A higher level of specificity in coding, however, can make all the difference in receiving adequate reimbursement and preventing denials. For example, if you perform a Pap smear on a patient who has two cervices, a code that specifies a duplicate cervix can clearly tell the payer that billing for both is not a duplicate service or billing error.
Changes to codes in this area of care take the form of expanding existing codes. Code 752.3 (other anomalies of uterus) has been expanded to seven distinct five-digit codes to capture the seven anomalies of the uterus:
752.31 Agenesis of uterus
752.32 Hypoplasia of uterus
752.33 Unicornuate uterus (This code would be reported if the unicornuate uterus did or did not have a separate uterine horn, or if the uterus had only one functioning horn.)
752.34 Bicornuate uterus
752.35 Septate uterus (This code would be reported whether the septate was complete or partial.)
752.36 Arcuate uterus
752.39 Other anomalies of uterus (This code category includes aplasia or any other Müllerian anomaly of the uterus that is not otherwise or elsewhere classified.)
New codes have been added to the 752.4 code category (anomalies of cervix, vagina, and external female genitalia) to expand the options. Before October 1, 2010, any of these conditions would have been coded as 752.49, an “other” category.
752.43 Cervical agenesis
752.44 Cervical duplication
752.45 Vaginal agenesis (This code can also be reported for vaginal hypoplasia.)
752.46 Transverse vaginal septum
752.47 Longitudinal vaginal septum
For a patient who has a history of one of these anomalies, you would report new code V13.62, (personal history of other [corrected] congenital malformations of genitourinary system) if this history was a factor in her current care.
Inserting and removing an IUD are integral services that most ObGyn practices provide, so it is imperative that your encounter forms reflect two new codes, to avoid denials for an invalid diagnosis code. A reminder: Code V45.51 (intrauterine contraceptive device) is a status code. It indicates that a patient has an IUD in place but you should never use it as a diagnosis code when the purpose of the visit is for you to check on the device and assess how it is working.
Changes in this area are:
Before October 1, 2010:
V25.1 Insertion
V25.42 Checking, reinsertion and/or removal After October 1, 2010:
V25.11 Encounter for insertion of intrauterine contraceptive device
V25.12 Encounter for removal of intrauterine contraceptive device
V25.13 Encounter for removal and reinsertion of intrauterine contraceptive device
V25.42 Encounter for routine checking of intrauterine contraceptive device
Regrettably, the number of patients who have a very high body mass index (BMI) is increasing. When surgery is planned, reporting this information in your coding can help establish 1) the medical need for significant additional work during the procedure or 2) health risks in support of therapy.
Code V85.4 (Body mass index 40 and over, adult) has been expanded to five new codes. They should be reported secondary to the type of obesity (i.e., codes 278.0x [overweight and obesity]).
V85.41 Body Mass Index 40.0–44.9, adult
V85.42 Body Mass Index 45.0–49.9, adult
V85.43 Body Mass Index 50.0–59.9, adult
V85.44 Body Mass Index 60.0–69.9, adult
V85.45 Body Mass Index 70 and over, adult
Fecal incontinence can present as problematic symptoms—fecal smearing, fecal urgency, incomplete defecation—but, until now, you only had one code to report any of these problems.
For that reason, 787.6 (incontinence of feces) has been expanded into four new five-digit codes. In addition, a new code has been added to report fecal impaction, which, in the past, was reported as 560.39, an “other” category code that was not specific to this problem.
New codes are:
560.32 Fecal impaction
787.60 Full incontinence of feces
787.61 Incomplete defecation
787.62 Fecal smearing
787.63 Fecal urgency
PERSONAL HISTORY OF DYSPLASIA
New codes have been added to complete the personal history codes for dysplasia. In addition to the existing code for cervical dysplasia history (V13.22), you can now report:
V13.23 Personal history of vaginal dysplasia
V13.34 Personal history of vulvar dysplasia
INDEX AND INSTRUCTIONAL CHANGES
These changes take effect October 1, 2010:
- Clarification that an abnormal Pap result indicated non-atypical endometrial cells should be reported using 795.09.
- Clearly indicate whether a fistula between the uterus and another organ is congenital (752.39) or noncongenital (619.0-619.9).
- Precocious menstruation should be coded as 259.1, not as a menstrual disorder.
- The terminology in the index and tabular sections has been revised to more clearly differentiate long-term from prophylactic use of medications. This change affects only code category titles and lookup terms, not existing code numbers.