Prepare for several hundred new ICD-10-CM codes now finalized to take effect Oct. 1. On June 16, CMS announced the addition of 395 new diagnosis codes, 25 deletions to the ICD-10-CM code set and 13 revisions. In addition, there are hundreds of changes to tabular instructions added in the addenda for the FY 2024 code set.
The new codes are spread throughout the code set, with several dozen pertaining to osteoporosis with fractures (M00-M99); retinopathy and muscle entrapment in the eye (H00-H59); and disease of the nervous system, including Parkinson’s disease and epilepsy (G00-G99); among others.
The final update confirms the introduction of five new codes for Parkinson’s disease:
- G20.A1 (Parkinson’s disease without dyskinesia, without mention of fluctuations).
- G20.A2 (Parkinson’s disease without dyskinesia, with fluctuations).
- G20.B1 (Parkinson’s disease with dyskinesia, without mention of fluctuations).
- G20.B2 (Parkinson’s disease with dyskinesia, with fluctuations).
- G20.C (Parkinsonism, unspecified).
Of the 395 new codes, 123 of them reside in the External causes of morbidity (V00-Y99) chapter, specifically new W codes to capture accidents and injuries such as W44.A1XA (Button battery entering into or through a natural orifice, initial encounter), W44.C0XA (Glass unspecified, entering into or through a natural orifice, initial encounter) and W44.H2XD (Knife, sword or dagger entering into or through a natural orifice, subsequent).
Check out notable changes
Take note of one final code revision that was not included in the proposed code changes: Code Q85.81 (PTEN tumor syndrome) has been changed to (PTEN hamartoma tumor syndrome). PTEN is a tumor suppressor gene that prevents uncontrolled cell growth. PTEN hamartoma tumor syndrome actually is a group of syndromes that involves a change to the PTEN gene that triggers the growth of tumors. A hamartoma is a benign growth composed of an abnormal mix of cells and tissues.
Here are some of the changes in the tabular addenda:
Chapter 1: Expanded lists of “code first” codes for A40 (Strepococcal sepsis) and A41 (Other sepsis). For example, both codes now instruct to code first for sepsis due to central venous catheter (T80.211-).
Chapter 5: Opioid-associated amnestic syndrome, a phenomenon of acute amnesia that can occur after fentanyl use, can now be reported, according to new inclusion terms added under codes for opioid dependence and opioid use: Opioid-associated amnestic syndrome with opioid dependence is added as an inclusion term under code F11.288 (Opioid dependence with other opioid-induced disorder). Similarly, opioid-associated amnestic syndrome without use disorder is now an inclusion term of code F11.988 (Opioid use, unspecified with other opioid-induced disorder).
Under Gender identity disorders, code F64.0 (Transsexualism) now includes the inclusion terms: Gender incongruence in adolescents and adults, and Transgender. Similarly, F64.2 (Gender identity disorder of childhood) includes Gender incongruence of childhood, and F64.9 (Gender identity disorder, unspecified) includes gender incongruence, unspecified.
Chapter 6: Category G05 (Encephalitis, myelitis and encephalomyelitis in diseases classified elsewhere) now specifies to code first systemic lupus erythematosus (M32.19).
Chapter 9: For codes in subcategory I87.2 (Venous insufficiency [chronic] [peripheral]), you are now instructed to code also for essential (primary) hypertension (I10), hypertensive chronic kidney disease (I12.-), hypertensive hear and chronic kidney disease (I13.-) and hypertensive heart disease (I11.-).
Chapter 11 – Diseases of the digestive system (K00-K95) includes changes that shift codes from Excludes 1 to Excludes 2 status. For example, D12.6 (adenomatous polyp of colon) and K63.5 (polyps of colon NOS) are currently listed as Excludes 1 codes for K51.4 (Inflammatory polyps of colon). The Excludes 1 status means the conditions cannot exist – or be coded – together. They will become Excludes 2 codes, meaning a patient might have both conditions.
Chapter 13 – Diseases of the musculoskeletal system and connective tissue (M00-M99), contains a variety of new instructions. For example, a new note for M32.19 (Other organ or system involvement in systemic lupus erythematosus) tells coders to use an additional code or codes “identify organ or system involvement, such as encephalitis (G05.3).”
A new note for M97 (Periprosthetic fracture around internal prosthetic joint) tells coders to code the “the specific type and cause of fracture, such as traumatic or pathological” first, if known.
Review the instructions for the 15 new codes in Chapter 14 – Diseases of the genitourinary system (N00-N99). Codes such as N06.22 (Seconday membranous nephropathy with isolated proteinuria) have a clarifying term: “Secondary membranous nephropathy, NOS.” You’ll also find a code first instruction to report the disease, disorder or poisoning that is causing the membranousnephropathy and a use additional code instruction to report the adverse effect of the drug causing the condition, when applicable. Finally, an Excludes1 note bars coders from reporting N04.22 (Secondary membranous nephropathy with nephrotic syndrome) with N06.22.
In Chapter 15 – Pregnancy, childbirth and the puerperium (O00-O9A), the use additional code instruction is revised to make it clear that coders should include a code from Z3A (Weeks of gestation) for pregnant patients when it is applicable to the encounter. The note will be revised from “code from category Z3A, Weeks of gestation, to identify the specific week of the pregnancy, if known,” to “code, if applicable, from category Z3A, Weeks of gestation, to identify the specific week of the pregnancy, if known.”
An excludes note revision for O04 (Complications following [induced] termination of pregnancy) will move Z33.2 (Encounter for elective termination of pregnancy, uncomplicated) and O07.- (Failed attempted termination of pregnancy) from Excludes1 to Excludes2 status.
Changes to Chapter 16 – Certain conditions originating in the perinatal period (P00-P96) include revised code first instructions for P04.1 (Newborn affected by other maternal medication). The update clarifies that withdrawal symptoms from maternal use of drugs of addiction should be reported if applicable, and adds P96.2 (withdrawal symptoms from therapeutic use of drugs in newborn). You’ll also find that P28.81 (Respiratory arrest of newborn) and P22.0- (Respiratory distress of newborn) have switched from Excludes1 to Excludes2 codes for P28.5 (Respiratory failure of newborn)
Changes in Chapter 19 – Injury, poisoning and certain other consequences of external causes (S00-T88) include changes to S22 (Fracture of rib[s], sternum and thoracic spine). The code first instructions for associated injury of an intrathoracic organ or the spinal cord has been revised to code also instructions. In addition, the Excludes1 note for R65.21 (Septic shock) has been deleted from T81.1 (Postprocedural shock)
Chapter 21 – Factors influencing health status and contact with health services (Z00-Z99) contains a host of changes, including guidelines for new code Z29.81 (Encounter for HIV pre-exposure prophylaxis). A code also note instructs coders to report risk factors for HIV, when applicable, such as Z20.6 (Contact with and [suspected] exposure to human immunodeficiency virus [HIV]) and Z72.5- (High risk sexual behavior). An extensive code also update for Z62.8 (Other specified problems related to upbringing) adds Z63.3- (Absence of a family member), Z63.4 (Disappearance and death of family member), Z63.5 (Disruption of family by separation and divorce), Z63.8 (Other specified problems related to primary support group) and Z63.7- (Other stressful life events affecting family and household), to the list of codes that should also be reported when applicable.
The update also adds new code Z91.85 (Personal history of military service) as an Excludes2 code for Z91.82 (Personal history of military deployment). Z91.82 is an Excludes2 code for Z91.85, which also has the clarify terms “personal history of serving in the armed forces” and “personal history of veteran.”
Finally,
Chapter 22 – Codes for special purposes
(U00-U85) will include the updated instructions for
U07.1 (COVID-19). When appropriate coders will also report
D68.8 (COVID-19 associated coagulopathy),
D65 (Disseminated intravascular coagulation),
D68.69 (Hypercoagulable states) or
D68.69 (Thrombophilia). The update was released during the The ICD-10 Coordination and Maintenance Committee Meeting, March 7-8 (
PBN 3/27/23 subscription required).