ICD-10 Sidebar: 600 to N40: Anticipate Fewer Enlarged Prostate Code Choices

Cyst moves to dissimilar family.

While you start getting test orders in ICD-10 with enlarged prostate as the ordering diagnosis, you can bid adieu to benign prostatic hypertrophy (BPH). That’s for the reason that the new code set streamlines enlarged prostate coding by collapsing existing eight ICD-9 codes into four.

Make ‘Hypertrophy’ Easy

BPH (600.0x, Hypertrophy [benign] of prostate) may be the ordering diagnosis when your lab carries out a prostate specific antigen (PSA) test 84153 (Prostate specific antigen [PSA]; total) or perhaps a prostate biopsy (such as 88305, Level IV - Surgical pathology, gross and microscopic examination; prostate, needle biopsy).

However you won’t see the term ‘BPH’ when ICD-10 goes into effect, as the new code set collapses ICD-9 terminology "hypertrophy (benign) of prostate," "benign localized hyperplasia of prostate," and "hyperplasia of prostate, unspecified" into a lone terminology: "enlarged prostate."

Here’s how the codes stack up:

The following listed three ICD-9 codes crosswalk to N40.0 (Enlarged prostate without lower urinary tract symptoms) in ICD-10:

• 600.00 – (Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptoms (luts))
• 600.20 – (Benign localized hyperplasia of prostate without urinary obstruction and other lower urinary tract symptoms (luts))
• 600.90 – (Hyperplasia of prostate, unspecified, without urinary obstruction and other lower urinary symptoms (luts))

Likewise, N40.1 (Enlarged prostate with lower urinary tract symptoms) replaces the following listed three ICD-9 codes:

• 600.01 – (Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts))
• 600.21 – (Benign localized hyperplasia of prostate with urinary obstruction and other lower urinary tract symptoms (luts))
• 600.91 – (Hyperplasia of prostate, unspecified, with urinary obstruction and other lower urinary symptoms (luts))

Expect One-to-One for Nodular Prostate

In the same ICD-10 code family, you’ll find the following listed direct crosswalks:

• 600.10 (Nodular prostate without urinary obstruction) changes to N40.2 (Nodular prostate without lower urinary tract symptoms)
• 600.11 (Nodular prostate with urinary obstruction) changes to N40.3 (Nodular prostate with lower urinary tract symptoms)

Prostate cyst moves out of the "enlarged prostate" code family to the "other and indefinite disorders of prostate" code family in ICD-10. You’ll see ICD-9 code 600.3 (Cyst of prostate) change to N42.83 (Cyst of prostate) once the new codes go into effect

ICD-10 Update: Let Complications Guide Your Ulcerative Colitis Coding

Look beyond location to arrive at the right codes.

Ulcerative colitis is a form of inflammatory bowel disease that you will normally see in your gastroenterologist’s practice, so you’ll are required to understand how your ICD-9 codes will change to ICD-10 codes when they come into effect. Paying attention to the presence or absence of complications related with ulcerative colitis is your key to correctly reporting the condition.

Review the Notes for These Details

You will be required to know what indications might cause your gastroenterologist to suspect a diagnosis of ulcerative colitis. Though, a final diagnosis can only be determined after suitable blood tests and observational findings in endoscopy.

Symptoms of ulcerative colitis can involve chronic diarrhea (R19.7, Diarrhea, unspecified), rectal bleeding, fecal urgency (R15.2, Fecal urgency), lower abdominal cramps (R10.9, Unspecified abdominal pain), blood in stool (K92.1, Melena), as well as weight loss.

Your gastroenterologist may review tests for instance whole blood counts, ESR, stool specimens, liver function tests, and c-reactive protein to reach a diagnosis of ulcerative colitis.

Your gastroenterologist will also carry out diagnostic procedures for instance a proctosigmoidoscopy (45300,Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]), sigmoidoscopy (45330, Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen[s] by brushing or washing[separate procedure]), colonoscopy (45378, Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) or colonoscopy with biopsy (45380, Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple) to confirm the diagnosis of ulcerative colitis. Throughout these procedures, your gastroenterologist will decide the extent of the problem and will also check the presence (or absence) of complications like obstruction, fistula, bleeding or any kind of abscess.

Reporting Ulcerative Colitis in ICD-9

Under ICD-9, ulcerative colitis is reported with ICD-9 code 556.x. The fourth digit identifies the location of the pathology. ICD-9 code 556.x expands to nine codes depending on location. In ICD-9, you do not pay attention to the presence of complications when you report the condition.

Notice Location Guidance and Complications

When ICD-10 comes into effect, the location of the lesion will decide your ICD-9 code. Besides the location, you are required to look for the presence of complications for instance rectal bleeding, intestinal obstruction, fistula, and abscesses as the code for ulcerative colitis in ICD-10 is further expanded to the fifth digit depending on the existence of these specified or unspecified complications.

ICD-10-CM: 172.4 and C43.4 Vary in 1 Main Way for Melanoma Coding

Plus: Get an up-to-date on the proposed implementation date.

News flash: On April 9, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius declared a proposed rule that includes a new ICD-10 implementation date: Oct. 1, 2014.

In case the new date has you feeling motivated to step up your preparations, check out this review of coding melanoma of the scalp and neck. It discloses how corresponding ICD-9 codes and ICD-10 codes with similar definitions may include dissimilar diagnoses.

ICD-9 Code:

• 172.4 (Malignant melanoma of skin of scalp and neck)

ICD-10 Codes

• C43.4 (Malignant melanoma of scalp and neck)
• D03.4 (Melanoma in situ of scalp and neck)

ICD-9-CM coding rules: ICD-9-CM teaches you to include melanocarcinoma, melanoma in situ of skin, and melanoma (skin) NOS under ICD-9 code 172.x (Malignant melanoma of skin).

ICD-10-CM changes: The dissimilarity between your choices of ICD-9 codes and ICD-10codes for this particular diagnosis is that ICD-10-CM does not include melanoma in situ (D03.-) from C43.- (Malignant melanoma of skin).

For melanocarcinoma the ICD-10-CM index entry tells you to "see melanoma." So for that diagnosis you’ll choose the accurate code from the melanoma entry and then substantiate your choice in the tabular listing.

Documentation: While selecting your ICD-10-CM code, you will first require confirming that whether the location of the melanoma is the scalp or neck. After that you will be required to determine whether the melanoma is documented as "in situ." The National Cancer Institute specifies that melanoma in situ is stage 0 melanoma. The abnormal cells are located in the epidermis in stage 0 melanoma.

As a medical oncology coder, you’re more expected to see a patient diagnosed with melanoma (not in situ) and most probably it will have metastasized. In case the oncologist documents stage I or above, or specifies the melanoma has metastasized, you’ll know that the melanoma is not in situ.

Medical Billing and Coding Tip: Code C43.- does not include melanoma in situ using an Excludes1 note. It specifies that the excluded diagnosis (D03.-, melanoma in situ) must never be used at the same time as the code that has the Excludes1 note (C43.-). Excludes1 is used once two conditions cannot take place together, for instance a congenital form and an acquired form of the similar condition.

Remember: While ICD-10-CM goes into effect, you must apply the code set and official guidelines in effect for the date of service reported to ensure accurate medical billing and coding.

ICD-10 Update: You’ll Be Required to Be More Precise with Muscle and Connective Tissue Disorders When ICD-10 Hits

Pay attention to the site of involvement.

While you’re coding for ligament disorders, palmar fascia contracture, foreign body granulomas, and muscle spasm, your ICD-10 code choices will increase substantially. Read on for advice on how to best describe these and other common connective tissue conditions.

Get Clinical Staff Used to Even More Specifics

To prepare doctors for this level of detail, you must start training now. Before the ICD-10 implementation date, coders will require educating their physicians on the need for a much higher degree of specificity in their diagnostic statements.

Identify Discrete Codes for Paraplegia, Fibromatoses

The ICD-9 codes for definite muscle disorders like 728.3 (Other specific muscle disorders) which includes disorders like athrogryposis and immobility syndrome (paraplegic) translate to two different ICD-10 codes. The ICD-10 code for immobility syndrome is M62.3 (Immobility syndrome [paraplegic]) and that for other specific disorders is M62.89 (Other specified disorders of muscle). "Immobility syndrome has been awarded a specific code for ICD-10, while ‘other specified disorders of the muscle’ has been left undefined to capture the remainder of the unspecified muscle disorders.

The ICD-9 code used for fibrosis in muscle ligaments, 728.79 (Other fibromatoses of muscle ligament and fascia), extends to a couple of ICD-10 codes as below:

• M72.1 (Knuckle pads)
• M72.4 (Pseudosarcomatous fibromatosis)

Narrow Down To a Common Code for Ligament Disorders

The ligament disorder code in ICD-10 is more generalized for including a broader array of ligament disorders. While the ICD-9 code 728.4 (Laxity of ligament) was exclusively descriptive of ligament laxity, the ICD-10 code M24.20 (Disorder of ligament, unspecified site) defines ‘disorder of ligament’. This means that disorders other than a lax ligament can be reported with this code.

There is a wider scope for the ICD-10 code M62.89 (Other specified disorders of muscle). The disorder can be in muscle tendons, fascia, ligament, or aponeurosis. The ICD-9 code 728.89 (Other disorders of muscle ligament and fascia), on the other hand, is more specific for ligament and fascia.

As far as the unspecified disorders of the connective tissues are concerned, you have ICD-9 code 728.9 (Unspecified disorder of muscle ligament and fascia). In ICD-10, you will go for code M62.9 (Disorder of muscle, unspecified). ICD-10 has listed a code definite to the muscle alone. There is also a definite code for disorder of ligament for ICD-10. The ligamentous disorder code is broken down by location, RT vs LT, with unspecified code for each body area when RT and LT are not listed. Coders can now be more definite as the actual tissue affected.

Look For Correct K Codes for Duodenal Ulcers in ICD-10

Obstruction is no more vital for accurate coding.

While reporting duodenal ulcers in ICD-10, you won’t have to be concerned about looking for obstructions: in its place, you’ll concentrate on perforation and hemorrhage to arrive at the appropriate ICD-10 code. See the following for more information on how duodenal ulcer dx coding will transform when ICD-10 goes into effect.

Your gastroenterologist might diagnose a duodenal ulcer on the basis of history, an in-depth examination, signs and symptoms for instance pain in the abdominal area underneath the sternum (that might be precipitated by intake of food or hunger), retching, vomiting along with bloating.

Your gastroenterologist may also carry out an endoscopy (43235, Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) or a breath test (for detection of H. pylori (83013, Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope [e.g., C-13] and 83014, Helicobacter pylori; drug administration) to reach at the diagnosis of a duodenal ulcer (532, Duodenal ulcer).

How to Report Duodenal Ulcers in ICD-9

As per ICD-9 classification, duodenal ulcers are reported with a fourth and a fifth digit depending on a number of factors for instance chronicity, with or without hemorrhage, perforation and obstruction.

How ICD-10 is Different?

When ICD-9 changes to ICD-10, the descriptors existing in ICD-10 will almost be similar as the descriptors that now exist in ICD-9. Though, the only change of note is that the fifth digit classification (based on the presence or absence of obstruction) has been joined to give a single code without indication about the presence or absence of obstruction.

Tip: While you are reporting for duodenal ulcers, two ICD-9 codes will now be represented by a single ICD-10 code as now the presence or absence of obstruction no longer forms the basis for classification.

According to this, ICD-10 code K26.4 (Chronic or unspecified duodenal ulcer with hemorrhage) will replace ICD-9 codes 532.40 (Chronic or unspecified duodenal ulcer with hemorrhage without obstruction) and 532.41(Chronic or unspecified duodenal ulcer with hemorrhage with obstruction).

Check out the following list for more instances of how two ICD-9 codes for duodenal ulcers are characterized by a single ICD-10 code:

• ICD-9: 532.50 (Chronic or unspecified duodenal ulcer with perforation without obstruction) and 532.51 (Chronic or unspecified duodenal ulcer with perforation with obstruction)
• ICD-10: K26.5 (Chronic or unspecified duodenal ulcer with perforation)
• ICD-9: 532.60 (Chronic or unspecified duodenal ulcer with hemorrhage and perforation without obstruction) and 532.61 (Chronic or unspecified duodenal ulcer with hemorrhage and perforation with obstruction)
• ICD-10: K26.6 (Chronic or unspecified duodenal ulcer with both hemorrhage and perforation)
• ICD-9: 532.00 (Acute duodenal ulcer with hemorrhage without obstruction) and 532.01 (Acute duodenal ulcer with hemorrhage with obstruction)
• ICD-10: K26.0 (Acute duodenal ulcer with hemorrhage)
• ICD-9: 532.10 (Acute duodenal ulcer with perforation without obstruction) and 532.11 (Acute duodenal ulcer with perforation with obstruction)
• ICD-10: K26.1 (Acute duodenal ulcer with perforation).