Proposed ICD-10-CM changes put a lot of skin in the game

by: Julia Kyles, CPC & Laura Evans, CPC Apr 17, 2017

You’ll have a manageable set of diagnosis code changes on Oct. 1 – a total of 406 new, revised and deleted codes – with providers who code non-pressure chronic ulcers receiving the bulk of the new codes in the form of 72 new diagnoses that fill in the blanks for ulcers without evidence of necrosis.

The ICD-10-CM codes were released with the proposed hospital inpatient prospective payment system rule April 14. In addition to the new codes for non-pressure ulcers, the proposed code sets contain 70 changes to eye codes: seven revisions to correct the spelling of entropion in trichiasis codes H02.051-H02.059, eight deleted blindness or low-vision codes that will be replaced by more detailed codes and 20 degenerative myopia codes. You’ll also find 40 new codes and four deletions for pregnancy, childbirth and the puerperium.

Some new codes are the result of deletions and expansions. For example, the proposed code set would delete O00.10 (Tubal pregnancy without intrauterine pregnancy) and replace it with three codes: O00.101 (Right tubal pregnancy without intrauterine pregnancy), O00.102 (Left tubal pregnancy without intrauterine pregnancy) and O00.109 (Unspecified tubal pregnancy without intrauterine pregnancy). The remainder of the new O codes address maternal care for abnormalities of the fetal heart rate or rhythm.

Additional changes to look for include:

Expansion of secondary pulmonary hypertension from one code to seven. Code I27.2 (Other secondary pulmonary hypertension) would become a subcategory heading and you would then select one of the new five-character codes, such as I27.22 (Pulmonary hypertension due to left heart disease) or I27.23 (Pulmonary hypertension due to lung diseases and hypoxia).

Intestinal obstruction codes (K56.6) expanded to permit coding for partial and complete when the cause is not specified or when it is not elsewhere classified. In addition, you’ll have new codes for partial (K91.31) and complete (K91.32) post-procedural intestinal obstruction.

The return of neurogenic claudication. Spinal stenosis, lumbar region (M48.06) will be replaced with spinal stenosis without neurogenic claudication (M48.061) and with neurogenic claudication (M48.062). The neurogenic claudication codes were inadvertently dropped during the transition from ICD-9-CM to ICD-10-CM.

The following chart provides a chapter-by-chapter summary of the proposed changes.

Chapter	New	Revised	Deleted
1: Certain infectious and parasitic diseases (A00-B99)	2	0	1
2: Neoplasms (C00-D49)	7	0	2
3: Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)	0	0	0
4: Endocrine, nutritional and metabolic diseases (E00-E89)	5	0	1
5: Mental, behavioral and neurodevelopmental disorders (F01-F99)	1	0	0
6: Diseases of the nervous system (G00-G99)	3	0	0
7: Diseases of the eye and adnexa (H00-H59)	55	7	8
8: Diseases of the ear and mastoid process (H60-H95)	0	0	0
9: Diseases of the circulatory system (I00-I99)	7	0	1
10: Diseases of the respiratory system (J00-J99)	0	1	0
11: Diseases of the digestive system (K00-K95)	23	0	6
12: Diseases of the skin and subcutaneous tissue (L00-L99)	72	0	0
13: Diseases of the musculoskeletal system and connective tissue (M00-M99)	5	8	1
14: Diseases of the genitourinary system (N00-N99)	15	3	1
15: Pregnancy, childbirth and the puerperium (O00-O9A)	40	4	0
16: Certain conditions originating in the perinatal period (P00-P96)	8	0	3
17: Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)	6	1	2
18: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)	3	0	0
19: Injury, poisoning and certain other consequences of external causes (S00-T88)	12	18	8
20: External causes of morbidity (V00-Y99)	54	3	0
21: Factors influencing health status and contact with health services (Z00-Z99)	6	2	0
Source: DecisionHealth analysis of the CY 2018 proposed new, revised and invalid code sets

Blog Tags: Breaking news, ICD-10

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