Your diagnosis coding for internal medicine will soon change in a few key areas, thanks to the recent release of the 2019 ICD-10-CM codes. Make sure you’re paying special attention to the new, revised, and deleted codes that will have a big impact on your billing and reimbursement for internal medicine.
In the 2019 ICD-10 update, the Centers for Medicare & Medicaid Services (CMS) revamped the codes for post-procedure infection, deleting three and adding 20 new codes, according to coding expert Jill Young in her webinar, “2019 ICD-10 Coding Changes for Internal Medicine.” As of Oct. 1, 2018, you’ll need to stop using the old codes and start using the new T81.4 series instead.
Use More Specific Codes for Post-Procedure Infections
Although you’ll still see T81.4 — Infection following a procedure, CMS has deleted the description below the code as well as the “Excludes 1” details, and then added:
Excludes 2: obstetrical surgical wound infection (O86.0-)
postprocedural fever NOS (R50.82)
postprocedural retroperitoneal abscess (K68.11)
CMS also added the following new codes under T81.4:
- 40 — Infection following a procedure, unspecified
- 41 — Infection following a procedure, superficial incisional surgical site (Subcutaneous abscess following a procedure; Stitch abscess following a procedure)
- 42 — Infection following a procedure, deep incisional surgical site (Intra-muscular abscess following a procedure)
- 43 — Infection following a procedure, organ and space surgical site (Intra-abdominal abscess following a procedure; Subphrenic abscess following a procedure)
- 44 — Sepsis following a procedure (Use additional code to identify the sepsis)
- 49 — Infection following a procedure, other surgical site
Watch out: Each of the above codes will require a seventh character (A, D, or S), according to Healthcare First. CMS will provide additional inclusion terms to help guide you to the appropriate code choice for the new codes T81.41-, T81.42-, and T81.43-.
Use New T74 and T76 Codes to Describe Exploitation
Additionally, many of the newly added codes are external cause codes that you will use to describe exploitation of children and adults—in the form of psychological abuse, bullying and intimidation, forced sexual exploitation, or forced labor exploitation, noted Healthcare First.
Chapter 19 contains a whole range of new codes under T74 — Adult and child abuse, neglect and other maltreatment, confirmed. First, CMS added to the descriptors for T74.3 — Psychological abuse, confirmed. It also revised T76.3 — Psychological abuse, suspected to now include “bullying and intimidation” and “intimidation through social media.”
Heads up: But more significantly, CMS added the following new codes:
- 5 — Forced sexual exploitation, confirmed
- 51 — Adult forced sexual exploitation, confirmed
- 52 — Child sexual exploitation, confirmed
- 6 — Forced labor exploitation, confirmed
- 61 — Adult forced labor exploitation, confirmed
- 62 — Child forced labor exploitation, confirmed
Pay attention: Under T76, CMS also added these new codes:
- 5 — Forced sexual exploitation, suspected
- 51 — Adult forced sexual exploitation, suspected
- 52 — Child sexual exploitation, suspected
- 6 — Forced labor exploitation, suspected
- 61 — Adult forced labor exploitation, suspected
- 62 — Child forced labor exploitation, suspected
Master Z Series Codes for Mental & Behavioral Health Exams
Don’t miss: Also, the 2019 ICD-10 updates include several new Z-codes, including Z04.81 — Encounter for examination and observation of victim following forced sexual exploitation, Z04.82 — …following forced labor exploitation, and Z04.89 — …for other specified reasons.
Z62.813 — Personal history of forced labor or sexual exploitation in childhood is another new ICD-10 code under the Z62 category of “Problems Related to Upbringing,” according to Beth Cobb, RN, BSN, Manager of Clinical Services at Medical Management Plus, Inc. This is one of the categories that identifies patients with potential health hazards related to socioeconomic and psychological circumstances.
These are just a sampling of the significant changes in the 2019 ICD-10 update, so make sure you’re preparing for all 112 coding revisions for internal medicine, Young stresses. Understanding how to select the correct codes is vital to your compliance and reimbursement.