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Getting Specific: ICD-10 for Plastic Surgery

By: Nextech | February 23rd, 2015

Getting Specific: ICD-10 for Plastic Surgery Blog Feature


The United States is currently the only developed country in the world that is still using the outdated ICD-9-CM Volume III for diagnosis codes, electronic health records, and insurance claims. However, this is soon to change.  As of October 1st 2015, the official final deadline for ICD-10 implementation, insurance companies will no longer be accepting ICD-9 for diagnosis or procedure codes.  This means that all healthcare professionals must begin learning ICD-10-CM and ICD-10-PCS codes now, especially as they apply to medical specialties.

In this three-part series, we have been examining ten of the most commonly used ICD-9-CM codes for each of three distinct specialties—Dermatology, Ophthalmology, and Plastic Surgery—and comparing them to their respective ICD-10-CM counterparts.  This demonstrates how the high specificity level of ICD-10-CM makes it far superior to ICD-9-CM (which is loaded with obsolete, outdated terminology as well as outmoded and ambiguous codes, not to mention inadequate data that fails to accommodate for a multitude of medical discoveries and advances that have occurred in recent decades).

ICD-10-CM Codes in Plastic Surgery

In Part 1 of this series, we discussed common ICD-9/10-CM codes specific to Dermatology, and in Part 2 we looked at codes specific to Ophthalmology.  For this third and final installment, we will look at ten commonly used Plastic Surgery-specific codes in the soon-to-be phased out ICD-9-CM system.  We will then look at how these codes can be translated into the new, more specific ICD-10-CM coding language.

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Let’s begin with a common diagnosis that has a fairly simple code translation:

Burn (any degree) involving less than ten percent of body surface with third degree burn, less than 10% or unspecified

In ICD-9-CM, this would fall under 948.00 (948 being the general category for “Burns classified according to extent of body surface,” and .00 to identify it as covering <10% of the body and involving a third degree burn).  In ICD-10-CM, this would be coded in the following manner:

Primary category: T (30-32, for burns and corrosions of multiple and unspecified body regions)

2-digit category: 31 (Burns classified according to extent of body surface involved)

So the primary code would be T31, which is then further specified (according to body surface involved) by a final digit, following a decimal point, to create a final diagnosis code:

T31.0: Burns involving less than 10% of body surface

Now let’s try one with multiple ICD-10-CM coding options:

Malignant neoplasm of the lip

This is coded in ICD-9-CM as 140, which just states the general diagnosis without much specification as to location.  In the ICD-10-CM language, however, there are a number of far more specific coding options.

Primary category: C (0-96, for neoplasms)

2-digit category: 00 (malignant neoplasm of lip)

So the primary code would be C00, and must now be specified (according to anatomic site) to create a final diagnosis code from the following possibilities:

C00.0: Malignant neoplasm of external upper lip

C00.1: Malignant neoplasm of external lower lip

C00.2: Malignant neoplasm of external lip, unspecified

C00.3: Malignant neoplasm of upper lip, inner aspect

C00.4: Malignant neoplasm of lower lip, inner aspect

C00.5: Malignant neoplasm of lip, unspecified, inner aspect

C00.6: Malignant neoplasm of commissure of lip, unspecified

C00.6: Malignant neoplasm of overlapping sites of lip

C00.9: Malignant neoplasm of lip, unspecified

For our third example, let’s look at one that’s a little more complex:

Cleft palate or cleft lip

These are coded in ICD-9-CM as 749.10 (cleft lip) and 749.20 (cleft palate), without much differentiation as to hard/soft palate and other factors.  In ICD-10-CM, however, these are categorized by more specific sets of coding options.

Primary category: Q (35-37, for cleft lip and cleft palate)

2-digit category: 35 (cleft palate); 36 (cleft lip); or 37 (cleft palate with cleft lip).

In this case, there are several possible primary codes to choose from, depending on the situation—Q35, Q36, or Q37.  The primary code as well as the specific, final diagnosis code will need to be chosen (according to location and other vital details) from the following possibilities:

Q35: Cleft palate

Q35.1: Cleft hard palate

Q35.3: Cleft soft palate

Q35.5: Cleft hard palate with cleft soft palate

Q35.7: Cleft uvula

Q35.9: Cleft palate, unspecified

Q36: Cleft lip

Q36.0: Cleft lip, bilateral

Q36.1: Cleft lip, median

Q36.9: Cleft lip, unilateral

Q37: Cleft palate with cleft lip

Q37.0: Cleft hard palate with bilateral cleft lip

Q37.1: Cleft hard palate with unilateral cleft lip

Q37.2: Cleft soft palate with bilateral cleft lip

Q37.3: Cleft soft palate with unilateral cleft lip

Q37.4: Cleft hard and soft palate with bilateral cleft lip

Q37.5: Cleft hard and soft palate with unilateral cleft lip

Q37.8: Unspecified cleft palate with bilateral cleft lip

Q37.9: Unspecified cleft palate with unilateral cleft lip

Our fourth example should be fairly common for anyone in Plastic Surgery:

Cosmetic plastic surgery, other (breast augmentation, facelift, etc.)

This is coded in ICD-9-CM as V50.1, identifying it only as “Other plastic surgery for unacceptable cosmetic appearance.”  Let’s see how this would be coded in ICD-10-CM.

Primary category: Z (40-53, encounters for other specified healthcare)

2-digit category: 41 (encounter for procedures for purposes other than remedying health state)

In this case, the primary code would be Z41.  The specific, final code would need to be chosen from the following possibilities:

Z41.1: Encounter for cosmetic surgery

Z41.2: Encounter for routine and ritual male circumcision

Z41.3: Encounter for ear piercing

Z41.8: Encounter for other procedures for purposes other than remedying health state

Z41.9: Encounter for procedure for purposes other than remedying health state, unspecified

Just to make sure you’ve got the idea, we’ll do one more step-by-step example:

Facial nerve disorders

This is coded in ICD-9-CM as 351.  Let’s see how various facial nerve disorders would be coded with ICD-10-CM.

Primary category: G (50-59, nerve, nerve root, and plexus disorders)

2-digit category: 51 (facial nerve disorders)

The primary code would be G51.  The specific, final diagnosis code (based on factors such as cause, symptoms, and situation) would be chosen from the following possibilities:

G51.0: Bell’s palsy

G51.1: Geniculate ganglionitis

G51.2: Melkersson’s syndrome

G51.3: Clonic hemifacial spasm

G51.4: Facial myokymia

G51.8: Other disorders of facial nerve

G51.9: Disorder of facial nerve, unspecified

You should now have at least a general understanding of how ICD-10-CM coding works in Plastic Surgery.  Therefore, the last five examples have been simplified a bit.  However, they still offer useful reference points for some of the more common ICD-9/10-CM codes that will be used in the Plastic Surgery specialty.

ICD-9-CM Code 470—Deviated nasal septum

ICD-10-CM Possibilities:

J34.2: Deviated nasal septum

ICD-9-CM Code 610.79—Cyst of the breast, solitary

ICD-10-CM Possibilities:

N60.0: Solitary cyst of breast

N60.01: Solitary cyst of right breast

N60.02: Solitary cyst of left breast

N60.09: Solitary cyst of unspecified breast

ICD-9-CM Code 611.01—Signs and symptoms of breast

ICD-10-CM Possibilities:

N64.5: Other Signs and symptoms in breast

N64.51: Induration of breast

N64.52: Nipple discharge

N64.53: Retraction of nipple

N64.59: Other signs and symptoms in breast

ICD-9-CM Code 736.05—Wrist/foot drop, acquired

ICD-10-CM Possibilities:

M21.3: Wrist or foot drop (acquired)

M21.33: Wrist drop (acquired)

M21.331: Wrist drop, right wrist

M21.332: Wrist drop, left wrist

M21.339: Wrist drop, unspecified wrist

M21.37: Foot drop (acquired)

M21.371: Foot drop, right foot

M21.372: Foot drop, left foot

M21.379: Foot drop, unspecified foot

ICD-9-CM Code 736.06—Clawhand, acquired

ICD-10-CM Possibilities:

M21.51: Acquired clawhand

M21.511: Acquired clawhand, right hand

M21.512: Acquired clawhand, left hand

M21.513: Acquired clawhand, unspecified hand

Hopefully, this blog series has provided those of you in the Dermatology, Ophthalmology, and Plastic Surgery specialties with a firm starting point for understanding and implementing the transition from ICD-9-CM to ICD-10-CM.  If there is a specialty you would like to see added to this list in the future, let us know in the comments and we will do our best to accommodate you.

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