ICD-9-CM changes: what they mean for the Ob/Gyn

V58.7, aftercare following surgery to specified body systems, not elsewhere classified. This new subcategory was added, along with 8 new fifth-digit codes. As with the aftercare code for neoplasm surgery, these require a more specific code to identify the reason for the encounter. Of these 8 codes, the following are the most likely to be of use to Ob/Gyns (note that code V58.76 excludes aftercare following sterilization reversal [V26.22]):

• V58.76 Aftercare following surgery of the genitourinary system, not elsewhere classified; aftercare following surgery for conditions classifiable to 520–579
  
• V58.77 Aftercare following surgery of the skin and subcutaneous tissue, not elsewhere classified; aftercare following surgery for conditions classifiable to 680–709
  

Code revisions for obstetrics

646.6X, infections of genitourinary tract in pregnancy. The note that specifies which conditions qualify for this code has been revised. “Conditions classifiable to 614–615” has been more clearly spelled out as including only 614.0–614.5 and 614.7–615.0. The code 614.6 is excluded because pelvic peritoneal adhesions do not represent an infection. If pelvic adhesions were complicating the pregnancy, the code 648.9X (other current conditions classifiable elsewhere), would be more appropriate.

674.1X, disruption of cesarean wound. An "excludes" note has been added. This code would not be reported if the patient had uterine rupture before the onset of labor (665.0X) or uterine rupture during labor (665.1X).

New codes for obstetrics

633, ectopic pregnancy. The codes in this category have been expanded to a fifth digit to describe an ectopic pregnancy by site, with or without an intrauterine pregnancy:

• 633.00 Abdominal pregnancy without intrauterine pregnancy
  
• 633.01 Abdominal pregnancy with intrauterine pregnancy
  
• 633.10 Tubal pregnancy without intrauterine pregnancy
  
• 633.11 Tubal pregnancy with intrauterine pregnancy
  
• 633.20 Ovarian pregnancy without intrauterine pregnancy
  
• 633.21 Ovarian pregnancy with intrauterine pregnancy
  
• 633.80 Other ectopic pregnancy without intrauterine pregnancy
  
• 633.81 Other ectopic pregnancy with intrauterine pregnancy
  
• 633.90 Unspecified ectopic pregnancy without intrauterine pregnancy
  
• 633.91 Unspecified ectopic pregnancy with intrauterine pregnancy
  

• V23.41 Pregnancy with history of preterm labor
  
• V23.49 Pregnancy with other poor obstetric history (used for a history of conditions classifiable to 630–643 and 645–676)
  

• V83.81 Cystic fibrosis gene carrier
  
• V83.89 Other genetic carrier status
  

Miscellaneous code revisions

New instructions. A new sequencing instruction has been added to the ICD-9. It reads, “Code, if applicable, any causal condition first.” Any code with this note may be used as a principal diagnosis if no causal condition is applicable or known. For instance, since this note appears after code category 788.3 (incontinence of urine), the coder would first code the cause of the patient’s incontinence. If it was due to genital prolapse (618.0–618.9), one of these codes would appear first on the claim. If the cause is not known, however, 788.3 is sufficient.

454.9, asymptomatic varicose veins. The descriptor for this code previously read “varicose veins of lower extremities, without mention of ulcer or inflammation.”

Miscellaneous code additions

040.82, toxic shock syndrome. A new code for this condition was added in recognition of its often-severe symptoms. This syndrome had previously been assigned as an inclusion term to the code 040.89 (other specified bacterial diseases). When assigning this, an additional code should be used to identify the organism involved.

454.8, varicose veins of the lower extremities, with other complications. This was added to fill the gap between varicose veins with ulcer and/or inflammation (454.0–454.2) and asymptomatic varicose veins (454.9). Use this code for findings of edema, swelling, or pain in conjunction with varicose veins.

795.3, nonspecific positive culture findings. This code has been expanded to 2 new codes with the addition of a fifth digit. The first of these is a reaction to the events of the past year:

• 795.31 Nonspecific positive findings for anthrax; positive findings by nasal swab
  
• 795.39 Other nonspecific positive culture findings (used for positive culture samples taken from the nose, throat, a wound or sputum)
  

• V01.81 Anthrax
  
• V01.89 Other communicable diseases
  

For more information

Coders can obtain the most current edition of ICD-9-CM from several sources: ACOG, the American Medical Association, Ingenix, Practice Management Information Corporation, and Channel Publishing, to name a few. You also can directly download a copy of the October 1, 2002 editions of ICD-9-CM Volume 1 (alphabetic index) and Volume 2 (tabular index) via the government Web site https://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/ftpicd9.htm. The files are in Adobe format, so you’ll need a copy of Adobe Acrobat Reader 5.0 (available for free download at https://www.adobe.com/products/acrobat/readstep2.html) to view the files.