Think fast: How quickly can you memorize more than 100 changes? You’d better have an idea, as that’s what you’ll have to do to keep up with the new general surgery ICD-10-CM codes—which take effect October 1, 2018. With 64 additions, 74 revisions, and 3 deletions to general surgery codes, the sooner you start to upgrade your skills, the better.
The changes for this year include modified general surgery clinic guidance, new and expanded codes for appendicitis, and updated codes for gallbladder disorders, says coding and reimbursement consultant Kim Garner-Huey in her live audio conference with ProfEdOnDemand. During her presentation “2019 ICD-10 Coding Changes for General Surgery,” Huey walks you through all you need to know for coding and billing success in the coming year.
Resources: You can also download the 2019 Addendum and Conversion Table code lists provided on the Center for Medicare & Medicaid’s (CMS) website for a fuller picture of all that’s new—including the very long list of revised finger fracture codes (S62.6).
Overall, this year’s changes to diagnoses for during surgery address nuances in quite a few disorders. To accurately paint a complete picture of the patient’s health for payers, hone your anatomy knowledge so you don’t get tangled in the tricky wording.
Let’s take a look at a few of the general surgery newcomers to your coding toolbox.
New Gallbladder Disorder Codes
You’ll find three new codes under the non-billable parent code K82.A – disorders of gallbladder in diseases that are classified elsewhere, including:
- A1, gangrene of the gallbladder in cholecystitis
- A2, perforation of the gallbladder in cholecystitis
Expanded Appendicitis Code Set
Two new codes address acute appendicitis with generalized peritonitis: K35.20 includes an abscess, while K35.21 does not.
Four new codes (K35.30-K35.33) cover acute appendicitis with localized peritonitis. For their definitions, check here.
Modified Cholangitis Codes
Up until now, you’ve had only K83 – Cholangitis. Now, there’s a code for primary sclerosing cholangitis (K83.01). And to code for other cholangitis, reach for K83.09.
Added Infection Codes
You’ll find a range of added codes for infection or sepsis following an obstetrics procedure. Under parent code O86.0, these new codes include:
- 00, infection of obstetric surgical wound, unspecified
- 01, …, superficial incisional site
- 02, …, deep incisional site
- 03, …, organ and space site
- 04, sepsis following an obstetrical procedure
- 09, infection of obstetric surgical wound, other surgical site
Added Urethral Stricture Codes
There are seven new urethral stricture codes for this year – under parent code N35.9 –separated by type of stricture, site, and male or female.
- 911, unspecified urethral stricture, male
- 912, unspecified bulbous urethral stricture, male
- 913, unspecified membranous urethral stricture, male
- 914, unspecified anterior urethral stricture, male
- 916, unspecified urethral stricture, male, overlapping sites
- 919, unspecified urethral stricture, male, unspecified site
- 92, unspecified urethral stricture, female
Updated Rectal Abscess Codes
You’ll also find coding revisions to capture the severity and type of a rectal abscess:
- 31, horseshoe abscess
- 39, other ischiorectal abscess
- 5, supralevator abscess
Revamped Post-Procedure Infection Codes
Post-procedure infection codes got a makeover for 2019. Ditch all the old ones and use the new T81.4 series instead. The code set is pretty simple. Add -XA, -XD, or -XS to the parent code to specify which visit occurred. For example:
T81.40, infection following a procedure, unspecified
- 40XA, initial encounter
- 40XD, subsequent encounter
- 40XS, sequela
There are 24 of these codes in total, and the pattern continues for the other 20 new codes.
- 41 (-XA, -XD, -XS), infection following a procedure, superficial incisional surgical site
- 42 (-XA, -XD, -XS), …, deep incisional surgical site
- 43 (-XA, -XD, -XS), …, organ and space surgical site
- 44 (-XA, -XD, -XS), sepsis following a procedure
- 49 (-XA, XD, -XS), infection following a procedure, other surgical site
Give Changes Time to Digest
CMS, the American Medical Association (AMA), and payers are joining forces to ensure claims are as specific as possible. They want to know – in just a few short codes – what exactly happened to the patient and what the physician’s plan of care is. You do have a lot of new information to absorb in the coming year, but taking a few hours now for a diagnosis coding “tune-up” will give you a huge advantage come October 1, 2018, advises Garner-Huey.
