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Coding Tip of the Month – November 2017

Total Hysterectomies

Written by: Natalie Sartori, Corporate Trainer

The October 1st updates included more than 3,500 new ICD-10-PCS codes. The intent and impact of many of the new codes was clearly apparent while others were less obvious. One example of this is the addition of qualifier “L Supracervical” applicable to the body part Uterus on table 0UT Female Reproductive System, Resection. We had previously trained that a total hysterectomy required two codes, one for resection of the uterus and one for resection of the cervix. The new qualifier “L Supracervical” changes the way we code a total hysterectomy. A total hysterectomy procedure now requires only one code. The Fourth Quarter 2017 Coding Clinic provides the following advice on page 68:

Coding Clinic, Third Quarter 2013, page 28, advised to code both the resection of the uterus and cervix for a total hysterectomy. now that there is a qualifier to distinguish supracervical hysterectomies, and the Alphabetical Index has been revised, how should an open total hysterectomy be coded?

Only one ICD-10-PCS code describing resection of the uterus is required for a total hysterectomy. Assign the following ICD-10-PCS code: 0UT90ZZ Resection of uterus, open approach.

Many of you may have the same reaction as I did after reading this. What about PCS guideline B3.2a Multiple procedure codes are required when the same root operation is performed on different body parts as defined by distinct values of the body part character? What the Coding Clinic leaves us to piece together is that we can now differentiate a hysterectomy with or without removal of the cervix, using the qualifier “L Supracervical” with a code for resection of the uterus. For example:

  • The code for a total abdominal hysterectomy is: 0UT90ZZ Resection of uterus, open approach. In this example the “Z No Qualifier” is indicating that both the uterus and cervix are removed.
  • The code for a laparoscopic supracervical hysterectomy is: 0UT94ZL Resection of uterus, percutaneous endoscopic, supracervical. In this example “L Supracervical” is specifying that only the uterus is removed and the cervix is left intact.

Another fact that a separate code is no longer required when the cervix is removed during a total hysterectomy is the revised alphabetic index.

2017 ICD-10-PCS Alphabetic Index 2018 ICD-10-PCS Alphabetic Index
supracervical see Resection, Uterus 0UT9
see Resection, Uterus 0UT9
see Resection, Cervix 0UTC
supracervical see Resection, Uterus 0UT9
total see Resectin, Uterus 0UT9

Finally, I have heard that some encoders may still be assigning two codes for a total hysterectomy. Please use caution and make sure you are applying this new qualifier correctly when coding hysterectomies. Also make a note that the advice provided in the 3rd Quarter 2013 Coding Clinic is now obsolete.