Radiology Coding Alert

Touch upon an assortment of categories you’re sure to encounter in the radiology specialty.

While procedural coding concepts within radiology may be tougher to grasp, the sheer quantity of ICD-10-CM codes means you should never overlook the influence that the annual changes will have on your day-to-day coding.

You’ve been briefed in two previous segments titled “Get Your First Look at Incoming Changes to ICD-10-CM 2021” and “Gear Up for a Second Round of ICD-10-CM 2021 Changes.” Now it’s time to further expand your knowledge with a third and final installment of ICD-10-CM codes to consider for October 1 and beyond.

Dive in for some crucial insights into new and revised codes and conditions affecting a variety of anatomic sites.

See What’s New With CKD Coding

While some of the most prevalent changes in 2021 come by way of ICD-10-CM code revisions, there are a few key code additions you should take note of. First, chronic kidney disease (CKD) diagnosis coding gets an overhaul with more specificity added for stage 3 CKD patients. Consider the following new codes:

• N18.30 (Chronic kidney disease, stage 3 unspecified)
• N18.31 (Chronic kidney disease, stage 3a)
• N18.32 (Chronic kidney disease, stage 3b)

When CKD is not documented with any further specificity beyond stage 3, you’ll revise your coding from N18.3 to N18.30. Stages 3a and 3b are based on a patient’s estimated glomerular filtration rates (eGFRs):

• 3a — eGFR between 45 and 59 ml/minute
• 3b — eGFR between 30 and 44 ml/minute

Keep in mind that the documentation does not need to identify stage 3a or 3b for you to report N18.31 or N18.32. So long as you have documentation in the patient’s chart of the documented eGFR, you may code to the respective CKD substage.

Check Out Updated Coding for N02-N07, Obstetrical Pelvic Complications

Another important set of new codes to add to your coding arsenal pertains to nephritis diagnoses with C3 glomerulonephritis or C3 glomerulopathy. First, get acquainted with the following new code within the N02 (Recurrent and persistent hematuria) category: N02.A (Recurrent and persistent hematuria with C3 glomerulonephritis).

Consider a few more new sets of codes falling within category code ranges N03-N07:

• N04.A (Nephrotic syndrome with C3 glomerulonephritis)
• N05.A (Unspecified nephritic syndrome with C3 glomerulonephritis)
• N06.A (Isolated proteinuria with C3 glomerulonephritis)
• N07.A (Hereditary nephropathy, not elsewhere classified with C3 glomeru­lonephritis)

“Keep in mind that most of the new and revised ICD-10-CM codes above relate to medical, as opposed to surgical, diseases of the kidney and urinary tract,” explains Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York Stony Brook. “These ICD-10-CM codes will be documented more often by a nephrologist than a radiologist. However, the radiologists should be aware of these diagnoses when they deal with both medical and surgical diseases in the same patient,” Ferragamo advises.

Continue on to round out your knowledge with a set of three new obstetrical complication codes:

• O99.891 (Other specified diseases and conditions complicating pregnancy)
• O99.892 (Other specified diseases and conditions complicating childbirth)
• O99.893 (Other specified diseases and conditions complicating puerperium)

While you may initially consider these codes to be exclusively relevant to the ob-gyn specialty, these codes will be reported for any obstetrical patients treated by a urologist for pelvic complications during or following childbirth. For instance, as of October 1, you’ll report code O99.891 when the urologist treats a patient for pelvic inflammatory disease and peritoneal (pelvic) adhesions during pregnancy.

Note New Mastitis Codes

Next up, you should consider a new set of specified granulomatous mastitis codes for patients receiving mammograms or other forms of imaging/treatment. Previously you’d resort to reporting code N61.0 (Mastitis without abscess) for granulomatous mastitis diagnoses, but that all changed as of October 1.

Background: Granulomatous mastitis is a “rare, chronic, inflammatory condition of the breast,” according to the ICD-10-CM proposal. You may not report this often, but you should know that this condition has a “progressive clinical course with multiple recurrences.” This condition may pose diagnostic and therapeutic challenges for treating providers, which means that the ability to track these cases can help by giving “providers/researchers access to incidence and prevalence data.”

You’ll report this condition with the following codes:

• N61.2 (Granulomatous mastitis)

o N61.20 (Granulomatous mastitis, unspecified breast)

o N61.21 (Granulomatous mastitis, right breast)

o N61.22 (Granulomatous mastitis, left breast)

o N61.23 (Granulomatous mastitis, bilateral breast)

Get More Specific With Q51.2-

For obstetrical imaging encounters, you’ll want tweak how you report the doubling of uterus for applicable clinical scenarios. You won’t change the category code Q51.2- (Other doubling of uterus), but you will delete Q51.20 (Other doubling of uterus, unspecified).

You’ll then revise Q51.21 from (Other complete doubling of uterus) to (Complete doubling of uterus). Notice the deletion of the word “Other” from the code descriptor. You’ll also see a similar revision to Q51.22 (Partial doubling of uterus), deleting the word “Other” from the old descriptor.

The inclusion note under Q51.28 (Other and unspecified doubling of uterus) will be revised from “Septate uterus, other specified” to “Septate uterus NOS.”

Beware These Excludes1 Changes

You’ll see that Chapter 21 (Factors influencing health status and contact with health service) is also not immune to the changes implemented in ICD-10-CM 2021. As of October 1, you’ll delete the Excludes2 note under category Z79 stating “long term (current) use of oral antidiabetic drugs (Z79.84)” and “long term (current) use of oral hypoglycemic drugs (Z79.84)” and move these same notes into an Excludes1 note under Z79.4 (Long term (current) use of insulin). Remember that an Excludes1 note means “NOT CODED HERE,” whereas an Excludes2 note means “Not included here.” A patient may have those two conditions at the same time.

Don’t Forget About a Brand-New Chapter

To conclude your ICD-10-CM coding updates for Oct. 1, 2020, pay close attention to the new codes available for reporting in Chapter 22 (Codes for special purposes), highlighted by code range U00-U85.

“Chapter 22 and its two codes were actually added to ICD-10-CM on an emergency basis on April 1 this year,” Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians, reminds coders. “Oct. 1, 2020, marks the first time they’ll be reflected in the annual update. If coders aren’t already aware of these codes, they should be,” Moore adds.