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PART 1: ICD-10 for the Pelvic Health Patient

Written by Kelly Huestis,PT,MPT

Starting to worry about how to apply ICD-10 for your pelvic health patients? Fear not. 

I’m here to walk you through some examples of typical patient codes.  Remember, this coding system is not as cookie-cutter as ICD-9 was, and it’s brand new to all of us.  So, we cannot guarantee that all payors will reimburse specific codes.    While there may be some easy crosswalks, not all codes will be simple.  I encourage you to share your success and unsuccessful stories among your colleagues so that we can all learn together.

 A few tips before we start:

1. You can supply 4 ICD-10 codes per 1500 claim form.

2. Some codes may require a 7th character. Be careful with these.  If they require it but are less than 6 characters long, use an X as a placeholder in the additional spots. *The 7th character will indicate if the diagnosis is encountered as an initial encounter, subsequent encounter, or sequela of another issue.

3. Make sure that your documentation supports your coding choices.

4. To download your own free ICD-10 electronic index zip files:

a. go to Medicare’s ICD-10 webpage: https://www.cms.gov/Medicare/Coding/ICD10/index.html

b. Click on CMS 2015 ICD-10-CM and GEMS on the left side of the screen

c. Download the 2015 Code Tables and Index

5. When looking up codes, don’t just stop at the Index. The tabular section lists exclusions, “code also’s”, and other details that are critical.

Case #1

Mrs. Jones is a 62 year old female with stress incontinence.  She presents with pelvic floor weakness, dyscoordination, and core weakness.  ICD-9 codes used previously included 728.2 muscle disuse atrophy, 781.3 lack of coordination, and 625.6 stress urinary incontinence, female.

Step 1: Finding an ICD-10  for pelvic muscle weakness

a. Click on the Index of your zip file.  Go to “A” for atrophy, atrophic.
b. Once you get to atrophy, scroll down to “muscle” and then specifically to pelvic (disuse) which is listed as code #N81.84.  You will use N81 as your guide in the tabular index.
c. Now click on the PDF listed Tabular
d. Click on chapter 14, Diseases of the Genitourinary System (N00-N99)
e. Click on N80-N98, Noninflammatory disorders of the female genital tract
f. Scroll down to N81.8, Other female genital prolapse and look for any exclusions or requirements such as a 7th character. None are listed here.
g. Continue to N81.84 pelvic muscle wasting (disuse atrophy of pelvic muscles and anal spincter).

h. Your code is N81.84

Step 2: Finding a code for muscular in-coordination

a. Click on the Index of your zip file.  Go to “I” for Incoordination

b. Once you get to Incoordinate/Incoordintion, scroll down to “muscle” and see code for muscular R27.8.

c. Now click on the PDF listed Tabular

d. Click on chapter 18, Symptoms, Signs, and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

e. Click on R25-R29, Symptoms and signs involving the nervous and musculoskeletal systems.

f. Scroll down to R27, Other lack of coordination and look for any exclusions or requirements such as a 7th character. Note that there are 3 diagnoses that may not be used if R27 is being used as an ICD-10 code.

g. Continue to R27.8 Other lack of coordination, this is your code.

Step 3: Finding a code for female stress urinary incontinence

a. Click on the Index of your zip file.  Go to “I” for Incontinence

b. Once you get to Incontinence, R32, scroll down to “urinary”, and then “stress (female) (male) N39.3 (NOTE:  Most urinary and fecal incontinence diagnoses are found this way!!!

c. Now click on the PDF listed Tabular

d. Click on chapter 14, Diseases of the Genitourinary System (N00-N99)

e. Click on N30-N39, Other diseases of the urinary system

f. Scroll down to N39, Other disorders of urinary system and look for any exclusions or requirements such as a 7th character. Note that there are 4 diagnoses that state Excludes2.  This means  that these excluded conditions are not part of the conditions and may be coded at the same time if appropriate.

g. Continue to N39.3, Stress Incontinence (female) (male).  This code also has further exclusions.  It may not be used when using the ICD-10 for mixed incontinence (N39.46).  However, if there are any overactive bladder symptoms, the code N32.81 for overactive bladder should also be coded.

h. In this case, if there is no overactive bladder, N39.3 is the appropriate ICD-10 code alone.

KEEP YOUR EYES OPEN

Keep your eyes on the Section on Womens Health Blog and our upcoming ICD-10 webpage under the Practice section for more details and samples, top 10 ICD-10 crosswalks, and other helpful links.  Stay tuned next week for an example on pelvic pain!

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ICD-10: READY … SET .. CODE!
Part 2: ICD -10 for the Pelvic Health Patient

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