This first major update marks the end of a five-year code freeze in place since 2011, and reflects the long list of changes that were presented at twice-yearly ICD-10 Coordination and Maintenance Committee meetings held throughout the freeze.
The Oct. 1 changes will include 1,974 new codes, 311 deleted codes and 425 revised codes – these numbers are very similar to the proposed code changes released back in March. Areas of the code set that were particularly impacted include Chapter 4 (Endocrine, nutritional and metabolic diseases), Chapter 13 (Diseases of the musculoskeletal system and connective tissue) and Chapter 19 (Injury, poisoning and certain other consequences of external causes). However, the changes are more extensive than the proposed code changes – these final changes include thousands of changes to Tabular instructions.
Chapter 1 (Certain infectious and parasitic diseases), which had no additions, deletions or revisions in the proposed code list released March 22, will receive just one change in the final update, which is the addition of a code for the Zika virus (A92.5).
Codes for periprosthetic fractures have been moved – for example, T84.040- (Periprosthetic fracture around internal prosthetic right hip joint) is set for deletion from Chapter 19 while M97.01- (Periprosthetic fracture around internal prosthetic right hip joint) is being added to Chapter 13.
In addition to a litany of new and revised codes to describe various forms of fractures, Chapter 19 also saw the deletion of a slew of concussion codes, all of which specify the length of time a patient lost consciousness. Come Oct. 1, coders will only be able to specify whether a patient who suffered a concussion lost consciousness (S06.0x9-) or not (S06.0x0-).
Hundreds of new diabetes codes are on the way, allowing for greater specificity with diabetic ophthalmic manifestations, such as E11.3493 (Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral). Also on the diabetes front is the new code Z79.84 (Long-term (current) use of oral hypoglycemia drugs). It will be available to capture patients who take oral medication for their diabetes.
New codes in Chapter 9 (Diseases of the circulatory system) will allow for the capturing of more serious forms of hypertension, with the additions of I16.0 (Hypertensive urgency), I16.1 (Hypertensive emergency) and I16.9 (Hypertensive crisis, unspecified), as well as for more specific forms of cognitive sequelae following strokes, such as memory loss, with I69.311 (Memory deficit following cerebral infarction).
Tabular notes get an overhaul
In addition to code changes, revisions were made to certain tabular instructions that should help to clear up some confusion. Notably, certain Excludes 1 notes have been revised to Excludes 2 notes, reflecting the guidance change in late 2015 that allowed for conditions excluded by Excludes 1 notes to be coded together as long as they weren’t related.
For example, conditions covered by codes ranging from F01 to F99 (Mental, behavioral and neurodevelopmental disorders) are now in an Excludes 2 note, instead of an Excludes 1 note, at the top of the category heading for R40 to R46 (Symptoms and signs involving cognition, perception, emotional state and behavior). This will mean that starting Oct. 1, a condition such as dementia (F03.90) can be coded along with a symptom such as dizziness (R42) without the coder having to find out whether the two are or are not related.
You’ll also find inclusion notes that will help you report the new codes. For instance, third degree perineal laceration during delivery IIIa (O70.21) has a note stating “third degree perineal laceration during delivery with less than 50% of external anal sphincter (EAS) torn.”
Encounter for prophylactic measures (Z29.1) includes encounter for administration of immunoglobulin, according to the clarifying note.
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