Monday, December 4, 2017

Hysterectomy Coding in ICD-10-PCS



Hysterectomy coding in ICD-10-PCS will be the focus of this “In the kNOWsegment.  When ICD-10-PCS codes were first adopted, we were trained that to code a total hysterectomy appropriately would require two codes: one for the resection of the uterus, and one for the resection of the cervix.  This followed the PCS guideline B3.2a which tells us that when the same root operation is performed on different body parts that have their own body part character we would code multiple procedures, thereby capturing each body part. 

Index:
Hysterectomy
    Total
       See Resection, Cervix 0UTC
       See Resection, Uterus 0UT9

So a laparoscopic total hysterectomy would have been coded as:

0 Medical and Surgical
U Female Reproductive
T Resection
9 Uterus
4 Percutaneous Endoscopic
Z No Device
Z No Qualifier

0 Medical and Surgical
U Female Reproductive
T Resection
C Cervix
4 Percutaneous Endoscopic
Z No Device
Z No Qualifier


Now fast-forward to the 2018 PCS updates and we see that there has been a change to this advice.  A new qualifier was added to the female reproductive table for resection.  This is the character “L” for supracervical.  This allows us to capture those hysterectomies when the physician has left the patient’s cervix in place, and only removes the uterus.  For example, if we were to code a laparoscopic supracervical hysterectomy our code assignment would be 0UT94ZL.

Index:
Hysterectomy
       Supracervical, see Resection, Uterus 0UT9
       Total, see Resection, Uterus 0UT9

0 Medical and Surgical
U Female Reproductive
T Resection
9 Uterus
4 Percutaneous Endoscopic
Z No Device
L Supracervical

If the procedure was a total hysterectomy performed laparoscopically, then the code would be 0UT94ZZ only.

0 Medical and Surgical
U Female Reproductive
T Resection
9 Uterus
4 Percutaneous Endoscopic
Z No Device
Z No Qualifier

Notice the Index change listing Total hysterectomy and only indicating Resection, Uterus as opposed to the previous index entry which referenced both uterus and cervix.  This change was addressed in the 4th Quarter 2017 Coding Clinic as well.

So, when coding total hysterectomy procedures for 2018 discharges, be sure to use only one ICD-10-PCS code.


Now you are In the kNOW!!


About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.

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  5. Question....should the supracervical code only be used when it is documented as such....ex: supracervical total hysterectomy.....on the ( op rpt, post op, pn, discharge, etc.

    ReplyDelete
    Replies
    1. While it is not imperative that the descriptor "supracervical" be used, it is helpful to see that term. As coders, it is important to read the operative report for details regarding the procedure performed in order to assign the correct code. In this case, look to see if the physician mentions leaving a cervical stump, or cutting across the cervix. If you are in doubt about whether or not the procedure was supracervical, check with a supervisor who may be able to identify the type of hysterectomy performed or query the provider.

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