Subject: Coding "ostomy" complications

A look at coding
'ostomies' and complications 

   If you've ever been tempted to code an infection or a hemorrhage after an ostomy as a complication from a surgical wound, you'll want to check out today's coding tip. 
   We also offer some OASIS guidance on when and when not to report ostomies as surgical wounds. 

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Ostomies: Some surgical openings aren't wounds on OASIS, or coded as surgical wound complications 
      An ostomy is a surgically created opening in the body for the discharge of body wastes -- but don't get thrown off course just because the ostomy opening was made by a surgeon.  
     Under ICD-10, ostomy openings are not considered to be surgical wounds except under certain conditions.
      That means complications such as an infection or a hemorrhage cannot be considered to be complications from a surgical wound, and should not be coded from Chapter 19. 

     Ostomies aren't surgical wounds
     Under OASIS C-2 criteria, ostomies are not reported as surgical wounds on M1342 except in the case of a surgical takedown or reversal.
     Any ostomy, with or without a drain, and any ostomy site healing on its own, without a surgical reversal, would NOT be reported as a surgical wound on M1342. Neither would the surgical line around a fresh stoma (the peristomal or mucocutaneous suture line.)

    Don't code from Chapter 19
    Neither should the complications which can sometimes occur after an ostomy -- hemorrhages, obstructions and infection, for example -- be coded as complications of a surgical wound.
    As tempting as it may be to code these complications from Chapter 19,  coders should always start in the Alpha to receive direction on locating the specific diagnostic code. Complication, in the Alpha index, has an exhaustive list of related diagnoses.
  If the ostomy is complicated, the body system is where you will find the assigned code for the condition.
   Complication of a Colostomy, for example, would not be coded from Chapter 19. Instead, it will be coded from Chapter 11.
    All colostomy, gastrostomy, enterostomy, and esophagostomy complications are coded to category K94.-.
   This includes excoriation and denuding of the skin surround the ostomy, infection of the ostomy site, hemorrhage of the ostomy site, and other complications.
    No additional code should be used when coding skin complications unless an infection is present, in which case an additional code should be used to specify the infection.

    No surgical aftercare code unless it's routine 
    When an ostomy complication is present, do not also assign a Z code for the ostomy. Only routine ostomies are assigned a Z code for surgical aftercare. Since Z codes indicate routine ostomy care, the Z code would not be appropriate in the case of a complicated ostomy.

     Here are some examples of correct ostomy complication coding:

Complication of Colostomy
Stoma K94.00
Hemorrhage K94.01
Infection K94.02
Malfunction K94.03
Mechanical K94.03
Specified NEC K94.00 

Complication of Tracheostomy
Granuloma J95.00
Hemorrhage J95.01
Infection J95.02
Malfunction J95.03
Mechanical J95.03
Obstruction J95.03
Specified type NEC J95.09
Tracheo-esophageal Fistula J95.04 

Complication of Cystostomy:
Stoma N99.518
Hemorrhage N99.511
Infection N99.511
Malfunction N99.512
Specified type NEC N99.518

Editor's Note: Thanks to Becky Craig for providing today's coding tip. In the next issue of The Monday Fix, Becky will review certain Intra- and Post- Procedural codes that are located within the body system chapters.    
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