ICD-10 Changes Remain Important

What’s another 1,900 diagnosis codes when medical practices have successfully implemented 68,000 ICD-10-CM codes? These additional diagnosis codes go into effect October 1, 2016 the same day that CMS’s grace period for unspecified codes ends. With forewarning and planning, medical practices can prepare for both.
The code set of both ICD-9 and ICD-10 were frozen, as CMS prepared for the transition. New codes were only added for new emergent diagnoses or conditions. This is the first update since the end of the code freeze. Some specialty societies have asked for additional codes to describe the conditions that they treat frequently that weren’t specific enough. Some of the changes create more work to describe conditions more specifically, including location and laterality.
Before ICD-10 was implemented in 2016, Medicare announced a grace period that allowed practices to submit unspecified codes as long as the code was valid and was in the correct category code. CMS noted at that time, that if the service performed had a national or local coverage determination, the diagnosis code would still need to support the medical necessity for the service. This grace period ends on September 30, 2016 at the very time that there are an additional 1900 codes. Of course, CMS hopes that physicians took advantage of the past year to understand ICD-10 coding and submit specific codes. And, in a frequently asked questions document, CMS notes that an unspecified diagnosis should only be submitted when there is not sufficient clinical information to select a more specific code. For example, if the type of pneumonia is not known at the time of the encounter, it is correct to select the unspecified pneumonia code.
So what changes will medical practices find in the updated diagnosis code set? There is a code for the Zika virus, A92.5. This was released prior to October 1 to allow medical practices to report the condition. There is also additional specificity in terms of location and laterality in some parts of the code sets. There are changes to terminology, without a change to the underlying meaning of the code; some codes were defined as “NOS” and are now defined as “unspecified.” Hodgkin’s lymphoma codes are expanded in category C81. Codes for ophthalmic complications of diabetes now have laterality added. In chapters that have a code for post-procedural complication due to hemorrhage and/or hematoma, these are now split and there are separate codes for post-procedural hematoma and post-procedural hemorrhage. There are also additional codes for cerebral infarction in the I63 category and for specific types of cognitive deficits after an intracerebral hematoma in category I69. Supervision of pregnancies with complications are more specific than they were last year.
Trauma has never been easy to code in ICD-10.  There are 450 new codes spread out over category S02, S03 and S06 which are head trauma codes. Category S49 (other and unspecified injuries of shoulder and upper arm) and S99 (other and unspecified injuries of ankle and foot) are also expanded.  There are additional external cause codes, about 50 new ones in category V47, car occupant in collision with fixed or stationary object. Coders and writers alike enjoyed finding odd external cause codes. 2017 brings us W26.2xxa, “contact with edge of stiff paper, initial encounter.” Paper cuts are the worst!
In addition, there are new status codes for observation of a newborn with certain conditions in category Z05, and for being a hepatitis carrier in category Z22.  There are more specific codes for the type of contraceptive device being monitored in category Z30. And, a code that will make surgical coders happy: Z53.31 laparoscopic surgical procedure converted to open procedure.
Medical practices should review the coding changes before October 1 and continue to select the most specific code possible for their services.

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