In this article, I have summarized the latest ICD-10 codes for OB GYN practice that are recently launched by The Centers for Medicare & Medicaid (CMS) in the ICD-10 Clinical Concepts Series.
Each guide in the series compiles key information about the medical codes. However, this series focuses on a few specialties and includes common ICD codes and medical coding guidelines for ob gyn practitioners.
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Abnormal Female Genital Cytology (Excluding Neoplasia and Malignancy Codes)
Excessive, Frequent and Irregular Menstruation
General Medical and Gynecological Examinations
Hypertension
Inflammation of Vagina and Vulva
Lump in Breast and Other Disorders of Breast
(ICD-10-CM R87.6, R87.61, R87.62 & R87.69)
Female cytology is a method of examining the vaginal content to study the trophic and cyclic functions of the sex hormones. Abnormal female cytology is a disease in which cells grow abnormally around the cervix which can also lead to cancer.
ICD-10-CM R87 is used to indicate abnormal findings in specimens from female genital organs. However, it is a non-billable/non reimbursable code because there is another range of medical codes that provide details of high specificity.
ICD-10-CM R87.6 indicates the diagnosis of abnormal cytological findings in specimens from female genital organs. It is a non-billable/non-reimbursable code because there is a range of medical codes under this code that define more specific details about other diagnoses.
ICD-10-CM R87.61 is a non-billable/ non-specific code used to indicate abnormal cytological findings in specimens from cervix uteri. The 2023 edition of this code became effective on October 1, 2022. It is the American version which could be different from the international versions of R87.61.
ICD-10-CM R87.62 is non-billable/non-specific code that indicates Abnormal cytological findings in specimens from vagina. However, R87.69 is a billable/specific ICD-10-CM code that indicates a diagnosis of abnormal cytological findings in specimens from other female genital organs for reimbursement purposes.
R87.69 is converted from the ICD-9-CM code of 792.9.
Other specific codes for the diagnosis of abnormal female genital cytology:
R87.610 Atypical squamous cells of undetermined significance on cytologic smear of cervix (ASC-US)
R87.611 Atypical squamous cells cannot exclude high grade squamous intraepithelial lesion on cytologic smear of cervix (ASC-H)
R87.612 Low grade squamous intraepithelial lesion on cytologic smear of cervix (LGSIL)
R87.613 High grade squamous intraepithelial lesion on cytologic smear of cervix (HGSIL)
R87.615 Unsatisfactory cytologic smear of cervix
R87.616 Satisfactory cervical smear but lacking transformation zone
R87.618 Other abnormal cytological findings on specimens from cervix uteri
R87.619* Unspecified abnormal cytological findings in specimens from cervix uteri
R87.620 Atypical squamous cells of undetermined significance on cytologic smear of vagina (ASC-US)
R87.621 Atypical squamous cells cannot exclude high grade squamous intraepithelial lesion on cytologic smear of vagina (ASC-H)
R87.622 Low grade squamous intraepithelial lesion on cytologic smear of vagina (LGSIL)
R87.623 High grade squamous intraepithelial lesion on cytologic smear of vagina (HGSIL)
R87.625 Unsatisfactory cytologic smear of vagina
R87.628 Other abnormal cytological findings on specimens from vagina
R87.629* Unspecified abnormal cytological findings in specimens from vagina
R87.69 Abnormal cytological findings in specimens from other female genital organs
N87.0 Mild cervical dysplasia
N87.1 Moderate cervical dysplasia
N87.9* Dysplasia of cervix uteri, unspecified
There are two diagnostic tests carried to detect abnormal female genital cytology i.e.
The HPV and Pap screening tests which are carried out to identify cervical cancer and prevent it at the right time.
ICD-10-CM codes for HPV tests
R87.810 Cervical high risk human papillomavirus (HPV) DNA test positive
R87.181 Vaginal high risk human papillomavirus (HPV) DNA test positive
R87.820 Cervical low risk human papillomavirus (HPV) DNA test positive
R87. 821 Vaginal low risk human papillomavirus (HPV) DNA test positive
R87.81 High risk human papillomavirus (HPV) DNA test positive from female genital organs
R87.811 Vaginal high risk human papillomavirus (HPV) DNA test positive
R87.82 Low risk human papillomavirus (HPV) DNA test positive from female genital organs
(ICD-9-CM 626.2 To 626.6 Range, 627.0)
Menstruation or periods is regular bleeding from women’s vagina after every lunar month. Every month, women’s bodies prepare for pregnancy during the cycle of 15 to 28 days in which the lining of your uterus thickens and the level of the hormone estrogen rises in your body.
After this phase, suddenly the level of the luteinizing hormone (LH) increases which causes your ovary to release egg which is also called ovulation. Then the egg leaves ovaries and flows through your fallopian tubes to your uterus. In this phase, hormone progesterone rises to help prepare your uterine lining for pregnancy.
If the egg is fertilized by sperm and attached itself to your uterine wall (implantation) then you can become pregnant otherwise if you don’t get pregnant then estrogen and progesterone levels drop and the thick lining of your uterus sheds during the menstrual period.
The blood that flows during menstruation contains blood cells and tissues from uterine wall lining. This phase lasts for 3 to 5 days which is different for all women. However, only the cycle duration could be slightly different but the process is similar for everyone.
ICD-10-CM N92 is a non-specific/non-billable code for Excessive, frequent and irregular menstruation. Therefore, it cannot be used for reimbursement purposes during ob gyn medical billing services because there is a range of ICD codes that are highly specific and provide more details about the diagnosis of different conditions. This code became effective on October 1, 2022. It is the American version of this code which could be different from the international versions of R92.
The more specific and billable ICD-10-CM codes for excessive, frequent, regular and irregular menstruation cycle are as follows:
N92.0 Excessive and frequent menstruation with regular cycle
N92.1 Excessive and frequent menstruation with irregular cycle
N92.2 Excessive menstruation at puberty
N92.3 Ovulation bleeding
N92.4 Excessive bleeding in the premenopausal period
N92.5 Other specified irregular menstruation
N92.6* Irregular menstruation, unspecified
(ICD-9-CM V70.0, V72.31, V72.32) (Excluding Contraceptive and Procreative Codes)
A gynecological examination is a process to assess the overall health of the female reproductive system. This exam is used to evaluate the health condition of a female's external and internal reproductive system along with the breasts.
Following are the ICD-10-CM codes for general medical and gynecological examinations:
Z00.00 Encounter for general adult medical exam without abnormal findings
Z00.01 Encounter for general adult medical exam with abnormal findings
Z01.411 Encounter for gynecological examination (general) (routine) with abnormal findings
Z01.419 Encounter for gynecological examination (general) (routine) without abnormal findings
Z01.42 Encounter for cervical smear to confirm findings of recent normal smear following initial abnormal smear
(ICD-9-CM 401.9)
Blood pressure is the force of blood pushing against the walls of arteries. When a healthcare professional measures your blood pressure then two numbers appear on the device. The first number is called systolic blood pressure that indicates the blood pressure when your heart contracts to push out the blood. The second reading is called diastolic indicates the blood pressure when the heart relaxes and fills with blood.
The normal blood pressure for most adults is defined as a systolic pressure of less than 120 and a diastolic pressure of less than 80. If blood pressure readings of systolic pressure is 130 or higher, or diastolic pressure is 80 or higher then its called high blood pressure or Hypertension.
The major causes of hypertension include old age, family history, race, and gender (men before age 55 have higher chances of hypertension than women).
The ICD-10-CM codes for hypertension are as follows:
I10 Essential (primary) hypertension
197.3 Postprocedural hypertension
It is important to maintain and verify the quality of clinical documentation in order to apply accurate medical codes. Obgyn medical coding specialists should collect verified details to understand the intent of an encounter and confirm the medical necessity of the procedure to support the accurate ICD-10 code selection.
For this purpose, we have mentioned some highly inevitable ob gyn coding guidelines to illustrate ICD-10 documentation and coding nuances related to your specialty.
The following guidelines help you understand how you could determine accurate ICD-10-CM and ICD-9-CM codes for ob gyn coding services. As a practitioner, you face different scenarios while delivering patient care services, therefore, in these guidelines, we have highlighted how you could understand the specificity of a scenario or procedure while applying obgyn ICD codes.
When applying ICD codes for ob gyn services, make sure that you have complete details on hand so you can apply highly specific medical codes and modifiers to describe the procedure or medication delivered. Ob Gyn practitioners should provide complete details of the pain characteristics to their medical coding team.
For example, if the pain is not a part of the disease then the medical coder will not assign additional code for tha pain.
Not only, medical coders use additional codes for non-subjective pain but they should also use highly specific medical codes to describe the area of pain.
Medical claims with “unspecified” codes are not reimbursed by insurance companies.
Obgyn medical coding specialists should include the patient history which is essential to justify any additional diagnostic testing in the medical claim. Without any reference to the history, the medical claim will get denied. On the other hand, providing patient history can help you justify and get paid for additional tests as well. E.g. ultrasound.
Note whether the encounter is for a specific issue or a “general” exam. There are different codes that are used to define tests and diagnosis. However, different players recognize different medical codes.
Therefore, it’s the responsibility of ob gyn medical coding specialist to apply medical codes for the services delivered according to the payer’s requirements.
As per the American Congress of Obstetricians and Gynecologists guidelines, a well-woman exam includes both a pelvic exam and a clinical breast examination. The justification to diagnose abnormal findings in the encounter is based on the presence of the breast lump.
ICD-10-CM can now highlight the side of the body. There are separate codes for left and right breast diagnosis. If there is no clinical status for a patient then there is no need to mention right versus left.
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