Brain illness and injury, with a focus on dementia-related diagnoses, occupy a high volume of the 1,495 proposed changes to the ICD-10-CM code set announced today.
The proposed ICD-10-CM code update, included within CMS' FY2023 hospital inpatient prospective payment system (IPPS) proposed rule, introduced 1,179 new codes, including several code additions to further identify the stage of severity and behavioral and psychological symptoms of dementia (BPSD), according to the rule. Diagnosis code changes should be finalized in June. They take effect Oct. 1 this year.
A proposal including several of the newly announced dementia codes was previously discussed during at the virtual March 2021 ICD-10-CM Coordination and Maintenance Committee meeting.
Although codes exist for dementia without and with behavioral disturbances, there is a need for additional detail on other key associated disorders, particularly psychotic disorders, mood disorders and anxiety, the proposal stated.
Some of the new codes proposed include:
- F02.811 (Dementia in other diseases classified elsewhere, unspecified severity, with agitation).
- F02.A11 (Dementia in other diseases classified elsewhere, mild, with agitation).
- F02.B11 (Dementia in other diseases classified elsewhere, moderate, with agitation).
- F02.C11 (Dementia in other diseases classified elsewhere, severe, with agitation).
The new proposed code changes also include a reissue the COVID-19 vaccine status-related codes that were previously implemented on April 1. They are: Z28.310 (Unvaccinated for COVID-19), Z28.311 (Partially vaccinated for COVID-19) and Z28.39 (Other underimmunization status).
This update also includes 28 revised codes and 288 codes deemed invalid. If finalized, these changes would take effect Oct. 1, 2022.
Note other coding highlights
- More than 85 code additions related to head injuries are proposed in section S00-S09 (Injuries to the head), including the following concussion codes: S06.0XAA (Concussion with loss of consciousness status unknown, initial encounter), S06.0XAD (Concussion with loss of consciousness status unknown, subsequent encounter) and S06.0XAS (Concussion with loss of consciousness status unknown, sequela).
- The bulk of new code changes occurred in Chapter 20 (External Causes of Morbidity) with over 450 additions proposed. This chapter permits the classification of environmental events and circumstances as the cause of injury and other adverse effects. Some of the new codes proposed include V20.09XA (Other motorcycle driver injured in collision with pedestrian or animal in nontraffic accident, initial encounter), V20.09XD (Other motorcycle driver injured in collision with pedestrian or animal in nontraffic accident, subsequent encounter) and V20.09XS (Other motorcycle driver injured in collision with pedestrian or animal in nontraffic accident, sequela).
- The chapter for mental, behavioral and neurodevelopmental disorders will see changes to vascular dementia code F01.50, which will be expanded to clarify what is meant by “without behavioral disturbances. The new descriptor will state “Vascular dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety.” The current descriptor is “Vascular dementia without behavioral disturbance.” Code F01.51 (Vascular dementia with behavioral disturbance) will become invalid and be replaced by 23 codes that detail the severity of the patient’s dementia and the type of behavioral disturbance.
- The codes for dementia in other diseases classified elsewhere (F02.80-F02.81) and unspecified dementia (F03.90-F03.91) are slated to undergo similar revisions.
- Planned revisions to the nervous system chapter include replacing the word “dementia” in codes G31.09 and G31.83 with the term “neurocognitive disorder.” For example, the current descriptor for “Other frontotemporal dementia” would become “Other frontotemporal neurocognitive disorder.”
- Another nervous system code G93.3 (Postviral fatigue syndrome) is slated for deletion and replacement with three more detailed codes.
- The cardiovascular system chapter will expand if the proposal to delete and replace 10 codes for conditions such as noninflammatory pericardial effusion (I31.3), ventricular tachycardia (I47.2) and thoracic aneurysm with rupture (I71.1) and without rupture (I71.2) are finalized.
- In the musculoskeletal and connective tissue chapter the word “stable” will be added to existing codes for slipped upper femoral epiphysis. For example, M93.011 (Acute slipped upper femoral epiphysis, stable [nontraumatic], right hip) to make room for changes to the code set than include codes for unstable slipped upper femoral epiphysis.
- The chapter for factors influencing health status will replace non-compliance codes Z91.11 (Patient's noncompliance with dietary regimen) and Z91.19 (Patient's noncompliance with other medical treatment and regimen) with codes that describe the reason for non-compliance.
FY2023 Proposed ICD-10-CM change counts by chapter
|
|
New
|
Revised
|
Invalidated
|
|
Chapter 1: Certain infectious and parasitic diseases (A00-B99)
|
2
|
0
|
1
|
|
Chapter 2: Neoplasms (C00-D49)
|
0
|
11
|
0
|
|
Chapter 3: Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)
|
20
|
0
|
3
|
|
Chapter 4: Endocrine, nutritional and metabolic diseases (E00-E89)
|
11
|
0
|
2
|
|
Chapter 5: Mental, Behavioral and Neurodevelopmental disorders (F01-F99)
|
83
|
3
|
4
|
|
Chapter 6: Diseases of the nervous system (G00-G99)
|
14
|
3
|
1
|
|
Chapter 7: Diseases of the eye and adnexa (H00-H59)
|
0
|
0
|
0
|
|
Chapter 8: Diseases of the ear and mastoid process (H60-H95)
|
0
|
0
|
0
|
|
Chapter 9: Diseases of the circulatory system (I00-I99)
|
43
|
0
|
10
|
|
Chapter 10: Diseases of the respiratory system (J00-J99)
|
1
|
0
|
0
|
|
Chapter 11: Diseases of the digestive system (K00-K95)
|
1
|
2
|
0
|
|
Chapter 12: Diseases of the skin and subcutaneous tissue (L00-L99)
|
0
|
0
|
0
|
|
Chapter 13: Diseases of the musculoskeletal system and connective tissue (M00-M99)
|
35
|
9
|
0
|
|
Chapter 14: Diseases of the genitourinary system (N00-N99)
|
139
|
0
|
7
|
|
Chapter 15: Pregnancy, childbirth and the puerperium (O00-O9A)
|
175
|
0
|
14
|
|
Chapter 16: Certain conditions originating in the perinatal period (P00-P96)
|
10
|
0
|
2
|
|
Chapter 17: Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
|
16
|
0
|
3
|
|
Chapter 18: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
|
0
|
0
|
0
|
|
Chapter 19: Injury, poisoning and certain other consequences of external causes (S00-T88)
|
104
|
0
|
0
|
|
Chapter 20: External causes of morbidity (V00-Y99)
|
477
|
0
|
237
|
|
Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)
|
48
|
0
|
4
|
|
Chapter 22: Codes for special purposes (U00-U85)
|
0
|
0
|
0
|
|
Total
|
1179
|
28
|
288
|