How are other practices billing for urinary supplies provided in the office? Are catheters and/or leg bags billable or included in the E/M code? What if there is no E/M code and patient presents for a nurse visit catheter exchange and needs a new leg bag?
Click here for more sample CPC practice exam questions with Full Rationale Answers
Laureen shows you her proprietary “Bubbling and Highlighting Technique”
Download your Free copy of my "Medical Coding From Home Ebook" at the top right corner of this page
Tag Archives: Urinary
Stress Urinary Incontinence – Surgical Intervention Coding for Urinary Sling
Stress Urinary Incontinence – Surgical Intervention Coding for Urinary Sling
March 2018
Urinary incontinence is the unintentional loss of urine. Stress Urinary Incontinence (SUI) is what occurs when there is stress or movement/ activity put upon your bladder. This activity can be something as minor as laughing, coughing, sneezing, running or lifting. SUI is not a condition related to “stress” in a psychological way, such as a person who is suffering from a mental anxiety or issue, SUI is purely related to a movement/activity that is related to a physical stress upon the body. .
There are four main types of urinary incontinence
Stress urinary incontinence is defined as the unintentional loss of urine caused by the bladder muscle contracting, involuntarily with physical movement. Some patients also experience a sense of urgency. SUI is much more common in women than men, however, the most common cause of SUI is a pelvic floor disorder, damage to, or weakening of the soft tissue that normally supports the urinary organs.
SUI is a direct result of the urinary sphincter muscle that controls the urethra becomes weakened, in addition to the weakening of the soft tissues. When both the muscle and the soft tissue supports become weak, this allows the release of urine to happen during a “stressful, physical event” such as laughing, coughing, sneezing, etc.
Coding interventions
SUI surgery is not exclusive just to the Urology specialty, many gynecologists also perform surgical intervention for SUI in women. CPT has given us many code choices for surgical intervention of SUI. Currently the most commonly used for treatment in both men and women are the surgical procedures for a urinary “sling”.
When a sling procedure is performed, the surgeon uses the patient’s own tissue (or other type of supply) to essentially “sling up” or “pex up” the uretha by inserting a strip of additional material/tissue to create an additional support system for the urethra. This support is sewn into the pelvic area to help keep the urethra in the proper physical location.
Slings can be used for both men and women with SUI.
Urinary Sling procedures can be performed as an open procedure or as a laparoscopic procedure. The two most common types of bladder slings are the TOT sling (transobturator tape sling) and the TVT sling (tension-free vaginal tape sling). The TOT sling and the TVT sling are normally performed as a quick 30 minute, outpatient procedures with a high success rate of nearly 90%. The incisions are small (less than one centimeter) and recovery times are quick. However, these procedures can be done in coordination with other surgical procedures.
The CPT codes below are those that are specifically related to SUI.
· 57288 Sling operation for stress incontinence (eg, fascia or synthetic) – Open Approach
· 57287 Removal or revision of sling for stress incontinence (eg, fascia or synthetic) – Open or laparoscopic Approach
· 53440 Sling Operation for correction of male urinary incontinence (eg, fascia or synthetic) – Open Approach
· 53442 Removal or revision of sling for male urinary incontinence (eg, fascia or synthetic) – Open Approach
· 51990 Laparoscopy, surgical; urethral suspension for stress incontinence
· 51992 Laparoscopy, surgical; sling operation for stress incontinence (eg, fascia or synthetic)
· 10120 Incision and removal of foreign body, subcutaneous tissue – simple
· 10121 Incision and removal of foreign body, subcutaneous tissue – complicated
When coding for these procedures, the coder need to carefully review the operative report to double check if the procedure is being performed laparoscopically or as an open procedure. The codes for the open approach include the 57287, 57288, 53440 and 53442. The physician/surgeon may state this is a “mini-laparotomy” however, this still means the surgical approach is “open”. If the physician documents the procedure was performed with a laparoscope, the codes 51990 and 51992 would be the correct codes to choose. If the sling is removed laparoscopically, the 57287 is the correct code to use regardless if the procedure was performed as an open procedure or a laparoscopic procedure.
Codes 53440, 53442, 51990, 51992, 57287 and 57288 all have a 90 day global period. Should a sling revision be surgically necessary during the global period, you will need to add modifier -78, to your code, as this is an unplanned return to the OR for a related procedure.
In addition, revision of an SUI sling procedure code(s) 57287 or 53442 both of these codes include replacement procedure of a sling (codes 57288 or code 53442) when performed on the same date of service. These codes are bundled in the CCI bundling edits from CMS, and do not allow a modifier to over-ride the bundling edit.
The usage of code 10120 and 10121 have become common when physicians have “removed” portions of a mesh erosion that has eroded into the subcutaneous tissues around the abdomen and groin areas. These integumentary codes are very specific if the mesh is only being removed from the subcutaneous tissue, and not a full excision or revision of the sling itself. When reporting CPT code 10120 or 101210 you will need to add either a modifier -58 or modifier -78 if the mesh erosion is treated in the office/procedure room. The verbiage of codes 10120/10121 strictly denotes in the definition as a removal of foreign body“subcutaneous” tissue.
Unfortunately, CPT does not give clear guidance as to what constitutes “simple” versus “complicated” when it comes to codes 10120 and 10121. So if you choose to use CPT Code 10121 (incision and removal of foreign body, subcutaneous tissues; complicated) when an incision is necessary to remove the foreign body you will need to educate the physician to document in the operative note that the removal was “complicated”. In addition, the physician should also document “why” the removal was complicated, with the usage of additional terms such as; embedded, deep, size, location, abnormality. It may necessitate having the physician document the amount of time spent in the removal to support the usage of the “complicated” code 10121, rather than the “simple” code 10120.
Operative Report SPARC suburethal Sling
PROCEDURE: SPARC suburethral sling
PREOPERATIVE DX: Stress urinary incontinence; hypermobility of urethra
POSTOPERATIVE DX: Stress urinary incontinence; hypermobility of urethra.
OPERATIVE PROCEDURE: SPARC suburethral sling.
FINDINGS & INDICATIONS: Outpatient evaluation was consistent with urethral hypermobility, stress urinary incontinence. Intraoperatively, the bladder appeared normal with the exception of some minor trabeculations. The ureteral orifices were normal bilaterally.
DESCRIPTION OF OPERATIVE PROCEDURE: This patient was brought to the operating room, a general anesthetic was administered. She was placed in dorsal lithotomy position. Her vulva, vagina, and perineum were prepped with Betadine scrubbed in solution. She was draped in usual sterile fashion. A Sims retractor was placed into the vagina and Foley catheter was inserted into the bladder. Two Allis clamps were placed over the mid urethra. This area was injected with 0.50% lidocaine containing 1:200,000 epinephrine solution. Two areas suprapubically on either side of midline were injected with the same anesthetic solution. The stab wound incisions were made in these locations and a sagittal incision was made over the mid urethra. Metzenbaum scissors were used to dissect bilaterally to the level of the ischial pubic ramus. The SPARC needles were then placed through the suprapubic incisions and then directed through the vaginal incision bilaterally. The Foley catheter was removed. A cystoscopy was performed using a 70-degree cystoscope. There was noted to be no violation of the bladder. The SPARC mesh was then snapped onto the needles, which were withdrawn through the stab wound incisions. The mesh was snugged up against a Mayo scissor held under the mid urethra. The overlying plastic sheaths were removed. The mesh was cut below the surface of the skin. The skin was closed with 4-0 Plain suture. The vaginal vault was closed with a running 2-0 Vicryl stitch. The blood loss was minimal. The patient was awoken and she was brought to recovery in stable condition.
Cpt Code:
57288 Sling operation for stress incontinence (eg, fascia or synthetic) – Open Approach
ICD-10CM :
N39.3 Stress incontinence (female) (male)
N36.41 Hypermobility of urethra
Operative Report Male Sling
General anesthesia administered and patient positioned in the dorsal lithotomy position. A 16F Foley catheter placed to drain the bladder. Peri-operative antibiotics are administered. A vertical incision is made to the perineum approximately 1-2 cm inferior to the penoscrotal junction and carried 1 cm anterior to the rectum. Dissection is continued through Colles’ fascia and the underlying bulbocavernous muscle. Sharp dissection is continued until the spongiosal bulb has been freely dissected. The perineal body is identified and dissection is continued proximally approximately 4 cm.
Attention is then focused on identification and marking of the anatomical and landmarks for placement of the surgical passers. The adductor longus tendon is identified and marked, each of the two trochar insertion sites are then marked, and insertion is performed just lateral to the inferior pubic ramus. The skin sites are incised and surgical passer placement is performed. A surgical finger is placed inside the perineal dissection and to identify the inferior pubic ramus where the passer will exit. Under manual guidance, the passer is advanced through the medial aspect of the obturator foramen, exiting at the level of the perineal body lateral to the spongiosal bulb. Care is taken to maintain a 45º angle during passage, therefore completing the trochar rotation. The passer is then hooked to the respective sling arm, which is then pulled though the obturator foramen to exit via the skin incision bringing the mesh into place. The mesh is then checked to ensure that twisting has not occurred. Subsequently, the opposite passer is placed in an identical fashion and the sling is pulled into place.
The central mesh anchor is sutured into place, with the posterior aspect fixed to the spongiosal tissue at the most proximal aspect of the bulbar dissection. The distal anchor is then sutured to the spongiosal tissue, each performed with 3-0 vicryl suture. Tensioning of the sling is now performed, by pulling the mesh arms so the bulb of the corpus spongiosum is brought cephalad by the sling. Sling tensioning is increased until 3-4 cm of proximal urethral movement is obtained. Bulbar suspension is confirmed by measuring proximal movement from the initial point of fixation to the perineal body. A cystourethroscopy is then performed to rule out any urethral or bladder injury. The arms of the mesh are cut below skin level and skin incisions closed with Dermabond. The perineal dissection is then closed with a standard 3-layer closure with absorbable suture.
Cpt Code:
53440 Sling Operation for correction of male urinary incontinence (eg, fascia or synthetic) – Open Approach
ICD-10CM :
N39.3 Stress incontinence (female) (male)
Operative Report – Laparoscopic removal
A laparoscopic approach was utilized to remove the polypropylene mesh sling from the retropubic space and , bladder, We entered the peritoneal cavity through the umbilicus and then placed 3 ancillary ports under direct vision . A 10-mm port is placed in the left paramedian region for suturing, and 5-mm ports are placed suprapubically and in the right paramedian region. After the pneumoperitoneum was created, and adhesiolyis was performed, and taken down, the bladder is filled in a retrograde manner with 200 mL to 300 mL of saline, allowing for identification of the superior border of the bladder edge. Entrance into the space of Retzius was accomplished with a transperitoneal approach using a Harmonic scalpel. The incision was made approximately 3 cm above the bladder reflection, beginning along the medial border of the right obliterated umbilical ligament. After entering the space of Retzius the pubic ramus was visualized; the bladder drained to prevent injury during dissection. Separation of the loose areolar and fatty layers using blunt dissection develops the retropubic space, and dissection is continued until the retropubic anatomy is clearly visualized. Identification of the sling mesh was made where it touches the pubic rami, approximately 3 cm lateral from midline. Once identified, the mesh was grasped and excised from the anterior abdominal wall and then peeled free of the pubic rami periosteum. Dissection was then continued down along the mesh toward the bladder and pubocervical fascia. Extensive scarring was encountered, and the mesh was cut out with the scarred tissue. In addition, the mesh was eroded into the bladder, and the dissection was continued down to where the mesh appeared to be eroded into the bladder. The mesh was removed but erosion was not found to be in the bladder. Dissection was continued down to and through the pubocervical fascia on both sides. An incision was then made suburethrally, and the remaining mesh below the urethra identified, cut in the midline, and freed up allowing removal of the entire portion of the mesh sling. All laparoscopic surgical devices were removed and accurate sponge and surgical devices accounted for. Patient then taken to the recovery area, and will be discharged when stable.
Cpt Code:
57287 Removal or revision of sling for stress incontinence (eg, fascia or synthetic) – Open or laparoscopic Approach
ICD-10CM :
T83.711D Erosion of implanted vaginal mesh to surrounding organ or tissue; subsequent encounter
Wrap up
The biggest challenge of coding for SUI is ensuring that the correct codes were chosen for either open or laparoscopic approach. In addition to ensuring that your codes for CPT are correct, but double check your ICD-10cm diagnoses for accuracy. And with all claims, follow them to ensure that they were submitted in a timely manner, but were also reimbursed correctly. If not, then file an appeal for readjudication or peer review as necessary.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC and ICD10 cm/pcs Ambassador/trainer is an E&M, and Procedure based Coding, Compliance, Data Charge entry and HIPAA Privacy specialist, with over 20 years of experience. Lori-Lynne’s coding specialty is OB/GYN office & Hospitalist Services, Maternal Fetal Medicine, OB/GYN Oncology, Urology, and general surgical coding. She can be reached via e-mail at [email protected] or you can also find current coding information on her blog site: http://lori-lynnescodingcoachblog.blogspot.com/.
Urinary Drug Testing Inconsistencies Coding
Does inconsistent lab results warrant an upcoding in the definitive CPT code? Ex: if we tested 7 drug classes (G0480) and the patient tested positive on 5 of those classes in which we performed additional testing to test the quantity, does that warrant a G0481 due to the additional testing?
Eroded artifical urinary spinchter
What would the ICD 10 code be for this?
URINARY INCONTINENCE TREATMENT AND MEDICAL TOURISM
If you suffer from leaking bladder accidents when you cough or laugh or sneeze, or if you have the urge of going to the bathroom all the time, you are not alone. Millions of people across all ages, both genders and all races are affected by this common problem that is termed urinary incontinence (UI), a loss of bladder control. The good news is that the underlying medical condition causing urinary incontinence is almost always treatable and today it is possible to get affordable treatment overseas through medical tourism.
URINARY INCONTINENCE TYPES AND TREATMENTS
Though urinary incontinence can be classified into several types, its three main types are: stress, urge and overflow.
Stress incontinence occurs during certain activities like coughing, sneezing, laughing, or exercise, and is most commonly caused by weak pelvic floor muscles.
Urge incontinence or overactive incontinence involves a sudden urge to urinate followed by instant bladder contraction and involuntary loss of urine, and occurs regardless of the amount of urine that is in the bladder.
Overflow incontinence is the constant dribbling of urine usually associated with urinating frequently and in small amounts, and may be caused by weak bladder muscles or a blocked urethra.
Depending on the cause, type and severity of urinary incontinence as well as your lifestyle, treatment approaches available to you may include weight loss, exercises, medications, bladder retraining (timed voiding), biofeedback, electrical stimulation, and if all else fails, then surgery.
MEDICAL TOURISM
Medical tourism is the act of traveling from one city to another within your country (domestic medical tourism) or to another country by crossing international borders (overseas medical tourism) to obtain medical care that is either not available or not affordable at your local provider. The popularity of medical tourism is largely due to the availability of high quality care at a highly discounted price.
Healthcare providers participating in medical tourism boast of modern facilities with state-of-the-art equipments and technologies, and surgeons who are trained or educated in the US or Europe – all this at a cost that’s 60% to 90% cheaper compared to typical US hospital rates.
SURGICAL TREATMENT OF INCONTINENCE ABROAD
Several procedures are offered abroad for the surgical treatment of all types of incontinence – stress, urge, overflow, mixed, etc.
For curing stress incontinence in women, sling procedures such as Tension-free transvaginal (TVT) sling, Transobturator tape (TOT) sling and Mini-sling procedure are available overseas. Another type of procedure for stress incontinence treatment offered abroad is bladder neck suspension procedure which includes Marshall-Marchetti-Krantz procedure (MMK procedure) or a variant of it called Burch procedure.
To treat severe urge incontinence, procedures offered overseas include augmentation cystoplasty or a newer procedure called sacral nerve stimulation.
For the treatment of urinary incontinence in men, some of the procedures available abroad include artificial urinary sphincter, male sling, and urinary diversion.
MEDICAL TOURISM DESTINATIONS FOR INCONTINENCE SURGERY
Some of the most popular countries that patients from the United States travel to for urinary incontinence procedures are Mexico, India, Singapore and Thailand.
Apart from the considerably lower cost of surgery, Mexico is preferred for another obvious reason – its close proximity to the United States. This means shorter travel times and more convenience for the medical tourist.
Singapore’s high quality of care along with the large concentration of internationally accredited hospitals in the country play a major role in its demand in the medical tourism market for incontinence surgery. Furthermore, English being the official language of the country makes communication with your international provider easy.
But, if you want the best value for your money then India is the answer. The medical tourism hotspot offers prices on procedures that are unbeatable. For instance, a TVT or a TOT procedure, inclusive of the hospital charges and the doctor’s fees, costs approximately USD2,500*.
Also note that urinary incontinence surgery abroad typically involves a 2-3 day stay at the hospital followed by a 3-6 day of recuperation or rehab at a nearby hotel before returning home.
So, if an incontinence surgery is what your local doctor has recommended and treatment abroad is what you wish to seek, then get your local doctor’s report along with any and all reports of diagnostic tests and then call upon a reputed medical tourism facilitator such as Healthbase for a consultation with an overseas incontinence specialist of your choice.
*Note: The price mentioned is for rough planning purposes only. The actual price charged may vary based on your specific medical condition, the provider chosen, currency fluctuations or for any other reason. Transportation, hotel accommodation and food are not included in the price.
About the author: The author works for Healthbase (http://www.healthbase.com), a medical tourism facilitator that connects patients to high quality healthcare in USA and abroad for a fraction of the typical cost of care in US, Canada and UK.
ICD-10cm – 2017 Urinary Diagnosis Codes and Male Genito-urinary Code Update! (Part 2)
ICD-10cm – 2017 Urinary Diagnosis Codes and Male Genito-urinary Code Update! (Part 2)
November 2, 2016
As we discussed in part one, the ICD-10CM code set used within the United States is maintained by the ICD Coordination and Maintenance Committee. It is this organization that is responsible for putting for the additions, deletions, and updates to ICD-10-cm code set on a yearly basis. This committee includes representatives from the National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS).
The ICD-10cm guidelines, as well as the actual numeric code set, should be reviewed frequently and used as a vital companion reference when coding for diagnosis in physician based and clinical diagnosis services. As a coding procedure, it is necessary to review all sections of the guidelines to fully understand all of the rules, procedural and instructional processes needed to code clinical documentation presented in the medical records properly.
The complete ICD-10cm guidelines can be found at the beginning of your ICD-10cm 2017 book and/or e-files. The new updates for the ICD-10 code set for 2017 actually went into effect on 10/01/2017. If you haven’t downloaded the new codes, or purchased your books yet, you really need to! Access to the new updates and revisions is an essential tool for coders and clinical providers.
As we look at some of the codes that affect Urology (genitourinary) there are a couple of areas that include both male and female gender codes. Even though we think of the “N” codes as primarily genito-urinary, some of the breast codes are also within the “N” code-set and affect both male and female gender. Be aware that some carriers have edits in place, that some carriers use edits and tag certain diagnoses as “female” only codes, when in fact they should be for both genders. If you are getting an edit or denial for an inappropriate gender, be sure to appeal, or contact the carrier/payer so the edit can be corrected.
Most of the changes in the Urologic code-set is for the codes involving renal tubule-intersitial diseases within the codes of N10 – N16. Of these the N10 is truly a three-character code, and the revision has been made to make it easier to understand.
Revise from N10 Acute tubulo-interstitial nephritis
Revise to N10 Acute pyelonephritis
Revise from Acute pyelonephritis
Revise to Acute tubulo-interstitial nephritis
To completely understand this code revision, be aware that an Acute interstitial nephritis can be the cause of acute renal failure complicated by medications, infection, and/or other causes. However, with this verbiage change, the physician or provider will only need to provide documentation for “Acute Pyelonephiritis” then if more documentation is found, the acute tubulo-interstitial nephritis will fall under this code set.
The next change is for the codeset of N13. Within this code set there was an addition of the code N13.0 to denote hydronephrosis with a UPJ obstruction. ICD-10cm also includes guideline direction for an excludes 2 note for the N13.0. In addition, it includes the revision for verbiage in the N13.6 pyonephrosis code and expanded out that code set.
Add N13.0 Hydronephrosis with ureteropelvic junction obstruction
Add Hydronephrosis due to acquired occlusion of ureteropelvic junction
Add Excludes2: Hydronephrosis with ureteropelvic junction obstruction due to calculus (N13.2)
No Change N13.6 Pyonephrosis
Revise from Conditions in N13.1-N13.5 with infection
Revise to Conditions in N13.0-N13.5 with infection
As we look at the codes within the code set of N30 – N39 Other diseases of the urinary system, there were minimal changes, however, the N36.0 Urethral Fistula code had a small revision change, as the excludes 1 notes, show an expanded out code from N50.8 to N50.89 which is now a five-character code from a four-character code.
In the codes for other specified disorders of the urethra code N36.8; ICD-10cm now denotes an “Excludes 1” notation
No Change N36.8 Other specified disorders of urethra
Add Excludes1: congenital urethrocele (Q64.7)
Add female urethrocele (N81.0)
A small verbiage change was made for the code N39.42 as they added the diagnosis of insensible (urinary) incontinence under the code N39.42
No Change N39.42 Incontinence without sensory awareness
Add Insensible (urinary) incontinence
The code set for N39.49 Other specified urinary incontinence actually added two new codes for 2017. These additions are very important as the previous code set we had to choose a much more vague diagnosis, where these new codes give us much better specificity.
Add N39.491 Coital incontinence
Add N39.492 Postural (urinary) incontinence
The next area of revision is within the codes specific to the male genital organs, and specifically regarding the prostate. The N40 code set simply added some verbiage revisions however, the N42.3 code set for dysplasia of prostate includes deletions within verbiage. Below outlines the added new codes, which encompass the deletion verbiage within the previous “excludes” notes.
No Change N42.3 Dysplasia of prostate
Delete Prostatic intraepithelial neoplasia I (PIN I)
Delete Prostatic intraepithelial neoplasia II (PIN II)
Delete Excludes1: prostatic intraepithelial neoplasia III (PIN III) (D07.5)
Add N42.30 Unspecified dysplasia of prostate
Add N42.31 Prostatic intraepithelial neoplasia
Add PIN
Add Prostatic intraepithelial neoplasia I (PIN I)
Add Prostatic intraepithelial neoplasia II (PIN II)
Add Excludes1: prostatic intraepithelial neoplasia III (PIN III) (D07.5)
Add N42.32 Atypical small acinar proliferation of prostate
Add N42.39 Other dysplasia of prostate
The N50 Other and unspecified disorders of male genital organs code set includes codes for much better specificity for genital pain. ICD-10cm 2017 deleted many diagnoses that were previously housed within the code set to now having a specific diagnosis added for better specificity. This is a huge boon to coders that previously used the non-specified codes for testicular pain and scrotal pain. As you can see below, there is also added specificity for laterality on the testes.
No Change N50.8 Other specified disorders of male genital organs
Delete Atrophy of scrotum, seminal vesicle, spermatic cord, tunica vaginalis and vas deferens
Delete Edema of scrotum, seminal vesicle, spermatic cord, testis, tunica vaginalis and vas deferens
Delete Hypertrophy of scrotum, seminal vesicle, spermatic cord, testis, tunica vaginalis and vas deferens
Delete Ulcer of scrotum, seminal vesicle, spermatic cord, testis, tunica vaginalis and vas deferens
Delete Chylocele, tunica vaginalis (nonfilarial) NOS
Delete Urethroscrotal fistula
Delete Stricture of spermatic cord, tunica vaginalis, and vas deferens
Add N50.81 Testicular pain
Add N50.811 Right testicular pain
Add N50.812 Left testicular pain
Add N50.819 Testicular pain, unspecified
Add N50.82 Scrotal pain
Add N50.89 Other specified disorders of the male genital organs
Add Atrophy of scrotum, seminal vesicle, spermatic cord, tunica vaginalis and vas deferens
Add Chylocele, tunica vaginalis (nonfilarial) NOS
Add Edema of scrotum, seminal vesicle, spermatic cord, tunica vaginalis and vas deferens
Add Hypertrophy of scrotum, seminal vesicle, spermatic cord, tunica vaginalis and vas
deferens
Add Stricture of spermatic cord, tunica vaginalis, and vas deferens
Add Ulcer of scrotum, seminal vesicle, spermatic cord, testis, tunica vaginalis and vas deferens
Add Urethroscrotal fistula
ICD-10cm 2017 also addressed the erectile dysrunction codes and revised the verbiage, in addition to adding new codes for specificity. The subtle verbiage change of “post surgical” to “post procedural” is a huge change in interpretation for coding and payer compensation. In addition to verbiage changes, the addition of four new codes will really enhance the coding specificity for urologic surgical procedures in relation to erectile dysfunction. The breakout below shows these revisions and additions.
Revise from N52.3 Post-surgical erectile dysfunction
Revise to N52.3 Postprocedural erectile dysfunction
Add N52.35 Erectile dysfunction following radiation therapy
Add N52.36 Erectile dysfunction following interstitial seed therapy
AddN52.37 Erectile dysfunction following prostate ablative therapy
Add Erectile dysfunction following cryotherapy
Add Erectile dysfunction following other prostate ablative therapies
Add Erectile dysfunction following ultrasound ablative therapies
Revise from N52.39 Other post-surgical erectile dysfunction
Revise to N52.39 Other and unspecified postproceduralerectile dysfunction
In part 1 of this article series we also addressed the mastitis codes below. Again, these codes are not necessarily “gender specific” and mastitis can develop in both male and female breasts. We included these in both part 1 and part 2 of this series, as these codes truly cross the gender male/female anatomy boundaries.
ICD-10cm 2017 added
Add N61.0 Mastitis without abscess
Add Infective mastitis (acute) (nonpuerperal) (subacute)
Add Mastitis (acute) (nonpuerperal) (subacute) NOS
Add Cellulitis (acute) (nonpuerperal) (subacute) of breast NOS
Add Cellulitis (acute) (nonpuerperal) (subacute) of nipple NOS
Add N61.1 Abscess of the breast and nipple
Add Abscess (acute) (chronic) (nonpuerperal) of areola
Add Abscess (acute) (chronic) (nonpuerperal) of breast
Add Carbuncle of breast
Add Mastitis with abscess
The N64 category only had a minor change in the revision from a 5-character code to a 6-character code.
No Change N64.1 Fat necrosis of breast
No Change Code first
No Change Code first
Revise from: breast necrosis due to breast graft (T85.89)
Revise to: breast necrosis due to breast graft (T85.898)
This is also a “repeat” of information from part 1, in this 2 part series. As we have previously reviewed for ICD-10cm 2017 pertaining to both urologic and gynecologic surgery, The following 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 6th 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 6thcharacter for increased specificity.
· Revise from: N99.82 Postprocedural hemorrhage and hematoma of a genitourinary system organ or structure following a procedure
· Revise to: N99.82 Postprocedural hemorrhage of a genitourinary system organ or structure following a procedure
o Revise from N99.820 Postprocedural hemorrhage and hematoma of a genitourinary system organ or structure following a genitourinary system procedure
o Revise to N99.820 Postprocedural hemorrhage of a genitourinary system organ or structure following a genitourinary system procedure
o Revise from N99.821 Postprocedural hemorrhage and hematoma of a genitourinary system organ or structure following other procedure
o Revise to N99.821 Postprocedural hemorrhage of a genitourinary system organ or structure following other procedure
· Add N99.84 Postprocedural hematoma and seroma of a genitourinary system organ or structure following a procedure
o Add N99.840 Postprocedural hematoma of a genitourinary system organ or structure following a genitourinary system procedure
o Add N99.841 Postprocedural hematoma of a genitourinary system organ or structure following other procedure
o Add N99.842 Postprocedural seroma of a genitourinary system organ or structure following a genitourinary system procedure
o Add N99.843 Postprocedural seroma of a genitourinary system organ or structure following other procedure
As ICD-10cm continues to be improved, we should also remember the goal of working hand in hand with the clinical providers of care to ensure that the clinical documentation of the patient record is clearly reflected by the procedure and diagnosis codes chosen and billed to the insurance payers. The patients’ medical record documentation is essential for determining the most appropriate codes and reimbursement. Failing to provide clear, concise and accurate documentation can lead to incorrect and/or inaccurate medical care and diagnosis; inappropriate or incorrect claims for services; claim denials or the worst case scenario of allegation of fraud/abuse. The verbiage revisions, added codes and expanded code set characters within ICD-10cm in 2017 is a welcome addition to making our job as coders that much better.
Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC and ICD10 cm/pcs Ambassador/trainer is an E&M, and Procedure based Coding, Compliance, Data Charge entry and HIPAA Privacy specialist, with over 20 years of experience. Lori-Lynne’s coding specialty is OB/GYN office & Hospitalist Services, Maternal Fetal Medicine, OB/GYN Oncology, Urology, and general surgical coding. She can be reached via e-mail at [email protected]or you can also find current coding information on her blog site: http://lori-lynnescodingcoachblog.blogspot.com/.