Physician practices are facing more than 845 ICD-10 changes, including 454 additions, 142 deletions, and over 250 revisions in 2018. The ICD-10 code set for 2018 includes quite a few changes of interest to ob-gyns. The updates for women’s health include new, revised and deleted ICD-10 codes. Partnering with an experienced medical coding outsourcing company could be the right option to ensure accurate reporting and proper reimbursement.

Ob-gyn Codes with Increased Specificity in 2018

There is greater specificity in reporting an unspecified lump in the breast in code section N63 and tubal and ovarian pregnancy codes have been expanded to allow identification of the affected side. There are 17 new codes for reporting of an antenatal screening encounter, with expanded reporting options for screening tests to determine fetal growth retardation and chromosomal abnormalities.

Gynecologic Code Changes

The two major changes in the gynecologic section are:

  • Addition of codes that describe a lump in the breast according to which breast and the location on the breast
  • Addition of a code for prophylactic removal of the fallopian tubes
  • Code N63 for an unspecified lump in the breast has been expanded to specify breast laterality and quadrant. The changes are as follows:
    • 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 left breast) with a fifth character specifying: 0 (unspecified quadrant), 1 (upper outer quadrant), 2 (upper inner quadrant), 3 (lower outer quadrant), and 4 (lower inner quadrant).
    •  
      There are new codes to identify the axillary tail and subareolar region of the breast:

    • N63.3 – (Unspecified lump in axillary tail) with a fifth character representing 1 (of the right breast) and 2 (of the left breast)
    • N63.4 – (Unspecified lump in breast, subareolar) with the fifth character representing 1 (right) and 2 (left)
  • Some other changes to gynecology codes:
    • Z31.5 Encounter for genetic counseling has been expanded to Encounter for procreative genetic counseling
    • Z40.02, Encounter for prophylactic removal of ovary(s) now refers to one or more ovaries without distinction of right or left
    • New code Z40.03, Encounter for prophylactic removal of fallopian tube(s)
    • Z80.8 Other endometriosis – addition of inclusion term “endometriosis of the thorax”
    • Z94.3, Premenstrual tension syndrome – deletion of inclusion term “premenstrual dysphoric disorder”

Code Changes for Obstetrics

  • Ectopic pregnancy codes

    The ectopic pregnancy code section O00 has been updated to specify laterality, that is, right or left structure affected. Codes O00.10, O00.11, O00.20, and O00.21 are no longer valid:

    • O00.1, Tubal pregnancy
      • O00.10, Tubal pregnancy without intrauterine pregnancy

        New codes:

        • 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

        New codes:

        • 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

        New codes:

        • 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

        New codes:

        • O00.211, Right ovarian pregnancy with intrauterine pregnancy
        • O00.212, Left ovarian pregnancy with intrauterine pregnancy
        • O00.219, Unspecified ovarian pregnancy with intrauterine pregnancy
  • Fetal heart rate abnormalities

    Along with O76, Abnormality in fetal heart rate and rhythm complicating labor and delivery, there are new codes to report a fetal heart rate or rhythm abnormality during the antepartum period:

    • 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
  • Antenatal screening

    Code section Z36 Encounter for antenatal screening of mother has been expanded to include 17 new codes that increase specificity for antenatal screening. It is important to take note of excludes notes and other inclusive terms.

    • Z36.0 Encounter for antenatal screening for chromosomal anomalies
      • Z36.1… raised AFP level
      • Z36.2… follow-up
      • Z36.3… malformations
      • Z36.4… fetal growth retardation
      • Z36.5… Encounter for antenatal screening for isoimmunization
    • Z36.8 Encounter for other antenatal screening
      • Z36.81… hydrops fetalis
      • Z36.82… nuchal translucency
      • Z36.83… congenital cardiac abnormalities
      • Z36.84… fetal lung maturity
      • Z36.85… Streptococcus B
      • Z36.86… cervical length
      • Z36.87… uncertain dates
      • Z36.88… fetal macrosomia
      • Z36.89… other specified antenatal screening
      • Z36.8A… antenatal screening for other genetic defects
    • Z36.9 Encounter for antenatal screening, unspecified

Other Changes for 2018

  • Z31.5 Encounter for genetic counseling – The description for this code has been revised to include the word “procreative”
    • Revised code Z31.5 Encounter for procreative genetic counseling
  • The changes for code section Z40.0 Encounter for prophylactic surgery for risk factors related to malignant neoplasms are:
    • Revised code: Z40.02 Encounter for prophylactic removal of ovary(s)
    • New code Z40.03 Encounter for prophylactic removal of fallopian tube(s)
  • New codes have been added to code section Z71.8, Other specified counseling:
    • New code: Z71.82 Exercise counseling
    • New code: Z71.83 Encounter for nonprocreative genetic counseling
  • The code description for Code Z79.890 Hormone replacement therapy (postmenopausal) has been revised to remove the word “postmenopausal” from the description:
    • Revised code: Z79.890 Hormone replacement therapy

In addition to paying attention to ob-gyn code updates, physicians need to ensure comprehensive documentation to support the specificity required for the new ICD-10 codes. Medical coding service providers can ensure compliance with the new coding guidelines only if the documentation is consistent, complete, and accurate.