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:
- 1—bleeding
- 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."