Gear Up for 2019 ICD-10-CM Code Changes—Part 2

Posted on 18 Sep, 2018 |comments_icon 0|By Elizabeth Debeasi

If you’re just joining our overview of ICD-10-CM code changes for 2019, you might want to back up and start at the beginning of this series. In Part 1, we address code changes that will primarily affect cardiology and emergency medicine, but these changes are worth noting, as you’ll likely encounter these diagnoses in your practice.

Today, let’s continue our ICD-10 review with code updates sure to impact gastroenterology, general surgery, internal medicine, and primary care practices.

Code Updates: Gastroenterology

Since the debut of ICD-10, you’ve had access to several codes that describe GI abscesses under the K61 (Abscess of anal and rectal regions). Still, while this section is robust, it’s never represented the spectrum of conditions you might encounter. 2019 addresses this issue with new codes to capture greater specificity for GI abscesses.

New Abscess Codes

Meet your new codes to represent anorectal supralevator and horseshoe abscesses:

  • K61.31Horseshoe abscess
  • K61.39Other ischiorectal abscess
  • K61.5Supralevator abscess

You previously reported horseshoe abscess with H61.1 (Rectal abscess), but that code doesn’t completely depict the condition, since a horseshoe abscess can be deep and spread throughout the rectum and sphincter. The new code establishes when your GI surgeon is required to perform a more invasive procedure than what’s typically involved.

The K61.5 code offers you a location-specific option when the patient’s abscess is in the supralevator space within the rectum. And new code K61.39 builds on the current description for K61.3 (Ischiorectal abscess), which has a note indicating that it covers “abscess of ischiorectal fossa.”

In cases when the patient has an ischiorectal abscess that lies outside of that descriptor, K61.39 will be the right code to report.

New Gallbladder and Cholecystitis Codes

This year’s new ICD-10-CM codes includes several that were requested last year (by the American Association for the Surgery of Trauma) but didn’t make it into the 2018 code set. Let’s take a look at the late arrivals.

Here’s an example of new codes to report gallbladder disorders:

  • K82.ADisorders of gallbladder in diseases classified elsewhere
  • K82.A1 — Gangrene of gallbladder in cholecystitis
  • K82.A2Perforation of gallbladder in cholecystitis

You’ll also find two new codes for cholangitis, which was covered under the catch-all code K83.0 (Cholangitis). Now, though, you can get more specific with the following:

  • K83.01Primary sclerosing cholangitis
  • K83.09Other cholangitis

Because primary sclerosing cholangitis is a complex chronic liver condition that typically requires non-surgical management, the new code will be useful in demonstrating medical necessity for related services such as MRCP, interventions by ERCP, and other encounters.

Added Specificity for Appendicitis

Effective Oct. 1, new codes will heighten specificity in appendicitis coding, allowing you to distinguish between different degrees of morbidity and risk for mortality. (To get the lowdown on these the new codes, refer to Part 1 in this series.)

Coders will need to identify when cases of appendicitis involve peritonitis, abscess, perforation, or gangrene, as the new coding options will depend on these facts. This will likely require your providers to ramp up their documentation to include more details.

Because this level of specificity isn’t always noted by physicians, you might want to speak with your providers to explain how the new codes will rely on clinical details further defining the extent and associated complications of your appendicitis cases.

Post-Procedural Infection Codes

The first thing you need to know is that three codes are slated for deletion. Say goodbye to:

  1. T81.4XXA (Infection following a procedure, initial encounter)
  2. T81.4XXD (Infection following a procedure, subsequent encounter)
  3. T81.4XXS (Infection following a procedure, sequela).

To replace the three deleted codes, ICD-10 is bringing in more than 20 new codes to nail down the nitty-gritty specifics of the post-procedural infection or other related conditions, all of which fall under the following parent codes:

  • T81.40Infection following a procedure, unspecified
  • T81.41Infection following a procedure, superficial incisional surgical site
  • T81.42Infection following a procedure, deep incisional surgical site
  • T81.43Infection following a procedure, organ and space surgical site
  • T81.44Sepsis following a procedure
  • T81.49Infection following a procedure, other surgical site

Remember to add a placeholder of “x” for the seventh character. The above codes represent the primary new codes, each of which will expand with additional characters to describe whether the encounter was initial, subsequent, or for sequela.

Here’s an example from the T81.40 section:

  • T81.40XAInfection following a procedure, unspecified, initial encounter
  • T81.40XDInfection following a procedure, unspecified, subsequent encounter
  • T81.40XSInfection following a procedure, unspecified, sequela

The remaining codes in the series follow the same lead, with the “A,” “D,” and “S” seventh character designations.

Code Updates: Internal Medicine & Primary Care

As sad as it is, forced labor and sexual exploitation are on the rise and affect all ages, genders, and people groups. That said, women and girls are at slightly higher risk, accounting for 55% of the 21 million estimated victims of forced labor and 22% of all sexual exploitation victims, according to the International Labour Organisation.

New Forced Labor & Sexual Exploitation Codes

Anticipate new code additions for confirmed forced labor and forced sexual exploitation. These codes include T74.5- (Forced sexual exploitation, confirmed) through T74.62XS (Child forced labor exploitation, confirmed, sequela).

Instructions with codes from category T74- (Adult and child abuse, neglect and other maltreatment, confirmed) tell you to report an additional code, if applicable, to identify any associated current injury. You should also report an additional external cause code to identify the perpetrator when known (Y07.-).

Also expect new codes for suspected forced labor and forced sexual exploitation T76.5- (Forced sexual exploitation, suspected) through T76.62XS (Child forced labor exploitation, suspected, sequela).

Instructions with codes from category T76- (Adult and child abuse, neglect and other maltreatment, suspected) likewise inform you, when applicable, to report an additional code to identify any associated current injury.

ICD-10 2019 also adds multiple Z codes you need to be aware of, including:

  • Z04.81Encounter for examination and observation of victim following forced sexual exploitation
  • Z04.3Encounter for screening examination for mental health and behavioral disorders
  • Z04.821Contact with and (suspected) exposure to Zika virus
  • Z04.813Personal history of forced labor or sexual exploitation in childhood

Z codes represent reasons for encounter, and you must report a corresponding procedure code with a Z code if the physician performs the procedure, according to ICD-10 instructions.

New Depression Codes

Screening for depression is currently restricted to a not otherwise specified code, Z13.89 (Encounter for screening for other disorder), requiring a provider to select the symptom and/or less specific screening code to establish a reason for the service provided.

With the increased attention to mental healthcare, though, comes a greater need for the ability to report more specific diagnoses.

As such, beginning Oct. 1, 2018, a new code group — Z13.3- (Encounter for screening examination for mental health and behavioral disorders) — will be added to ICD-10. You’ll now have four new mental health screening code options to from which to report, including:

  • Z13.30 — Encounter for screening examination for mental health and behavioral disorders, unspecified
  • Z13.31— Encounter for screening for depression
  • Z13.32 — Encounter for screening for maternal depression
  • Z13.39 — Encounter for screening examination for other mental health and behavioral disorders.

You should also take note of the screenings covered by Z13.39, which will include screenings for alcoholism and intellectual disabilities after Oct. 1.

Don’t forget about notes with codes. For example, T74.3 (Psychological abuse, confirmed) has new notes clarifying that the code is appropriate for “Bullying and intimidation, confirmed” and “Intimidation through social media, confirmed.”

Learn More

Stay tuned for Part 3 in this series as we continue our specialty-by-specialty breakdown of ICD-10 code changes. We plan to dig in to updates primarily affecting obstetrics and gynecology, as well as pediatrics—so don’t miss out!

You have only days to prepare for ICD-10-CM code changes, but not to worry.

Sail into the 2019 code season with TCI’s ICD-10-CM for Physicians & Hospitals 2019 — brimming with new and revised ICD-10-CM codes and their descriptors, along with expert guidance and the vital features you need for correct coding and reimbursement. Pick up your copy today of this best-in-class ICD-10-CM coding book, which is packed with numerous bonus features you won’t find in any other ICD-10-CM code book.

Also, to receive practical ICD-10 training strategies, answers to your ICD-10 coding questions, specific examples to help you apply ICD-10 coding fundamentals, check out ICD-10 Coding Alert.


Elizabeth Debeasi
Marketing Writer/ Editor

Elizabeth works on an array of projects at TCI, researching and writing about modern reimbursement challenges. Since joining TCI in 2017, she has also covered the nuts and bolts of cybersecurity, compliance with federal laws, and how to tap into the advantages of Telehealth services.

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