The codes in N61 and N64 had some minor changes.  ICD-10cm 2017 added

Add Mastitis with abscess

These codes were expanded from the N61 category of inflammatory disorders of the breast.  However,  take note that the mastitis code set N61 denotes “nonpuerperal” within it.  If it is a puerperal mastitis, those diagnoses are found in the “O” codes under the code set of O91 – Infections of breast associated with pregnancy, the puerperium and lactation. 

The N64 category only had a minor change in the revision from a 5-character code to a 6-character code.

  Revise to: breast necrosis due to breast graft (T85.898)

The N83 code set included a number of changes, in that the code set was expanded to include codes for an unspecified side, left and right side laterality codes throughout the N83 code set.  The laterality notation for the N83 code set includes the ovary, fallopian tube and broad ligament.  These changes are:  

In the next series of code set changes that present some terrific updates for gynecologic coding is the updates for the hypertrophy of vulva in code set N90.6.    The addition/expansion of these codes was a nice surprise to see added for 2017.  In the past the hypertrophy vulva/labia was very generic in the code set.  In 2017 these codes have been added and now have given us three much more diagnostically driven diagnoses.  We still have an “unspecified” code, but we now have the option to code as CALME (Childhood Asymmetric Labium Majus Enlargement) or utilize the newly added “other specified” hypertrophy. 

ICD-10cm has also given the gynecology codes an expansion for the diagnosis of dyspareunia.  For patients who have been a diagnosed with dyspareunia, payers oftentimes been view or tag in the edits as an inconsequential, or not medically relevant diagnosis to many surgical cases performed in gynecology.   The definition of dyspareunia is painful sexual intercourse due to medical or psychological causes.  Patients describe the pain location as primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix.  It has also been noted to affect a small portion of the vulva or vagina.  There have also been notations that it is felt all over the genital areas both inside and out.  As a coder, it is our responsibility to ensure that we communicate to the providers to give us better clinical documentation for the diagnosis of dyspareunia.  If it is clinically documented more clearly, it will help ensure clearer medical necessity for our insurance claims.

The code set for the diagnosis of dyspareunia has now been taken from a simple code of N94.1 to the expanded code set seen below.

The last area of review for ICD-10 pertaining to gynecology, is the verbiage revision(s) to the N99.82X and an addition of N99.84X code sets based upon the verbiage revision.  These codes were revised and added to separate out terms that were previously combined.  In N99.92 it states “Postprocedural hemorrhage and hematoma” and this was revised to simply be “post procedural” hemorrhage.  ICD-10 then included expansion for a 6^th character for added specificity.   The verbiage removal of “hematoma” was then added to seroma and added to the code set N99.84, with the expansion of the 6^thcharacter for increased specificity.