes malignancies confined to the origin site without invasion of neighboring tissues, although they can grow large enough to cause major problems.

New codes that indicate carcinomas in situ include:

• 233.30 (Carcinoma in situ of breast and genitourinary system; unspecified female genital organ)
• 233.31 (- vagina), including severe dysplasia of vagina and vaginal intraepithelial neoplasia III (VAIN III)
• 233.32 (- vulva), including severe dysplasia of vulva and vulva intraepithelial neoplasia III (VIN III)
• 233.39 (- other female genital organ).

Did you know? If the pathology report returns with indications of dysplasia, the neoplasm is in transition from being benign to becoming malignant. If the process continues and the mass is left untreated, the neoplasm could eventually become malignant.

Bright side: -These new carcinoma codes will of course help us code to the highest specificity,- says Gloria Kirkham, CPC, OGS, coding specialist at Womens Health Partnership PC in Carmel, Ind.

If you find yourself confused, ICD-9 2008 revises the notes under 184 (Malignant neoplasm of other and unspecified female genital organs), 622.1 (Noninflammatory disorders of cervix; dysplasia of cervix [uteri]), 623.0 (Noninflammatory disorders of vagina; dysplasia of vagina), and 624.0 (Noninflammatory disorders of vulva and perineum; dystrophy of vulva) to exclude one or all of these new codes.

Bonus: Also, the notes under existing code 233.1 (.. cervix uteri) specify -adenocarcinoma in situ of cervix.- This means a malignant neoplasm of epithelial cells in glandular or glandlike patterns.

Example: To determine whether the patient has carcinoma in situ, the ob-gyn must perform a biopsy. Typically, if the physician notes suspicious lesions during a pelvic examination, the physician would then perform vaginal or vulvar colposcopy. But even if the physician suspects this pre-malignant condition, you have to wait for the pathology report before assigning one of the new codes.

2. Kraurosis and Leukoplakia Shift to 5-Digit Codes

Prior to Oct. 1, when you look for a code to reflect kraurosis or leukoplakia of the vulva, you-ll use 624.0 (... dystrophy of vulva). But ICD-9 2008 changes that. Instead, you-ll use the five-digit code 624.09 (- other dystrophy of vulva), which specifically includes a notation underneath for kraurosis and leukoplakia.

There's more: Code 624.09 is part of three new codes dealing with vulvar and perineal noninflammatory disorders. The others are 624.01 (Vulvar intraepithelial neoplasia I [VIN I]), which includes mild vulvar dysplasia, and 624.02 (Vulvar intraepithelial neoplasia II [VIN II]), which also represents moderate vulvar dysplasia.

Important: Most pathology reports will differentiate between mild and moderate dysplasia, but if they do not or the pathology report is not clear, you should seek your physician's guidance before assigning a code.

3. Move Malignant Ascites Search to Back of Book

The ICD-9 2008 list adds two codes for ascites in Chapter 16 (Symptoms, Signs, and Ill-Defined Conditions):

• 789.51 -- Malignant ascites
• 789.59 -- Other ascites.

What this is: Malignant ascites is excess fluid, containing cancer cells, in the space between the tissues lining the abdomen and abdominal organs (the peritoneal cavity). The new malignant ascites code is an improvement because ICD-9 2007 indexes malignant ascites under 197.6 (Secondary malignant neoplasm of respiratory and digestive systems; retroperitoneum and peritoneum), but the 197.6 entry doesn't reference ascites, says South Carolina reimbursement and coding professional Erin Goodwin, CPC, CMC. Snag: Code 789.51 is in the ICD-9 manual's signs and symptoms chapter rather than being listed in a malignant code category.

4. Uncomplicate New Pregnancy Complication Codes

ICD-9 fleshes out the notes underneath several pregnancy complication codes and adds a new one to your cache of possible diagnoses.

The revisions and new code -will certainly aid our ob-gyn's documentation, especially when you are trying to prove a high level of difficulty,- Kirkham say.

New exclusions: For instance, 646.3 (Other complications of pregnancy, not elsewhere classified; habitual aborter) includes the notation -Excludes: without current pregnancy (629.81).- Similarly, 654 (Abnormality of organs and soft tissues of pelvis) excludes -trauma to perineum and vulva complicating current delivery (664.0-644.9).-

Also, 664.2 (Trauma to perineum and vulva during delivery; third-degree perineal laceration) excludes -anal sphincter tear during delivery not associated with third-degree perineal laceration (664.6).- Exclusions like these will help you avoid making coding mistakes.

New details: When you saw -atony of uterus- but with no mention of hemorrhage in your ob-gyn's delivery notes, you might have looked at the ICD-9 manual with dread. But as of Oct. 1, you-ll know that you should use 661.2 (Abnormality of forces of labor; other and unspecified uterine inertia). A similar notation under 661.2 excludes -atony of uterus with hemorrhage (666.1)- and -postpartum atony of uterus without hemorrhage (669.8).-

Code 666.1 (Postpartum hemorrhage; other immediate postpartum hemorrhage) describes postpartum atony of uterus with hemorrhage but excludes atony of uterus without hemorrhage (661.2) and postpartum atony of uterus without hemorrhage (669.8).

If your ob-gyn documents an anal sphincter tear the patient had prior to delivery that then complicated the delivery, you might have found yourself wondering what code to use. Thanks to ICD-9 2008, you-ll have a specific detail underneath 654.8 (Congenital or acquired abnormality of vulva) that tells you to use this code. Also, you-ll see an exclusion note for -anal sphincter tear (healed) (old) not associated with delivery (569.43).-

You-ve got a new code to learn as well: 664.6 (Anal sphincter tear complicating delivery, not associated with third-degree perineal laceration [0, 1, 4]). And it excludes third-degree perineal laceration code 664.2.

5. Learn These New Infection Codes

If your ob-gyn sees a patient for an infection due to a central venous catheter or due to an infusion, you-ve got two new codes at your disposal: 999.31 (Infection due to central venous catheter) and 999.39 (Infection following other infusion, injection, transfusion, or vaccination).

Good news: -I-m glad to see codes like these coming out,- Horn says. -It's so much easier in that you won't use the NEC (not elsewhere classified) or NOS (not otherwise specified) codes as often anymore.-

Bonus: Finally, you-ve got a new code for human parvovirus: 079.83 (Parvovirus B19). The notations include the terminology of -Parvovirus NOS- and excludes erythema infectiosum (fifth disease), which is code 057.0.