Otolaryngology Coding Alert

Begin preparations now to hit the ground running on Oct. 1.

Oct., 2017 will bring about another set of new and revised code changes to the CMS 2018 ICD-10-CM.

Specifically, you will be required to incorporate 363 new codes, 142 deletions, and more than 250 revised codes into your coding repertoire. While this year offers substantially fewer new diagnosis codes than last year, there’s enough otolaryngology-relevant material that you should consider beginning your 2018 ICD-10 preparations sooner, rather than later.

Read on for the most pertinent, specialty-specific changes to the ICD-10-CM.

Know these New and Revised Codes

You will find some codes to be entirely new additions to the ICD-10-CM, but keep an eye out for other codes that have only changed the descriptor, not the actual code itself. Consider this list of new and revised ICD-10-CM codes:

ICD-10 Features 2 New Forms of Apnea

You will want to take note of two specific changes when coding apnea of any specified nature. Primary central sleep apnea now comes with an idiopathic label, when documented, along with the addition of an entirely new diagnosis code for hypopnea. With the addition of code G47.31 (Idiopathic central [primary] sleep apnea), you will want to make sure you are fluent with the rules on when and when not to code a disease as idiopathic.

“Only when the physician includes the term ‘idiopathic’ in their diagnosis should you apply code G47.31,” states Lindsay Della Vella, COC, medical coding auditor at Precision Healthcare Management in Media, Pennsylvania. “When there is no documentation of ‘idiopathic’ primary sleep apnea, you will want to default to the unspecified code, G47.30 (Sleep apnea, unspecified). Do not make the false assumption that a lack of documented etiology implies that the disease is of an idiopathic origin,” Della Vella instructs. You will find these two new codes under “Apnea, apneic (of) (spells)” in the ICD-10 index.

Apnea, apneic (of) (spells)

Sleep ⇒ central (primary) ⇒

• G47.31 (Idiopathic central [primary] sleep apnea)

Sleep ⇒ obstructive (adult) (pediatric) ⇒

• G47.33 (Hypopnea)

Note Altered Surgical Complications and Infections Code

Despite their lack of frequency, you’ll want to be aware of these changes in coding various complications following a surgical procedure. If a patient experiences an infection or stitch abscess of a wound closure in the postoperative period, you will now remove the fifth character from code T81.40, using code T81.4XX- instead. The same code applies for all postoperative infections. You will apply code T81.4XX- in any situation where a patient presents with an infection of a surgical site. T81.4XX- can be found under the terms “Complication(s) (from) (of)” and “Infection, infected, infective (opportunistic)” in the ICD-10 index.

Complication(s) (from) (of)

Procedure ⇒ Surgical procedure ⇒

• T81.4XX- (Wound infection)
• T81.4XX- (Stitch abscess)

Infection, infected, infective (opportunistic)

Due to or resulting from ⇒ surgery, operation wound, postoperative wound, postprocedural ⇒

• T81.4XX-

Imperfect Branchial Cleft Closures Gain Specificity

Finally, you should take note of a new change in codes for congenital malformations of branchial cleft closures. ICD-10 will designate a code for imperfect closure of branchial cleft cysts, fistulas, and/or sinuses. You will want to use code Q18.0 if a branchial cleft cyst, fistula, and/or sinus is identified. Use code Q18.2 with no further specificity beyond branchial cleft. You will find these revised codes under the term “Imperfect” in the ICD-10 index.

Imperfect

Closure (congenital) ⇒

• Q18.2 (Branchial cleft NOS)

Closure (congenital) ⇒ branchial cleft NOS ⇒

• Q18.0 (Cyst, fistula, and/or sinus)