ICD-10 Will Bring One-To-One Equivalents

As we get ready to embrace ICD-10 Codes, many of you might be dreading the transition. But rest assured. Many a time you'll find simple one-to-one relationships between old and new codes. That is the case for hyperplasia; but even then you need to stay alert. You'll still need to carry over the same coding conventions.

For example, think that your ob-gyn suspects hyperplasia. She detects and documents 'endometrial thickening' during an ultrasound examination. What diagnosis should you use here?

Just because your ob-gyn documents endometrial thickening doesn't mean the patient has endometrial hyperplasia (621.30, Endometrial hyperplasia, unspecified; or 621.31, Simple endometrial hyperplasia without atypia). Many coders commit this mistake.

Remember this pitfall: If you encounter the same scenario in 2013, you shouldn't necessarily report the straight forward hyperplasia equivalents N8500 (Endometrial hyperplasia, unspecified) and N8501 (Simple endometrial hyperplasia without atypia). Take note how these definitions are exactly the same.

Coding tips: Do not be swayed by 'endometrial thickening'. You shouldn't code this as hyperplasia as physicians do not always consider the thickening of the uterus "abnormal;" as a matter of fact, it is just a monthly 'ramp up' for all women. Don't report hyperplasia until the ob-gyn has carried out a biopsy, and you have a pathology report that confirms this condition.

Solution: As you have no code to describe the patient's condition, you should report 793.5 (Nonspecific abnormal findings by ultrasound of genitourinary organs). Endometrial thickening is a finding and not a diagnosis. As such, you should locate the diagnosis code in the signs and symptoms section of ICD-9. If you take a look under 'thickened endometrium', this'll lead you to 793.5.

In the ICD-10 alphabetic index, you will not see 'thickened endometrium' referenced at all so you would usually rely on the choices given by one of the equivalent tables that have been produced (such as the ICD-10 bridge found at a coding resource like Supercoder/) based on the ICD-9 code 793.5.

Word of caution: If you look up 793.5's ICD-10 equivalent, you will find that the National Center for Health Statistics still lists R93.4 (Abnormal findings on diagnostic imaging of urinary organs), which is incorrect because the uterus is not a urinary organ.