For coders who use ICD-10-PCS, 2018 brought a big change to female reproductive system coding. Originally, coding a hysterectomy necessitated two separate codes: one for resection of the uterus, and another for resection of the cervix. According to Procedure Coding System (PCS) guideline B3.2a, “During the same operative episode, multiple procedures are coded if the same root operation is performed on different body parts as defined by distinct values of the body part character.” This means that prior to 2018, a laparoscopic total hysterectomy would be coded with 0UT94ZZ and 0UTC4ZZ.
Under the new update, however, this old rule does not always apply. The new year saw the introduction of the “L” qualifier, a new addition that replaces the second “Z” and denotes a supracervical hysterectomy, or a procedure in which the uterus is removed but the cervix is left in place. For this procedure, the code would be 0UT94ZL.
To accompany this change, the ICD-10-PCS book has been updated to alter the definition of a hysterectomy. Several lines specifying how the procedure must use multiple codes have all been deleted, and replaced with the simpler directive “Based on guidance from the Index, only one ICD-10-PCS code describing resection of the uterus is required for a total hysterectomy.”
As you probably noticed, the new 0UT94ZL code approach does not code any procedure related to the cervix, as only the uterus is operated upon in this scenario. However, the supracervical L code is still necessary; without it, there is no proof that the cervix was not part of the operation, and the claim will be denied. Coders and billers should take extra care when coding these operations in order to make sure that they receive proper reimbursement and handle each claim correctly and efficiently.