by Bonnie G. Schreck, CCS CPC COC CCS-P COBGC
Aug 16th, 2016
The final list of the new ICD-10- CM codes that become effective October 1, 2016 has been released. There are approximately 1600 changes to the code set, making up for the four years the ICD-10- CM codes have not had a complete update. For fiscal year (FY) 2017, updates to the 2017 ICD-10- CM gynecology codes include more detailed codes, laterality, revision of postprocedural and other complications, such as problems with genitourinary implants and prostheses.
Breast Inflammatory Disorders of the Breast
The breast inflammatory disorders have been expanded and include the following two new codes:
N61.0 Mastitis without abscess
N61.1 Abscess of the breast and nipple
Ovaries and Fallopian Tubes
For most ovary and fallopian tube codes that did not previously indicate laterality, new codes have been added for right (character of 1) and left (character of 2). The unspecified code has a character of 0 (zero) or 9. These subcategory codes are:
N83.0- Follicular cyst of ovary
N83.1- Corpus luteum cyst
N83.20- Unspecified ovarian cysts
N83.29- Other ovarian cysts
N83.31- Acquired atrophy of ovary
N83.32- Acquired atrophy of fallopian tube
N83.33- Acquired atrophy of ovary and fallopian tube
N83.4- Prolapse and hernia of ovary and fallopian tube
N83.51- Torsion of ovary and ovarian pedicle
N83.52- Torsion of fallopian tube
Vulvular Hypertrophy
Hypertrophy of the vulva, N90.6-, has been expanded to include code N90.61 Childhood asymmetric labium majus enlargement or CALME, which is a female’s outer outer labia that has become swollen or enlarged on one side because of excess tissue growth. This extra tissue mass causes one side of the labia to be larger than the other, leading to an asymmetrical appearance.
Other codes that have been added include the following two codes:
N90.60 Unspecified hypertrophy of vulva
N90.69 Other specified hypertrophy of vulva
Dyspareunia
Dyspareunia is difficult or painful sexual intercourse. Previously identified with only one code, new codes have been created, which include:
N94.10 Unspecified dyspareunia
N94.11 Superficial (introital) dyspareunia (pain upon entry)
N94.12 Deep dyspareunia
N94.19 Other specified dyspareunia
Postprocedural Complications (Genitourinary Chapter [N codes])
For postprocedural hemorrhages, hematomas, and seromas, all of which were previously reported with one code from subcategory N99.82-, has now been separated into individual codes:
N99.820 Postprocedural hemorrhage of a genitourinary system organ or structure following a genitourinary system procedure
N99.821 Postprocedural hemorrhage of a genitourinary system organ or structure following other procedure
N99.840 Postprocedural hematoma of a genitourinary system organ or structure following a genitourinary system procedure
N99.841 Postprocedural hematoma of a genitourinary system organ or structure following other procedure
N99.842 Postprocedural seroma of a genitourinary system organ or structure following a genitourinary system procedure
N99.843 Postprocedural seroma of a genitourinary system organ or structure following other procedure
Congenital Anomaly: Longitudinal vaginal septum
A longitudinal vaginal septum is a congenital anomaly where a wall of tissue running down the length of the vaginal canal, partitions the space into two vaginal passageways.
The following codes have been added to identify the different types:
Q52.120 Longitudinal vaginal septum, nonobstructing
Q52.121 Longitudinal vaginal septum, obstructing, right side
Q52.122 Longitudinal vaginal septum, obstructing, left side
Q52.123 Longitudinal vaginal septum, microperforate, right side
Q52.124 Longitudinal vaginal septum, microperforate, left side
Q52.129 Other and unspecified longitudinal vaginal septum
Genitourinary Mesh Implant and Prosthetic Device Complications
Repairs of a prolapsed uterus is sometimes performed using implanted mesh material. Previously included in codes for complications associated with other prosthetic implant materials, implanted mesh now has separate codes:
T83.728- Exposure of other implanted mesh into organ or tissue
T83.79X- Other specified complications due to other genitourinary prosthetic materials, initial encounter
The 7 th character of A (initial encounter), D (subsequent encounter), or S (sequela) is added to identify the episode of care.
For subcategory codes T83.81X- (embolism), T83.82X- (fibrosis), T83.83X - (hemorrhage), T83.84X– (pain), T83.85X– (stenosis), T83.86X– (thrombosis), terminology has been revised in the code descriptions; ‘of’ has been changed to ‘due to’.
Examples of this change are:
Previous code description:
- T83.81XA Embolism of genitourinary prosthetic devices, implants and grafts, initial encounter
New code description:
- T83.81XA Embolism due to genitourinary prosthetic devices, implants and grafts, initial encounter
Contraception
Codes have been added for a visit that prescribes the different types of contraception available for use. These codes are:
Z30.015 Encounter for initial prescription of vaginal ring hormonal contraceptive
Z30.016 Encounter for initial prescription of transdermal patch hormonal contraceptive device
Z30.017 Encounter for initial prescription of implantable subdermal contraceptive
Z30.44 Encounter for surveillance of vaginal ring hormonal contraceptive device
Z30.45 Encounter for surveillance of transdermal patch hormonal contraceptive device
Z30.46 Encounter for surveillance of implantable subdermal contraceptive
Gestational Carriers
New codes have been added to report when a gestational carrier, or a surrogate mother, is seen for a medical service. This is a woman who bears a child on behalf of another woman, either from her own egg fertilized by the other woman's partner, or from the implantation in her uterus of a fertilized egg from the other woman. The two new codes are:
Z31.7 Encounter for procreative management and counseling for gestational carrier
Z33.3 Pregnant state, gestational carrier
Uterine Scar
For those patients who have had a previous surgery and have a uterine scar, code Z98.891
History of uterine scar from previous surgery is reported.
For more information on the 2017 ICD-10- CM update, go to: https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD- 10-CM- and-GEMs.html
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