All Entries Tagged With: "ICD-10 coding"

Note changes for OB codes in ICD-10

Even though it’s still early to start studying and learning ICD-10 codes, at this point you should at least take a look at codes you commonly assign to get a sense of the changes and to see whether there are any significant differences regarding coding conventions.

For example, note Chapter 11 in the ICD-9 Manual, “Complications of Pregnancy, Childbirth, and the Puerperium.” This chapter will be Chapter 15 in ICD-10. Rather than reporting codes according to the episode of care, coders will report pregnancy codes by trimester in ICD-10.

Currently under ICD-9, pregnancy coding is defined by the following episodes of care:

• Unspecified
• Delivered
• Antepartum

However, coders will report pregnancy codes in ICD-10 based on the stage of pregnancy:

• First trimester
• Second trimester
• Third trimester

According to ICD-10 guidelines, trimesters are counted from the first day of the last menstrual period, and they are defined as follows:

• First trimester: Fewer than 14 weeks, zero days
• Second trimester: Fourteen weeks, zero days to fewer than 28 weeks, zero days
• Third trimester: Twenty-eight weeks, zero days until delivery

Have you taken a look at the codes you will most frequently report for your specialty in ICD-10? Share your quick tip for your specialty codes.  Did any of the new codes or the code descriptions surprise you? What interested you most about the changes?

Understand excludes notes in ICD-10

ICD-10 will bring a lot of welcome changes and correct many of the issues and shortcomings with ICD-9. One particular source of confusion with ICD-9 relates to the excludes notes. In ICD-9, the excludes notes can mean two things:

1. Do not code both of these codes together under any circumstances (e.g., a non-obstetrics code such as 629.81 [habitual aborter without current pregnancy] with an obstetrics code such as 646.33 [habitual aborter, antepartum condition], or a component of combination code 785.4 [gangrene] with combination code 440.24 [atherosclerosis of the extremities with gangrene]).

2. A particular condition is not classified to a specific code, but the coder is directed to another code or code category for the proper code for that particular condition; however, if both conditions occur, coders should assign the code that specifies both conditions. For example, code 787.9X (other digestive system symptoms) excludes gastrointestinal (GI) hemorrhage (code 578.x); however when both GI hemorrhage and diarrhea are present, then the coder can report both codes. An additional example would be when certain neurological symptoms classifiable to the 781 code category are present but they are not due to depression (code 311), the coder can code the neurological symptoms along with 311 despite the excludes note because both conditions are present.

This is very confusing concept in ICD-9 that will not be present in ICD-10.

In ICD-10, you will find the following:

• An excludes 1 note: meaning that the two codes are never assigned together
• An excludes 2 note: meaning simply that a different code should be assigned for that specific condition

I currently use ICD-10 to resolve personal coding questions of this nature when there is no other official guidance available. For example, I was trying to determine whether or not I can code pulmonary hypertension along with essential hypertension, which has been a controversial coding question for a long time. To make up my mind as to how I was going to treat the excludes note, I checked the ICD-10 codes for pulmonary hypertension, and the type of excludes note there is an excludes 1 note. So I used that to help me decide that I will only report code 416.0 or code 401.9, but I will not report both codes together.