As an experienced coder, you’ve probably been keeping up with all the news about the ICD-10-CM codes effective Oct. 1, 2018. Which means you’ve heard a lot about one word: “other.” Yes, this word has been getting attention in coding circles as payers are tiring of seeing it on claims since the grace period ended a while back. But now CMS is adding more detailed codes to quash overuse of unspecific ICD-10 codes.
For gastroenterology, there are only 17 ICD-10-CM changes coming, but 16 of those are added codes – and their definitions often differ by only a word or two – meaning you’ll need your best memorization tricks ready, says coding consultant Jill Young in her presentation “2019 ICD-10 Coding Changes for Gastroenterology.” During this live webinar, Young walks you through the new codes (and the lone revision!) so you can master the nuances between each appendicitis, abscess, and gallbladder disorder code definition.
Sharpen Your Anatomy Knowledge to Keep Up with New Codes
Ready to hear about 2019’s newest appendicitis ICD-10 codes? Here’s a quick breakdown of what’s new for gastroenterology this year:
Acute appendicitis, generalized peritonitis
- 20, no abscess
- 21, with abscess
Acute appendicitis, localized peritonitis
- 30, no perforation (e.g., rupture) or gangrene
- 31, with gangrene but no perforation
- 32, with perforation but no abscess
- 33, with perforation and abscess
Look to the record: The wording of K35.30-35.33 can be very tricky. Read the documentation extra carefully and report only what’s in the medical record. Look for clues like a lack of blood flow to the appendix, which would indicate gangrene for code K35.31.
*Other appendicitis
- 890, other acute appendicitis, no perforation or gangrene
- 891, other acute appendicitis without perforation but with gangrene
Abscess
- 31, horseshoe abscess
- 39, other ischiorectal abscess
- 5, supralevator abscess
Gallbladder/biliary tract disorders
- A (parent code, nonbillable), disorders of gallbladder in diseases that are classified elsewhere
- A1, gangrene of the gallbladder in cholecystitis (gallbladder inflammation)
- A2, perforation of the gallbladder in cholecystitis
- 01, primary sclerosing cholangitis
- 09*, other cholangitis
*Use caution: You’ll certainly still encounter situations when you’ll have to use “other” codes – for example, if the record doesn’t indicate generalized or localized peritonitis, you can’t code for them. But be sure to cross all your t’s and dot all your i’s – documentation supporting medical necessity must always accompany claims with “other” or “unspecified” codes, or you run the risk of payer questioning, claim denial, and audit findings.
3 Key Definitions to Help You Code Better
The importance of knowing your anatomy in-and-out can’t be stressed enough. To code properly for the right type of abscess — gangrene versus perforation, primary sclerosing cholangitis versus other cholangitis, etc. — you must have a solid knowledge of all these terms. Instead of just memorizing the new codes, take time to familiarize yourself with all the terminology. These three terms are essential to understand the updated codes:
- Generalized v. localized peritonitis: Peritonitis is the inflammation of the peritoneum, or the serous membrane lining the abdomen cavity and covering the abdominal organs. As the peritoneum becomes inflamed, the patient feels pain at that site – this is localized If irritating material, such as blood or pus, enters the peritoneal cavity, that entire area becomes sensitive and painful, causing generalized peritonitis.
- Cholangitis: An inflammation in the bile duct system, typically associated with a bacterial infection. Something (often a gallstone) blocks the passage of bile from the liver and gallbladder into the small intestine. Primary sclerosing cholangitis is a rare but chronic bile duct disease, often believed to be caused by an autoimmune issue, and requires a liver transplant in order to be cured.
Gain Credibility with Improved Coding Skills
Remember: Filing thorough, accurate claims isn’t just about receiving deserved reimbursement anymore. You must tell the full story of the patient’s health, co-morbidities and all, in order to keep Medicare happy under the Merit-Based Incentive Payment System (MIPS) – a methodology which private payers very well may join in on soon. Don’t wait to get these codes right; start now taking the necessary steps to get these codes down before Oct. 1, 2018.
