Reimbursement Advisor

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

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Daunted by the thought of sifting through all the diagnostic coding changes that went into effect last month? Fear not: Our expert has done the legwork for you. Here, she highlights key changes.


 

KEY POINTS
  • The code for nonspecific abnormal Papanicolaou smear of cervix (795.0) has been expanded to 4 new codes to more closely match the Bethesda Pap interpretation language.
  • The code for ectopic pregnancy (633) has been expanded to describe an ectopic pregnancy with the presence or absence of an intrauterine pregnancy.
  • ICD-9 has added a new sequencing instruction: “Code, if applicable, any causal condition first.” Codes with this note may be used as a principal diagnosis if no causal condition is applicable or known.
  • A new code for toxic shock syndrome (040.82) was added in recognition of its often-severe symptoms.
It’s that time again—time to take a look at the latest round of changes in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes, which went into effect on October 1. Since the changes for 2002-2003 are numerous, with many (including 31 new diagnostic codes) directly affecting Ob/Gyn practice, it’s a good idea to review your patient encounter forms to make sure they’re up to date. Be aware, however, that some payers may wait until January 1, 2003, before processing claims with the new codes. Be sure to check with yours before implementing these changes.

Code revisions for gynecology

256.2, postablative ovarian failure. Artificial menopause (627.4) has been deleted from the “excludes” note that goes with code 256.2. If the patient is experiencing symptoms related to artificial menopause, report 627.4 along with this code.

256.3, other ovarian failure. The instructions to use an additional code for states associated with artificial menopause has been changed to read “states associated with natural menopause (627.2).”

622.1, dysplasia of cervix (uteri). Some terms have been added to the inclusion list that follows the code number. Among the conditions that now qualify for this code are cervical intraepithelial neoplasia I and II, high-grade squamous intraepithelial dysplasia (HGSIL), and low-grade squamous intraepithelial dysplasia (LGSIL).

627.2, natural menopause, and 627.4, artificial menopause. ICD-9 has now added the term “symptomatic” to these codes to differentiate them from asymptomatic menopause.

V49.81, postmenopausal status (age-related) (natural). This code’s descriptor was revised to include the term “asymptomatic” as a counterpart to the changes to 627.2 and 627.4, described above.

V58.83, encounter for therapeutic drug monitoring. A new note added to this code instructs coders to also report a second code indicating any associated long-term current drug use (V58.61–V58.69).

New codes for gynecology

795.0, nonspecific abnormal Papanicolaou smear of cervix. This has been expanded to 4 new codes with the addition of a fifth digit, to more closely match the Bethesda Pap interpretation language. (Note that a repeat Pap due to insufficient cell collection is now coded as 795.09 according to ICD-9-CM Coordination and Maintenance Committee staff. Previously, V76.2 was recommended for insufficient cells):

  • 795.00 Nonspecific abnormal Papanicolaou smear of cervix, unspecified
  • 795.01 Atypical squamous cell changes of undetermined significance favor benign (ASCUS favor benign); atypical glandular cell changes of undetermined significance favor benign (AGUS favor benign)
  • 795.02 Atypical squamous cell changes of undetermined significance favor dysplasia (ASCUS favor dysplasia); atypical glandular cell changes of undetermined significance favor dysplasia (AGUS favor dysplasia)
  • 795.09 Other nonspecific abnormal Papanicolaou smear of cervix:
  • benign cellular changes
  • unsatisfactory smear
998.3, disruption of operation wound. With the addition of a fifth digit, this code has been expanded to 2 new codes that allow the coder to differentiate between an external and internal wound dehiscence. An example of an external wound would be 1 from abdominal surgery; an internal wound might be vaginal cuff sutures. If the surgeon does not specify which, default to the external wound code:
  • 998.31 Disruption of internal operation wound
  • 998.32 Disruption of external operation wound; disruption of operation wound not otherwise specified
V13.2, other genital system and obstetric disorders. This code has been expanded to 2 new codes with the addition of a fifth digit. The American College of Obstetricians and Gynecologists (ACOG) presented this proposal, along with the 1 discussed under the obstetric code changes, to capture information about women with a history of preterm labor, which is associated with complications in future pregnancies. (Note that V13.21 is used to indicate a patient who is not currently pregnant. V13.29 would be used to indicate a past personal history of, for example, dysplasia when the current or last few Paps were normal):
  • V13.21 Personal history of preterm labor
  • V13.29 Other genital system and obstetric disorders
V58.42, aftercare following surgery for neoplasm. Use this code when the procedure involves neoplasms classifiable to diagnostic codes 140–239. You’ll also need another aftercare code to fully identify the reason for the encounter. For instance, was the purpose of the visit chemotherapy after the surgery (V58.1) or attention to surgical dressings (V58.3)?

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