Radiology Coding Alert

You will check complete vs. partial for placenta previa and intrauterine pregnancy with ectopic pregnancy.

With the ICD-10 update fast approaching next month, now is time for you to learn the changes that can impact your radiology diagnosis coding. Here are some key codes for conditions of the placenta and pancreas and ectopic pregnancy.

Watch out: Also, you should know what an “x” means, when present, in the ICD-10 codes.

Distinguish Complete vs. Partial for Placenta Previa

ICD-10 will become specific for complete and partial placenta previa. When looking for a diagnosis code for placenta previa, you should focus on three key terms which imply the position of the placenta.

What is placenta previa? Placenta previa implies that the placenta is lying unusually low in the uterus.

Complete vs. partial: Placenta previa is said to be complete when the placenta covers the whole of internal os of the cervix and partial when it covers part of the internal os. When the placenta lies low in the uterus but does not cover or encroach upon the internal os, your physician will document a low lying placenta.

Here are two revisions that you will get to see for placenta previa with and without hemorrhage:

• O44.0- (Placenta previa specified as without hemorrhage, …) will become (Complete placenta previa NOS or without hemorrhage …)
• O44.1- (Placenta previa with hemorrhage, …) will become (Complete placenta previa with hemorrhage, …).

Make note of the following new codes that will be added to the ICD-10 list:

• O44.2- (Partial placenta previa NOS or without hemorrhage, …)
• O44.3- (Partial placenta previa with hemorrhage, …)
• O44.4- (Low lying placenta NOS or without hemorrhage, …)
• O44.5- (Low lying placenta with hemorrhage, …)

Note: The fifth digit represents trimester in these codes for placenta previa.

Confirm Intrauterine Pregnancy before Submitting a Diagnosis of Ectopic Pregnancy

For the abdominal pregnancy codes, check for a concomitant uterine pregnancy.

The approaching changes in ICD-10 will include deletions of existing codes for abdominal, tubal, ovarian, and other ectopic pregnancy. You will have new codes, two for each of these ectopic pregnancies, to specify of the ectopic pregnancy had a concomitantly occurring intrauterine pregnancy. These anticipated changes are listed in Table 1.

Note: You will have similar changes to report an unspecified ectopic pregnancy.

Infections and Necrosis will Guide Your Pancreatitis Reporting

The codes for pancreatitis will introduce granularity. Table 2 lists the codes for acute pancreatitis that will be deleted and the new ones that will take their place. Now, you will have codes for acute pancreatitis with and without infection or necrosis, and with necrosis only.

Also: You will find some more changes in the GI system codes. These include changes in the codes for ‘other specified diseases of pancreas’ and an unclassified malabsorption due to intolerance.

The ICD-10 revisions will make way for specific code for exocrine pancreatic insufficiency. You will delete code K86.8 (Other specified diseases of pancreas) and add codes K86.81 (Exocrine pancreatic insufficiency) and K86.89 (Other specified diseases of pancreas).

You will also have a specific choice for gluten sensitivity, which is not due to celiac disease. The code K90.4 (Malabsorption due to intolerance, not elsewhere classified) will be deleted and the following two new codes will be added:

• K90.41, Non-celiac gluten sensitivity
• K90.49, Malabsorption due to intolerance, not elsewhere classified.

Equate the ‘x’ in ICD-10 Codes With a Placeholder

If you see an ‘x’ in an ICD-10 code, it means that the diagnosis code requires a seventh character — but the ICD-10 code is not six digits in length already. In these cases, ignoring the ‘x’ will only lead your claim being rejected.

For example, consider these ICD-10 codes containing X:

• M80.08xD (Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with routine healing)
• S33.6xxA, (Sprain of sacroiliac joint, initial encounter)
• W14.xxxS, (Fall from tree, sequela.)

Example: An established patient reports to the practice for treatment of a pathological vertebra fracture with age-related osteoporosis. The patient has received care for the injury already, and is reporting for routine follow-up care. Notes indicate a level-two E/M service. For this diagnosis, you will submit code M80.08xD.