We’re back with Part 3 in our series on ICD-10-CM code changes, which are fast approaching implementation date. If you missed our earlier posts, be sure to read Part 1 and Part 2 to get the jumpstart you need to keep your claims on track come October 1st.
Now to move on with the lowdown on Dx code changes for ob-gyn and pediatrics!
Of the 450+ 2019 ICD-10-CM code changes, 33 apply directly to ob-gyn — from lumps in the breast and multiple gestation pregnancies to uterine disorders and obstetric surgical wound infections.
Staying on top of the new and revised ICD-10 codes should be a priority for your ob-gyn practice. Keep reading for an overview of the most relevant changes you’ll need to put under your belt to secure your deserved pay.
If you code for multiple-gestation pregnancies, you’ll choose from over a dozen new codes that specify that the number of chorions and amnions equal the number of fetuses. These include:
Pentachorionic, penta-amniotic pregnancy (quintuplets)
Hexachorionic, hexa-amniotic pregnancy (sextuplets)
Heptachorionic, hepta-amniotic pregnancy (septuplets)
Zika diagnosis codes were added in a couple of different places in the 2019 ICD-10-CM code set:
You’ll also add more detail to your coding for obstetric surgical wound infections with new codes for:
postprocedural fever NOS (R50.82)
postprocedural retroperitoneal abscess (K68.11)
Subcutaneous abscess following an obstetrical procedure
Stitch abscess following an obstetrical procedure
Intramuscular abscess following an obstetrical procedure
Sub-fascial abscess following a procedure
Intraabdominal abscess following an obstetrical procedure
Subphrenic abscess following an obstetrical procedure
Use Additional code to identify the sepsis
Remember: In 2019, you’ll need an additional character for O86.0- that provides more detail about the wound site. If you forget to add the additional character, the payer won’t accept the code.
New Postpartum Depression Codes
New codes are coming to distinguish postpartum depression from puerperal psychosis. The existing code F53 (Mental and behavioral disorders associated with the puerperium, not elsewhere classified) is out — replaced with codes F53.0 for postpartum depression and F53.1 for puerperal psychosis.
Your ob-gyn practice also needs to make note of new Z codes for exams and screenings:
Still, additional changes are on the horizon, including revisions to breast lump, ovarian pregnancy, fallopian tube removal codes, and more.
Pediatric coders will find many code revisions and additions found in Chapter 16, Certain conditions originating in the perinatal period (P00-P96).
Newborn affected by amnionitis, newborn affected by membranitis, and newborn affected by placentitis have been deleted from P02.7. These items will now be indicated by a fourth character, specifically P02.78:
Newborn affected by FIRS
Newborn affected by amnionitis
Newborn affected by membranitis
Newborn affected by placentitis
A similar change has been made to P04.1, which no longer includes newborn affected by cancer chemotherapy and newborn affected by cytotoxic drugs. A note has been added to this code, instructing coders to “code first withdrawal symptoms from maternal use of drugs of addiction, if applicable (P96.1)”.
Also, Excludes1: maternal use of drugs of addiction (P04.4-) has been deleted.
New codes added to the P04.1 category include:
New codes have also been added to P04.4 (Newborn affected by maternal use of drugs of addiction) and P04.8 (Newborn affected by other maternal noxious substances).
New Infections Specific to the Perinatal Period
P35 Congenital viral diseases
A new code has been added for congenital Zika virus disease, P35.4. Coders are instructed to use an additional code to identify manifestations of congenital Zika virus disease.
Transitory Electrolyte Disturbances in the Neonatal Period
P74 has undergone a major overall in 2019, with several new options to depict transitory endocrine and metabolic disorders specific to newborns. These code additions include:
Development Disorders Get Much Needed Specificity
Up until the now, diagnoses like autism were lumped in with all other development disorders in an undifferentiated Z13.4 — which should drive home the need for more code options to precisely name specific conditions.
To address this need, the 2019 ICD-10-CM code set is expanding on Z13.4- (Encounter for screening for certain developmental disorders in childhood) to offer four more screening codes for childhood developmental disorders, including:
Coders should note the Excludes1 instruction for Z13.4- that prohibits reporting with Z00.1- (Encounter for newborn, infant and child health examinations) has been deleted and replaced with an Excludes2 note, clarifying that Z13.4- codes are separately reported from the codes with Z00.12- (Encounter for routine child health examination).
Additionally, a new Z code has been added to the Z62 category “Problems Related to Upbringing” that identifies patients with potential health hazards related to socioeconomic and psychosocial circumstances. Based on documentation, it is acceptable for nonphysician clinicians to report this new code, Z62.813 (Personal history of forced labor or sexual exploitation in childhood).
Join us later this week for Part 4 in this series, where we’ll unpack the 100+ code changes for ophthalmology! And if you missed our earlier posts, be sure to check out Part 1, which unravels key code changes for cardiology and emergency medicine. In Part 2, we lay out new diagnostic codes primarily impacting gastroenterology, general surgery, internal medicine, and primary care.
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