ICD-10 2018: This Is Why Documenting Site Matters for Undescended-Testicle Coding

document location for more accurate coding

Our initial overview of ICD-10-CM 2018 looked at specialties with a large number of changes. But there are plenty of important changes coming Oct. 1, 2017, that didn’t fit into that quick analysis. Case in point: Urology has some interesting new codes that will be important for anyone who reports services related to congenital undescended testicles.

Does Your Documentation Have What It Takes?

The new codes fit into the existing subcategories of Q53.1- (Undescended testicle, unilateral) and Q53.2- (Undescended testicle, bilateral). To ensure accurate code choice, be sure your clinicians are documenting the anatomic location information you need, such as intraabdominal, inguinal, or high scrotal, along with whether the condition is unilateral or bilateral.

Here are the codes expected to be implemented Oct. 1, 2017, as part of ICD-10-CM 2018:

  • Q53.111, Unilateral intraabdominal testis
  • Q53.112, Unilateral inguinal testis
  • Q53.13, Unilateral high scrotal testis
  • Q53.211, Bilateral intraabdominal testes
  • Q53.212, Bilateral inguinal testes
  • Q53.23, Bilateral high scrotal testes.

Tip: You will still have distinct codes for an ectopic perineal testis diagnosis in 2018: Q53.12 (Ectopic perineal testis, unilateral) and Q53.22 (Ectopic perineal testis, bilateral).

Be Sure Procedure Coding and Diagnosis Coding Match

If the correct diagnosis code for your case is a bilateral code, such as bilateral intraabdominal testes code Q53.211, your procedure code may need a modifier 50 (Bilateral procedure).

Codes like 54650 (Orchiopexy, abdominal approach, for intra-abdominal testis [e.g., Fowler-Stephens]) and 54692 (Laparoscopy, surgical; orchiopexy for intra-abdominal testis) are priced as unilateral codes on the Medicare Physician Fee Schedule.

How do you know? Those specific codes have a bilateral indicator of 1 on the fee schedule, which means a 150 percent payment adjustment applies for bilateral procedures.

More specifically, a MAC bases the payment for these codes “on the lower of: (a) the total actual charge for both sides or (b) 150 percent of the fee schedule amount for a single code.”

The payer will apply the bilateral payment adjustment before applying the multiple procedure payment rules.

How About You?

Based on what you’ve seen, will your clinicians’ documentation need to change to help you choose among new ICD-10-CM codes? Or does their documentation already include this information?

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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