Chapter 10: Respiratory System
The AHA responded to an inquiry regarding left vocal cord paralysis resulting from the sacrifice of the laryngeal nerve during a parathyroidectomy. The patient was evaluated for the excision of recurrent parathyroid carcinoma located in the left tracheoesophageal groove. The laryngeal nerve was enveloped by the parathyroid mass and consequently had to be excised along with the mass.
The subsequent vocal cord paralysis is not deemed a complication of the parathyroidectomy; rather, it was an anticipated result of the procedure. In this instance, the appropriate ICD-10-CM code to assign is J38.01 (Paralysis of vocal cords and larynx, unilateral), rather than a complication code.
Chapter 13: Musculoskeletal System and Connective Tissue
The AHA addressed a query concerning a patient who underwent left anterior cruciate ligament repair with graft and meniscus root repair. The patient returned for a follow-up visit, during which a cyclops lesion of the left knee was identified. A cyclops lesion, also known as arthrofibrosis, is a complication associated with the device utilized in the repair. The Alphabetic Index refers to the main term Arthrofibrosis, joint, in relation to ankylosis. However, the cyclops lesion is not specifically listed.
Initially, assign ICD-10-CM code T84.82XA (Fibrosis due to internal orthopedic prosthetic device, implants and grafts, initial encounter), followed by M24.662 (Ankylosis, left knee) for the cyclops lesion.
Additionally, the AHA addressed a question regarding an abscess at the site of a prior gunshot wound (GSW) to the right popliteal fossa resulting from an assault.
First, assign ICD-10-CM code M72.8 (Other fibroblastic disorder) for the abscess, S81.031S (Puncture wound without foreign body, right knee, sequela) for the GSW, and external cause code X95.9XXS (Assault by unspecified firearm discharge, sequela). The index entry for the abscess is “Wound, open.”
Chapter 14: Urinary System
AHA provided a response regarding hepatorenal syndrome associated with acute kidney injury. A patient experienced an acute kidney injury (AKI) likely resulting from hepatorenal syndrome (HRS), which was secondary to metastatic breast cancer affecting the liver. The inquiry was whether the AKI and HRS should be documented separately or if the AKI is deemed a component of the HRS.
Within the ICD-10-CM code category N17.- (Acute kidney failure), there is a note indicating to also code the “associated underlying condition.” This implies that K76.7 (Hepatorenal syndrome) must also be included in the coding.
Under the section heading N17-N19, which covers Acute kidney failure and chronic kidney disease, there exists an Excludes2 note for HRS. This further suggests that both conditions can be reported. Consequently, both codes N17.8 (Other acute kidney failure) and K76.7 (Hepatorenal syndrome) should be recorded for the AKI resulting from HRS.
Chapter 15: Pregnancy, Childbirth, and the Puerperium
Missed abortion complicated by hemorrhagic shock
AHA responded to an inquiry regarding a missed abortion complicated by hemorrhagic shock. The fetal demise occurred at 16 weeks of gestation; however, the abortion procedure was not conducted until 20 weeks.
The critical aspect of this inquiry is that the fetal demise took place at 16 weeks (coded as O02.1 for a missed abortion prior to the completion of 20 weeks gestation), while the abortion was executed at 20 weeks (coded as O36.4- for maternal care concerning intrauterine death after 20 weeks).
The code should reflect the timing of the fetal demise, not the timing of the abortion procedure.
Therefore, utilize a code from O02.- and a code from O04.- for any complications.
Extension of hysterotomy incision with uterine laceration during cesarean section
AHA addressed a question concerning the extension of a hysterotomy incision accompanied by uterine laceration during a cesarean section. The laceration was sutured.
In addition to the delivery code(s), include ICD-10-CM codes O71.81 (Laceration of uterus, not elsewhere classified [NEC]) for the uterine laceration and O75.4 (Other complications of obstetric surgery and procedures) for the incision extension. In the Alphabetic Index, locate Complications, obstetric, procedure specified NEC, to find code O75.4. This indicates that the laceration was a complication arising from the cesarean procedure.
Bartholin’s abscess complicating delivery
AHA also responded to an inquiry regarding a Bartholin’s abscess that was drained during a cesarean delivery. The patient was 29 weeks pregnant and delivered during this encounter.
The appropriate ICD-10-CM code appears to be O23.59- (Infection of other part of genital tract in pregnancy). However, this code lacks a sixth digit for “in childbirth.” The guidelines specify that when the classification does not provide an “in childbirth” option, one should use a digit that describes the current trimester, which in this case is the third trimester.
Refer to the Excludes1 note under the heading of Inflammatory diseases of female pelvic organs (N70-N77), which states, “Excludes1: inflammatory diseases of female pelvic organs complicating … pregnancy, childbirth and the puerperium.” Consequently, code N75.1 (Abscess of Bartholin’s gland) is not reported.
Code O75.3 (Other infection during labor) is also not reported, as genital tract infections complicating pregnancy are classified using O23.59-.
In addition to the delivery code(s), include O23.593 (Infection of other part of genitourinary tract in pregnancy, third trimester).
Chapter 16: Certain Conditions Originating in the Perinatal Period
AHA addressed a question regarding whether jaundice in a preterm delivery can be classified as neonatal jaundice or if additional documentation is required.
ICD-10-CM assumes a connection between jaundice and newborn prematurity; therefore, assign code P59.0 (Neonatal jaundice associated with preterm delivery).