Effective Oct. 1, 2016, the 2017 ICD-10 CM edits are in force! ICD hasn't been updated for three years, so there are a LOT of new, revised and deleted codes. In this blog I'll point out the major changes to the codes used in gynecology and obstetrics. I'll also provide you with a link to just those changes, as well as a link to the entire set of updates for 2017. But first, I'd like to review some of the main changes to OB coding that came about with the switch to ICD 10 last year.
CODING OBSTETRICS IN ICD-10
ICD 10's obstetric codes are found in Chapter 15 and begin with the letter "O". A few codes are also found in Chapter 21, the "Z" codes ("V" codes in ICD 9). Chapter 21 covers "Factors influencing health status and contact with health services". In addition to changing chapters and alphanumeric designations, ICD 10 added codes to capture the trimester, the weeks of pregnancy, and the fetus affected in multiple gestations, for the first time in United States coding.
Trimesters are counted from the first day of the last menstrual period. They are defined as follows:
ICD 10 further instructs to "Use additional code from category Z3A, Weeks of gestation, to identify the specific week of the pregnancy". Thus, every encounter in the prenatal record must include a code from Z3A._. The Z3A._ code follows the O00 - O9A codes for obstetric complications.
Another major change to OB coding in ICD 10 is the use of a 7th character extension to denote the fetus affected by the mother's condition, when there are multiple gestations. This extension is required for code categories O31, O32, O33.3 to O33.7, O35, O36, O40, O41, O60.1 to O60.2, O64, and O69. If the fetus cannot be determined, the number 0 is used in the 7th position. Remember that when adding a 7th character extension, the letter "X" is used as a placeholder to get you out to 7 characters. Example: O31.21X2 Continuing pregnancy after intrauterine death of one fetus or more, first trimester, fetus 2.
Finally, when coding multiple gestations, O30._, the codes have been expanded to include the number of gestations, amniotic sacs, and placentae, in addition to the 7th character designation for the affected fetus. For example: O30.212, Quadruplet pregnancy with two or more monochorionic fetuses, second trimester.
2017 CHANGES IN OBSTETRICS
Chapter 15 includes expansions for many categories. The ectopic pregnancy codes (O00) have been expanded to include without intrauterine pregnancy and with intrauterine pregnancy. A category of codes for molar pregnancy (O09.A) has been added. Codes 010 - O16 Edema, proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperium have also been expanded to code for complicating childbirth and complicating the peurperium.
A new code has been added for the use of oral hypoglycemic drugs: O24.415 Gestational diabetes mellitus in pregnancy, controlled by oral hypoglycemic drugs. Category O34.21 Maternal care for scar from previous cesarean delivery has been expanded to identify the different types of scars. Codes have been added to O44 Placenta previa to specify the type of previa. Finally, the codes for third degree perineal laceration have been expanded to include the degree of laceration:
O70.2 Third degree perineal laceration during delivery
In Chapter 21 Factors influencing health status and contact with health services (Z00-Z99), there is a change to the weeks of pregnancy codes, Z3A._. The description has been changed to add the words if known: Z3A Weeks of gestation - Note: Codes from category Z3A are for use, only on the maternal record, to indicate the weeks of gestation of the pregnancy, if known. In addition, there are new Z codes for "gestational carrier":
2017 CHANGES IN GYNECOLOGY
In Chapter 14, Diseases of the Genitourinary System, the category N39.4 Other specified urinary incontinence has been expanded to include three different types of urinary incontinence. Two types of inflammatory disorder of the breast have been added, N61.0 Mastitis without abscess and N61.1 Abscess of the breast and nipple. Category N83 Noninflammatory disorders of ovary, fallopian tube and broad ligament now includes laterality, for example N83.11 Corpus luteum cyst of right ovary.
Codes have been added to N90.6 Hypertrophy of vulva and N94.1 Dyspareunia to expand the types of conditions captured by the code set. A new code was created for N93.1 Pre-pubertal vaginal bleeding. Finally, category N99 Intraoperative and postprocedural complications and disorders of genitourinary system, not elsewhere classified has been greatly expanded.
Chapter 21 has a few additions affecting the gynecological practice. For Encounter for routine gynecological examination ICD 10 now provides the options of with abnormal findings and without abnormal findings. Several contraceptive choices have been added to Z30.4 Encounter for surveillance of contraceptives:
DOWNLOAD THE ICD 10 UPDATES FOR OB/GYN
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Kimberly A. Sherman, MA, CPC - Reimbursement warrior and HIPAA guru.