Is your ob-gyn practice using the new codes correctly? 3 quick questions say for sure.
This year, ICD-9 2010 brought new hyperplasia, mammogram, and fertility preservation codes. In some cases, these codes simply expanded on existing options, and it’sup to you to spot when you should report the new versus old alternatives. Dig in to these three scenarios to see if you can choose the proper code for services performed on or after Oct. 1.
Scenario 1: Pick Apart New Puerperal Options Your ob-gyn documents “a puerperal infection,” a bacterial illness following childbirth. How would you report this?
A. 670.0 — Major puerperal infection
B. 670.1x [0,2,4] — Puerperal endometritis
C. 670.2x [0,2,4] — Puerperal sepsis
D. 670.3x [0,2,4] — Puerperal septic thrombophlebitis
E. 670.8x [0,2,4] — Other major puerperal infection
Scenario 2: Don’t Overlook 671 Category Notes You’re reporting a code from the 671 (Venous complications in pregnancy and the puerperium) category, but you need to provide what additional information? Select one of the following options:
A. If the patient has deep phlebothrombosis, either in the antepartum (671.3x) or postpartum (671.4x) period,you should also apply a secondary diagnosis from code category 453 (Other venous embolism and thrombosis).
B. If the patient has been using anticoagulants for a long time and is currently using them, report V58.61 toindicate this.
C. Both of the above, if applicable.
D. None of the above.
Scenario 3: Update Your Hyperplasia Codes Your ob-gyn diagnoses a patient with endometrial hyperplasia (either endometrial intraepithelial neoplasia [EIN] or benign hyperplasia). How would you report these conditions? Choose two.
A. For EIN, you would use either 233.2 (Carcinoma in situ of other and unspecified parts of uterus) or 621.33 (Endometrial hyperplasia with atypia)
B. For benign hyperplasia, use 621.30 (Endometrial hyperplasia, unspecified) or 621.31 (Simple endometrial hyperplasia without atypia).
C. 621.34 — Benign endometrial hyperplasia
D. 621.35 — Endometrial intraepithelial neoplasia (EIN)
Answer Number 1: Trick question. Your ob-gyn must document more specifically the infection type. That means with more information, your best options are B-D.
You’ll need to include a fifth digit for these codes. A fifth digit of “0” represents “unspecified as to episode of care or not applicable.” A fifth digit of “2” means“delivered with mention of postpartum complication.” Your other option, a fifth digit of “4,” represents “postpartum condition or complication” (which you would report only after the ob-gyn discharges the patient after delivery).
Watch out: Prior to Oct. 1, you would lump all puerperal infections into one code (670.0). You can still report this for unspecified puerperal infections, but here’s the problem: If the patient requires hospitalization, your payer will most likely deny your claim at your first submission. That means wasted time appealing the claim.
Answer Number 2: C. ICD-9 added some notes under the 671 category to clarify that your ob-gyn’s documentation needs to supply additional information, and your coding must reflect that. In other words, if you report a code from the 671 category and the patient has been using anticoagulants, you need to include V58.61. Otherwise, your payercould reject your claim.
Answer Number 3: C and D. You should use new codes 621.34 and 621.35. “ICD-9 introduced these new codes because pathologists increasingly use a disease classification that distinguishes the benign hormonal effects of unopposed estrogens (benign hyperplasia) from emergent precancerous lesions (EIN),” explains Melanie Witt, RN, CPC, COBGC, MA, a coding expert based in Guadalupita, N.M.
Heads up: If you chose A and B, you’re not entirely incorrect. You can still use the old codes in answer A or B. Older physicians still use the older, four-tier hyperplasia statements, but “over time, the more accurate distinctions between types of hyperplasia will replace the old,” Witt says. A note in ICD-9 will instruct providers to use newer codes rather than the older ones. An additional note accompanying the EIN diagnosis indicates that if the ob-gyn diagnoses the patient with malignant neoplasm of endometrium with endometrial intraepithelial neoplasia, you should report the code for the malignancy (182.0, Malignant neoplasm of body of uterus;corpus uteri, except isthmus) instead.
Wanna try 4 more questions that test your mammogram, fertility preservation, lab & personal history coding prowess? Download your 2 FREE sample issues of Ob-Gyn Coding Alert here.
Don’t miss the ob-gyn coding & reimbursement update — an audio training event with Melanie Witt.
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