ICD-10-CM code changes: What's new for 2018

The list of new and revised International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes has been published, with changes becoming effective on October 1, 2017. This year, you can look forward to minimal code changes for gynecologic conditions. The biggest change in this category is the addition of codes that describe a lump in the breast according to which breast and the location on the breast, as well as the addition of a code for prophylactic removal of the fallopian tubes. The codes related to obstetrics will have more extensive changes. You will find revisions to the codes for ectopic pregnancy, a new set of codes for addressing an abnormal fetal heart rate during the antepartum period, and, most welcome of all, an expansion of the single code for antenatal testing to 17 very specific codes.

Gynecologic code changes

The single code N63, Unspecified lump in breast, has been expanded to include codes for both the right and the left breast. Code N63 therefore will be considered invalid after October 1, 2018. Expanded codes include:

• N63.0, Unspecified lump in unspecified breast
• N63.1, Unspecified lump in the right breast
  • N63.10, Unspecified lump in the right breast, unspecified quadrant
  • N63.11, Unspecified lump in the right breast, upper outer quadrant
  • N63.12, Unspecified lump in the right breast, upper inner quadrant
  • N63.13, Unspecified lump in the right breast, lower outer quadrant
  • N63.14, Unspecified lump in the right breast, lower inner quadrant
• N63.2, Unspecified lump in the left breast
  • N63.20, Unspecified lump in the left breast, unspecified quadrant
  • N63.21, Unspecified lump in the left breast, upper outer quadrant
  • N63.22, Unspecified lump in the left breast, upper inner quadrant
  • N63.23, Unspecified lump in the left breast, lower outer quadrant
  • N63.24, Unspecified lump in the left breast, lower inner quadrant
• N63.3, Unspecified lump in axillary tail
  • N63.31, Unspecified lump in axillary tail of the right breast
  • N63.32, Unspecified lump in axillary tail of the left breast
• N63.4, Unspecified lump in breast, subareolar
  • N63.41, Unspecified lump in right breast, subareolar
  • N63.42, Unspecified lump in left breast, subareolar

Other changes to gynecologic codes

There has been a minor change to the description for code Z31.5, Encounter for genetic counseling. It now is described as "Encounter for procreative genetic counseling."

The code Z40.02, Encounter for prophylactic removal of ovary(s), now refers to one or more ovaries without distinction of right or left, and a new code has been added for removal of the fallopian tube(s), Z40.03, Encounter for prophylactic removal of fallopian tube(s).

The inclusion term "endometriosis of the thorax" has been added to code N80.8, Other endometriosis.

The inclusion term "premenstrual dysphoric disorder" has been deleted from code N94.3, Premenstrual tension syndrome. If the patient has been diagnosed with this condition, the code F32.81, Premenstrual dysphoric disorder, should be reported, as this is considered a mental health issue.

The "excludes 1" note under code Z87.41, Personal history of dysplasia of the female genital tract, has been revised. The codes for personal history of intraepithelial neoplasia III that may not be reported with this code are Z86.001 and Z86.008.

Obstetric code changes

The ectopic pregnancy codes have been revised to include references to the right or left structure affected, which means the codes change from 5 digits to 6 digits in length, and the codes O00.10, O00.11, O00.20, and O00.21 will no longer be valid.

• O00.1, Tubal pregnancy
  • O00.10, Tubal pregnancy without intrauterine pregnancy
    • O00.101, Right tubal pregnancy without intrauterine pregnancy
    • O00.102, Left tubal pregnancy without intrauterine pregnancy
    • O00.109, Unspecified tubal pregnancy without intrauterine pregnancy
  • O00.11, Tubal pregnancy with intrauterine pregnancy
    • O00.111, Right tubal pregnancy with intrauterine pregnancy
    • O00.112, Left tubal pregnancy with intrauterine pregnancy
    • O00.119, Unspecified tubal pregnancy with intrauterine pregnancy
• O00.2, Ovarian pregnancy
  • O00.20, Ovarian pregnancy without intrauterine pregnancy
    • O00.201, Right ovarian pregnancy without intrauterine pregnancy
    • O00.202, Left ovarian pregnancy without intrauterine pregnancy
    • O00.209, Unspecified ovarian pregnancy without intrauterine pregnancy
  • O00.21, Ovarian pregnancy with intrauterine pregnancy
    • O00.211, Right ovarian pregnancy with intrauterine pregnancy
    • O00.212, Left ovarian pregnancy with intrauterine pregnancy
    • O00.219, Unspecified ovarian pregnancy with intrauterine pregnancy

New codes for fetal heart rate abnormalities

New codes have been added to report a fetal heart rate or rhythm abnormality during the antepartum period. Until now, there only has been a code that addresses this issue during labor and delivery, O76, Abnormality in fetal heart rate and rhythm complicating labor and delivery.

• O36.83, Maternal care for abnormalities of the fetal heart rate or rhythm
  • O36.831, Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester
  • O36.832, Maternal care for abnormalities of the fetal heart rate or rhythm, second trimester
  • O36.833, Maternal care for abnormalities of the fetal heart rate or rhythm, third trimester
  • O36.839, Maternal care for abnormalities of the fetal heart rate or rhythm, unspecified trimester

Several codes redefined

ICD-10 has corrected an "excludes" note error for the code O99.1, Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism complicating pregnancy, childbirth, and the puerperium. In 2017, any hemorrhage with coagulation defects defined in code category O45.- or codes O46.0-, O67.0, or O72.3 could be reported with O99.1. This set of codes has now been redefined as an "excludes 1" note, which means that they may not be reported with O99.1 since they are considered inclusive.

More specific codes added for antenatal screening

Great news for those awaiting a more specific code for antenatal screening: The code Z36 has been expanded to more closely match the codes that were available in ICD-9-CM, but it goes beyond the basic list in that codes have been added for things like nonvisualization of anatomic structures on a previous scan and screening for cervical length and fetal lung maturity. Be sure to pay attention to the excludes notes and other inclusive terms.

• Z36, Encounter for antenatal screening of mother (Screening is the testing for disease or disease precursors in asymptomatic individuals so that early detection and treatment can be provided for those who test positive for the disease.)

  Includes: Encounter for placental sample (taken vaginally)

  Excludes 2: O28.-, Abnormal findings on antenatal screening of mother
  

  • Z36.5, Encounter for antenatal screening for isoimmunization
  • Z36.4, Encounter for antenatal screening for fetal growth retardation
    Intrauterine growth restriction (IUGR)/small-for-dates
  • Z36.3, Encounter for antenatal screening for malformations
    Screening for a suspected anomaly
  • Z36.2, Encounter for other antenatal screening follow-up
    Nonvisualized anatomy on a previous scan
  • Z36.1, Encounter for antenatal screening for raised alpha-fetoprotein level
    Encounter for antenatal screening for elevated maternal serum alpha-fetoprotein level
  • Z36.0, Encounter for antenatal screening for chromosomal anomalies
• Z36.81, Encounter for antenatal screening for hydrops fetalis
  • Z36.8A, Encounter for antenatal screening for other genetic defects
  • Z36.89, Encounter for other specified antenatal screening
  • Z36.88, Encounter for antenatal screening for fetal macrosomia
    Screening for large-for-dates
  • Z36.87, Encounter for antenatal screening for uncertain dates
  • Z36.86, Encounter for antenatal screening for cervical length
    Screening for risk of preterm labor
  • Z36.85, Encounter for antenatal screening for Streptococcus B
  • Z36.84, Encounter for antenatal screening for fetal lung maturity
  • Z36.83, Encounter for fetal screening for congenital cardiac abnormalities
  • Z36.82, Encounter for antenatal screening for nuchal translucency
  • Z36.81, Encounter for antenatal screening for hydrops fetalis
• Z36.9, Encounter for antenatal screening, unspecified

Code changes for abortion and complications

The code range for use with Z3A, weeks of gestation, has changed from O00-O9A to O09-O9A to reflect the guideline change last year to remove the requirement to use this code with any code that describes pregnancy with an abortive outcome (codes O00-O08).

In addition, if a patient has retained products of conception (POC) after either a spontaneous or elective abortion, report the "without complication" code for the retained POC (O03.4, Incomplete spontaneous abortion without complication, or O07.4, Failed attempted termination of pregnancy without complication). If any other complication occurred in addition to the retained POC, use the code for that particular complication and not O03.4 or O07.4.

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