Proposed changes to the ICD-10-CM code set include new codes for ectopic pregnancy, vanishing twin syndrome, cardiomyopathy, osteomyelitis, numerous toxic effect codes and personal history of clostridiodes difficile infection, among others.
The update, which include 184 new codes, 30 invalidated codes and four revised codes, was released Friday, April 10, as part of the proposed Medicare FY2027 Hospital Inpatient PPS (IPPS) rule. If finalized, the changes will take effect Oct. 1.
Take note of additions, revisions and deletions
The proposed FY 2027 ICD-10-CM code set will delete C75.9 (Malignant neoplasm of endocrine gland, unspecified) and add three new codes to describe cancers of the oral cavity and throat.
- C78.31 (Secondary malignant neoplasm of larynx).
- C78.32 (Secondary malignant neoplasm of pharynx).
- C79.83 (Secondary malignant neoplasm of oral cavity).
New endocrine codes E89.830 and E89.838 allow tracking of hypoglycemia occurring after bariatric and other surgeries.
An expansion of cardiomyopathy codes I42.0 and I42.8 will allow reporting of familial-genetic dilated cardiomyopathy and arrhythmogenic cardiomyopathy. A new code, I47.22 tracks catecholaminergic polymorphic ventricular tachycardia (CPVT), a condition in which a structurally normal heart lapses into dangerous, irregular heart rhythms during stress or exercise. Also, look for new codes for other heart arrhythmias including Brugada syndrome (I49.81) and ventricular bigeminy (I49.82).
Providers will have five new codes for sinusitis related to dental infections, damage and procedures, such as implants. Four codes will describe the specific sinus, with a fifth code for use when the provider doesn’t specify the sinus.
- J34.830 (Odontogenic sinusitis, maxillary sinus).
- J34.831 (Odontogenic sinusitis, ethmoid sinus).
- J34.832 (Odontogenic sinusitis, frontal sinus).
- J34.833 (Odontogenic sinusitis, sphenoid sinus).
- J34.839 (Odontogenic sinusitis, unspecified).
A new code for moderate hepatic fibrosis (K74.0A) allows more accurate coding of the liver disorder. Also, look for new digestive system codes for prevesical pelvic abscess (K6A.01) and other pelvic abscesses and diseases not elsewhere specified.
Look for changes to codes related to conditions of the flank in the skin and subcutaneous tissue chapter. You’ll find a new code L02.237 revisions that exclude the flank from three codes if the proposed changes go through (the revised text is underlined):
- L02.232 (Carbuncle of back [any part, except buttock and flank]).
- L03.312 (Cellulitis of back [any part except buttock and flank]).
- L03.322 (Acute lymphangitis of back [any part except buttock and flank]).
In the musculoskeletal chapter, expanded codes for plantar fasciitis (M67.A-) and plantar fascial fibromatosis (M72.2-) as well as other osteomyelitis (M86.8X-), will allow coding specific to laterality. A new code, M04.3 reports the severe, adult onset autoinflammatory disease known as VEXAS syndrome.
New genitourinary codes report intraoperative and post-procedural nipple ischemia (N99.860) and necrosis (N99.861).
More than a dozen codes allow reporting of specific types of ectopic pregnancies, such as O00.121 (Right interstitial ectopic pregnancy without intrauterine pregnancy). Other new codes focus on a continuing pregnancy after vanishing twin syndrome of one fetus or more, and will be reported by trimester and fetus. Consider, for example, O31.41X1 (Continuing pregnancy after vanishing twin syndrome of one fetus or more, first trimester, fetus 1).
New congenital codes will report familial cancer syndrome with pathogenic BRCA1 (QA1.790) and BRCA2 (QA1.791).
A signs and symptoms code, R78.72 reports abnormal levels of Gadolinium, a rare-earth metal used in MRI contrast, in the blood.
New Chapter 19 codes report toxic effects of alkenes, used in production of plastics, cycloparaffins, an industrial degreaser, and other organic solvents. For example: T52.811A, Toxic effect of alkenes, accidental (unintentional), initial encounter. In addition, look for new codes describing toxic effects of hexamethylene diisocyanate (T59.8-), a curing agent for automobile paint. New codes also report toxic effects of medetomidine (T65.85-), a veterinary sedative that is sometime mixed with fentanyl in the illicit drug trade.
The proposed ICD-10-CM update adds new war-related codes in Chapter 21: Factors influencing health status and contact with health services (Z00-Z99):
- Z77.32 (Contact with and [suspected] exposure to burn pits in war theater).
- Z77.33 (Contact with and [suspected] exposure to Agent Orange).
The proposed changes will also add four blast overpressure codes to chapter 21:
- Z77.40 (Contact with and [suspected] exposure to unspecified blast overpressure).
- Z77.41 (Contact with and (suspected] exposure to low-level blast overpressure).
- Z77.42 (Contact with and (suspected] exposure to high-level blast overpressure).
- Z77.49 (Contact with and (suspected] exposure to other blast overpressure).
The FY2026 update added blast overpressure codes in military operations and war operations to the external causes of morbidity chapter.
Additional chapter 21 changes include a code for patients who’ve had C. Difficile:
Z86.17 (Personal history of Clostridioides difficile infection).
An article printed
in a 2019 issue of The Lancet explains that
Clostridioides difficile is the same as
Clostridium difficile. Clostridioides difficile is currently listed as a clarifying term for the
A04.7 (Enterocolitis due to Clostridium difficile) family of codes. However, the proposed update does not make changes to the other
C. Diff. codes.
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FY2027 ICD-10-CM proposed change counts
|
|
Chapter
|
New
|
Revised
|
Invalidated
|
|
Chapter 1: Certain infectious and parasitic diseases (A00-B99)
|
0
|
0
|
0
|
|
Chapter 2: Neoplasms (C00-D49)
|
3
|
0
|
1
|
|
Chapter 3: Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)
|
2
|
0
|
1
|
|
Chapter 4: Endocrine, nutritional and metabolic diseases (E00-E89)
|
2
|
0
|
0
|
|
Chapter 5: Mental, Behavioral and Neurodevelopmental disorders (F01-F99)
|
1
|
0
|
0
|
|
Chapter 6: Diseases of the nervous system (G00-G99)
|
0
|
0
|
0
|
|
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)
|
9
|
0
|
3
|
|
Chapter 10: Diseases of the respiratory system (J00-J99)
|
6
|
0
|
0
|
|
Chapter 11: Diseases of the digestive system (K00-K95)
|
6
|
0
|
0
|
|
Chapter 12: Diseases of the skin and subcutaneous tissue (L00-L99)
|
1
|
3
|
0
|
|
Chapter 13: Diseases of the musculoskeletal system and connective tissue (M00-M99)
|
31
|
0
|
9
|
|
Chapter 14: Diseases of the genitourinary system (N00-N99)
|
2
|
0
|
0
|
|
Chapter 15: Pregnancy, childbirth and the puerperium (O00-O9A)
|
44
|
0
|
0
|
|
Chapter 16: Certain conditions originating in the perinatal period (P00-P96)
|
0
|
0
|
0
|
|
Chapter 17: Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
|
6
|
0
|
0
|
|
Chapter 18: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
|
1
|
0
|
0
|
|
Chapter 19: Injury, poisoning and certain other consequences of external causes (S00-T88)
|
60
|
0
|
15
|
|
Chapter 20: External causes of morbidity (V00-Y99)
|
0
|
0
|
0
|
|
Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)
|
10
|
1
|
1
|
|
Chapter 22: Codes for special purposes (U00-U85)
|
0
|
0
|
0
|
|
Total
|
184
|
4
|
30
|
Resource