News
ObGyn Medicare and CPT coding changes that could affect your income in 2015
Although Medicare reimbursement looks bleak for the coming year, awareness of some coding changes could help your bottom line
Unspecified codes still play a role
Unspecified ICD-10-CM codes still come into play when the clinician does not have enough information to assign a more specific code—that is, when, by the end of an encounter, no further information is available to assign a more specific diagnosis. For example, if a patient has signs of a fibroid upon examination, only the unspecified code can be reported until the clinician can discover whether it is intramural, submucosal, or subserosal. However, it would be equally incorrect to assign an unspecified code to an encounter once the nature of the fibroid has been determined.
Take note of these differences in coding
Here is a list of important new gynecologic coding requirements, which are presented in alphabetical order.
Amenorrhea, oligomenorrhea (N91.0–N91.5) and dysmenorrhea (N94.4–N94.5) will require documentation to indicate whether the condition is primary or secondary. Although an unspecified code is available, once treatment is begun the cause should be known and documented.
Artificial insemination problems will have a section:
- N98.0 Infection associated with artificial insemination
- N98.1 Hyperstimulation of ovaries
- N98.2 Complications of attempted introduction of fertilized ovum following in vitro fertilization
- N98.3 Complications of attempted introduction of embryo in embryo transfer
- N98.8 Other complications associated with artificial fertilization
- N98.9 Complication associated with artificial fertilization, unspecified.
Breast cancer codes will require documentation of which breast and what part of the breast is affected.
Contraceptive management highlights:
- Injectable contraceptives will have new codes for the initial prescription (Z30.013) and subsequent surveillance (Z30.42)
- IUD encounter for the prescription will have a new code (Z30.014), which is reported when the IUD is not being inserted on the same day
- Subdermal contraceptive implant surveillance will no longer have a specific code but will be included in the “other” contraceptive code Z30.49.
Conversion of a laparoscopic procedure to an open procedure will not have a code.
Cystocele, unspecified, will have code N81.10.
Dysplasia of vagina will be expanded into 3 codes based on mild, moderate, or unspecified: N89.0–N89.3.
Female genitourinary cancer codes:
- Documentation of right or left organs and which part of the uterus is affected will be required
- Cancer in situ of cervix will be expanded by site on the cervix: D06.0–D06.7
- Cancer in situ of the endometrium will have a specific code: D07.0.
Genuine stress urinary incontinence will only be referred to as stress incontinence (male or female). The code is now located in the urinary section of Chapter N: N39.3.
Genitourinary complications due to procedures and surgery will be organized in 1 section: N99
- Some conditions have more than 1 code based on cause:
- N99.2 Stricture of vagina due to surgical complication
- N89.5 Stricture of vagina not due to surgical complication
- N99.4 Pelvic adhesions due to surgical complication
- N73.6 Pelvic adhesions not due to surgical complication - Other codes will differentiate between intraoperative or postprocedure complications and whether the surgery is on the genitourinary system or a different surgery:
- N99.61 Intraoperative hemorrhage and hematoma of a genitourinary system organ or structure complicating a genitourinary system procedure
- N99.62 Intraoperative hemorrhage and hematoma of a genitourinary system organ or structure complicating other procedure
- N99.820 Postprocedural hemorrhage and hematoma of a genitourinary system organ or structure following a genitourinary system procedure
- N99.821 Postprocedural hemorrhage and hematoma of a genitourinary system organ or structure following other procedure.
Gynecologic examinations will have to include information on whether or not there were genitourinary abnormal findings on the exam. If so, an additional secondary code will be required to identify the abnormality: Z01.411 and finding code. (Without abnormal findings: Z01.419.) For instance, a diagnosis of bacterial vaginosis is made during the examination. The abnormal findings are not those from other areas such as the breast or thyroid.
Hematuria documentation must differentiate between gross: R31.0, benign essential:R31.1, or other forms: R31.2.
High-risk sexual behavior problems must be documented by heterosexual, bisexual, or homosexual behavior: Z72.51–Z72.53.
Hormonal contraceptives, long-term use, will have a specific code: Z79.3.
Hyperplasia without atypia (simple, complex, or benign) will be rolled into a single code: N85.01.
Immunizations, prophylactic, will not have specific codes as to type. An encounter for any type of immunization is Z23.
Pelvic pain will have its own symptom code: R10.2.
Personal history for cancer has been expanded:
- Personal history of cancer in situ:
- Z86.000 of breast
- Z86.001 of cervix uteri
- Z86.008 of other site - Personal history of benign neoplasm:
- Z86.012 of other benign neoplasm
- Z86.03 of uncertain behavior (borderline malignancies).
Procedures not carried out will be expanded in ICD-10 to include 2 new codes:
