Oct. 1 Deadline: Get Up-to-Speed on 2019 ICD-10 Codes for Ob-Gyn

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.

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