Radiology Coding Alert
Prep for More New and Revised ICD-10 Codes
Specificity is a theme, especially in coding breast lumps and pulmonary hypertension. As you are now aware, ICD-10 will implement the new coding changes beginning in October. It's important that you look over the complete set of changes, as radiology is one of the only coding specialties to cover such a broad range of diagnoses. In addition to last month's new and revised codes, consider the following ICD-10-CM changes. I.D. Breast Lumps, Masses, or Nodules Using These Codes One of the most pertinent ICD-10-CM changes to the field of radiology involves newly assigned codes for any unspecified lump, mass, or nodule of the breast. As of October 1, you will report any lump, mass, or nodule of the breast by laterality and quadrant, when specified. You will also have the option to incorporate codes for lump, mass, or nodule diagnoses pertaining to the axillary tail and subareolar areas of the breast. Know Your Anatomy An ability to distinguish each anatomical area of the breast and its surrounding parts is crucial in determining the most accurate diagnosis code. "As far as the axillary tail is concerned, this may be an area of confusion for some coders," relays Kimberly Berry, CPC, RCC, coding specialist at Trust HCS Healthcare Consulting Services in Springfield, Missouri. "You'll want to remember that the axillary tail, also known as the Tail of Spence, is a component of the breast tissue that extends into the axillary region," describes Berry. Codes: ICD-10 2018 lists these codes for lump, mass, nodule(s), nodular, swelling (of): Pulmonary Hypertension Gets More Specific Previously, pulmonary hypertension was divided between five codes, including primary versus secondary pulmonary hypertension. With the new ICD-10 changes, you will immediately opt for groups 1-5 of pulmonary hypertension when specified by the physician. If the grouping is not specified, do not code according to group, even if the diagnosis fits the criteria for a particular grouping. You also want to be careful discerning between pulmonary hypertension "with" and "due to." "The physician must make clear that the pulmonary hypertension is a symptom of a particular disease or disorder in order to code as 'due to,'" says Barry Rosenberg, MD, chief of radiology at United Memorial Medical Center in Batavia, New York. You may code using the term "with" when there are symptoms that are occurring alongside the pulmonary hypertension, but the causation between one versus the other is not definitive. Finally, there will now be a separate set of codes for secondary pulmonary hypertension. Instead of acting as the default pulmonary hypertension code, you will now find the sub-term "secondary" and choose between secondary arterial pulmonary hypertension or secondary specified NEC pulmonary hypertension. Here's how ICD-10 will group the following pulmonary hypertension codes beginning in October. Hypertension, hypertensive (accelerated) (benign) (essential) (idiopathic) (malignant) (systemic) Pulmonary ⇒ Pulmonary ⇒ with Pulmonary ⇒ due to Pulmonary ⇒ secondary Code by Degree of Intestinal Obstruction Another revision to the ICD-10 index will change the way coders report intestinal obstruction. Previously, intestinal obstruction was not specified by degree of obstruction, but rather the etiology of the obstruction. Now, both factors will need to be taken into consideration when coding intestinal obstruction charts. Specifically, you will opt for partial, complete, or incomplete obstruction codes when specified by the provider. These changes also extend to the postoperative and specified NEC intestinal obstruction codes. Take a look at how ICD-10 will present intestinal obstruction in the index beginning in October. Obstruction, obstructed, obstructive ⇒ Intestine ⇒ Postoperative ⇒ Specified NEC ⇒ Remember New Antenatal Screening, Ulnar Fracture, and Spinal Stenosis Codes Additionally, you will find numerous Z36.- (Encounter for antenatal screening of mother) codes, including Z36.86 (Encounter for antenatal screening of cervical length) and Z36.4 (Large for fetal growth retardation). Gaining a foundational understanding of each of these new "encounter" codes will be pivotal in correctly coding obstetrical imaging going forward. Finally, you'll want to be aware of a subtle change when coding ulnar fractures and spinal stenosis. For a fracture of the ulnar head, you will want to begin using code S52.60- (Fracture of ulnar head...). Spinal stenosis of the lumbar region changes from M48.06 to M48.061 (... lumbar region [NOS] [without neurogenic claudication]). For diagnoses of lumbar spinal stenosis with neurogenic claudication, you will want to apply the newly assigned code M48.062 (... with neurogenic claudication). Visit the following CMS link to brief yourself on all the 2018 ICD-10 codes, most of which pertain to radiology in one form or another: https://www.cms.gov/Medicare/Coding/ICD10/2018-ICD-10-CM-and-GEMs.html.
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