Monday, August 26, 2013

ICD-10: Shift Your Hemorrhoid Diagnosis To 184 From 455



Now that the date for implementation of ICD-10 has been decided, you must start preparing for the transition. Beginning October 1, 2014, when coding for hemorrhoid cases you will need to compare your anesthesiologist’s notes with those of the surgeon even more often. This is because the new ICD-10 code set adds codes for "internal and external" in addition to codes for internal, unspecified, or external hemorrhoids. However, this is not the only change that you’ll notice when you choose a hemorrhoid diagnosis in ICD-10

Note the hierarchy

Under the present ICD-9 code set, you have 10, four digit codes under the category 455 (Hemorrhoids). The fourth digit 0-9 separates each code depending on whether the hemorrhoids are internal, external, or unspecified, and also whether the patient exhibits specific complications.
ICD-10, in contrast, provides following three choices (four digit codes) depending on whether the hemorrhoids are thrombosed, have other complications, or have no complications:

  •        I84.0—Thrombosed hemorrhoids
  •        I84.1—Hemorrhoids with other complications
  •       I84.2—Hemorrhoids without complication.

Establish location using a fifth digit

Under ICD-10, you would use the fifth digit to show hemorrhoid location as follows:

  • 0—Unspecified
  • 1—Internal
  • 2—External
  • 3—Internal and external.

Specify complication with sixth digit 

After you made your selection to the correct five-digit code, you’ll need to add further specificity to explain if the patient has one of the "other" complications. For subcategory I84.1x, you have the options to choose from the following sixth digits:


  • 1bleeding 
  • 2—prolapsed
  • 3—strangulated
  • 4—ulcerated.

 Consider for example a patient has internal and external ulcerated haemorrhoids. In this case you would report the code I84.134 (Internal and external ulcerated hemorrhoids) in ICD-10. 

Again, for the same condition, you’d have to select a more general code that could represent any number of complications (such as bleeding, prolapsed, strangulated, or ulcerated) under ICD-9. However, ICD-10 allows you to gain specificity by capturing "internal and external" hemorrhoids, and by identifying that the complication is "ulcerated."