Starting on Oct. 1, 2018, you will need to begin using the new codes in the updated 2019 ICD-10-CM/PCS. There were hundreds of new, deleted, and revised codes in the latest update, and the Ob-Gyn specialty wasn’t spared. Many of the changes that will impact your coding are in Chapter 15 of the ICD-10.
Prepare yourself: Between coordinating Ob-Gyn clinical documentation from physicians and other staff on the one hand and tackling various payers’ Ob-Gyn medical necessity guidelines on the other, you have a lot on your plate. Coding guru Lori-Lynne Webb understands—and sets out, in her Virtual Boot Camp sessions on 2019 Coding Updates for Ob-Gyn, to help you tackle all the coding updates for ICD-10-CM/PCS, CPT, and HCPCS.
Select the Trimester for Multiples
If you’re like other Ob-Gyn coders, you rely quite a bit on Chapter 15 (Pregnancy, Childbirth and the Puerperium) for your ICD-10-CM codes. In the 2019 ICD-10 updates, the Centers for Medicare & Medicaid Services (CMS) added 18 new codes in this chapter alone to cover triplets, quadruplets, and other multiple gestations, noted Meridian Medical Management.
Pay attention: The 2019 ICD-10-CM has many new, more specific code choices for multiple gestation (O30). Under O30.1 — Triplet pregnancy, you now have the following codes:
- 13 — Triplet pregnancy, trichorionic/triamniotic
- 131 — …first trimester
- 132 — …second trimester
- 133 — …third trimester
- 139 — …unspecified trimester
Similarly, under O30.2 — Quadruplet pregnancy, you now have the following new codes:
- 23 — Quadruplet pregnancy, quadrachorionic/quadra-amniotic
- 231 — …first trimester
- 232 — …second trimester
- 233 — …third trimester
- 239 — …unspecified trimester
And under O30.8 — Other specified multiple gestation, CMS has added several new codes:
- 83 — …number of chorions and amnions are both equal to the number of fetuses
- Pentachorionic, penta-amniotic pregnancy (quintuplets)
- Hexachorionic, hexa-amniotic pregnancy (sextuplets)
- Heptachorionic, hepta-amniotic pregnancy (septuplets)
- 831 — … first trimester
- 832 — …second trimester
- 833 — …third trimester
- 839 — …unspecified trimester
Keep in mind: Although not every code in Chapter 15 specifies the trimester, some—especially many of the new codes added for 2019—will require a trimester component. According to Amerigroup, you should follow the ICD-10 definitions for trimesters, which are as follows:
- 1st trimester: Less than 14 weeks, 0 days.
- 2nd trimester: 14 weeks, 0 days to less than 28 weeks, 0 days.
- 3rd trimester: 28 weeks, 0 days until delivery.
Heed Special Sepsis Coding Instructions
What’s more: CMS also revised and added new codes in Chapter 15 relating to infections of obstetrical surgical incisions. Under O86.0 — Infection of obstetrical surgical wound, CMS added the note:
Excludes 1: complications of procedures, not elsewhere classified (T81.4-)
postprocedural fever NOS (R50.82)
postprocedural retroperitoneal abscess (K68.11).
New: CMS also added the following diagnosis codes:
- 00 — Infection of obstetrical surgical wound, unspecified
- 01 — …superficial incisional site
- Subcutaneous abscess following an obstetrical procedure
- Stitch abscess following an obstetrical procedure
- 02 — …deep incisional site
- Intramuscular abscess following an obstetrical procedure
- Sub-fascial abscess following a procedure
- 03 — …organ and space site
- Intraabdominal abscess following an obstetrical procedure
- Subphrenic abscess following an obstetrical procedure
- 04 — Sepsis following an obstetrical procedure
- Use Additional code to identify the sepsis
- 09 — Infection of obstetric surgical wound, other surgical site
Important: You should assign an additional ICD-10 code when reporting sepsis following an obstetrical procedure (O86.04-), to identify the infectious agent, according to Revenue Cycle Advisor.
Study the ICD-10 Coding Updates Carefully
Remember: When treating the pregnant patient, you should apply the codes in Chapter 15 before codes from other ICD-10 chapters, Amerigroup stressed. You may use codes from other chapters to report additional conditions when needed to provide more specificity, however.
Also, the ICD-10 codes in Chapter 15 refer to the mother only. You should assign these codes on only the mother’s record and never on the newborn’s record.
Key takeaway: Make sure you’re current on all the 2019 ICD-10, CPT, and HCPCS coding changes for the Ob-Gyn specialty (within Chapter 15 and elsewhere), so you can prepare for the impact on your practice, third-party payers, reimbursement, and claims denials, Webb stressed.
