Continue your team’s training on new coding guidance for existing diagnosis codes. This overview covers updated instructions such as clarifying terms, Excludes notes and Code also notes that will go into effect Oct. 1, in ICD-10-CM chapters 11, 14, 15, 18, 18 and 21.
Chapter 11: Diseases of the digestive system (K00-K95)
New codes are responsible for several changes in this chapter. For example, there are two new clarifying terms for K31.1 (Adult hypertrophic pyloric stenosis):
- Acquired hypertrophic pyloric stenosis.
- Adult pyloric stenosis.
The update reflects the addition of code K31.B (Hypertrophic pyloric stenosis, in childhood).
Diagnosis codes K65.1 and K31.B describe a blockage of the pyloric sphincter caused by an overgrowth in the cells of the pyloric muscle.
New pelvic abscess codes (K6A.0-) will be added to the list of Code also conditions for diagnoses in the K57 (Diverticular disease of intestine) category and added as Excludes2 codes for K65.1 (Peritoneal abscess).
The addition of code K74.0A (Hepatic fibrosis, moderate fibrosis) will trigger changes to the clarifying terms for K74.01 (Hepatic fibrosis, early fibrosis). Specifically, stage 2 hepatic fibrosis will be deleted, and the term “mild hepatic fibrosis” will be added to help coders distinguish it from the new code.
Chapter 14: Diseases of the genitourinary system (N00-N99)
The new pelvic abscess codes are also added as Code also diagnoses for the subcategory inflammatory diseases of female pelvic organs (N70-N77).
Chapter 15: Pregnancy, childbirth and the puerperium (O00-O9A)
Clarifying terms “cervical pregnancy” and “cornual pregnancy” under O00.8 (Other ectopic pregnancy) will be deleted because new diagnosis codes (O00.4- and O00.5-) describe those conditions.
You’ll find new clarifying terms that list specific syndromes in the O35.1 (Maternal care for [suspected] chromosomal abnormality in fetus) subcategory. For example, Patau syndrome is a clarifying term for seventh-character code O35.11 (Maternal care for [suspected] chromosomal abnormality in fetus, Trisomy 13) and Klinefelter, Trisomy X and XYY syndrome are new clarifying terms for O35.15 ( … ; sex chromosome abnormality).
Chapter 18: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
Look for Excludes note switches for two codes. For R26.2 (Difficulty in walking, not elsewhere classified), the code for unsteadiness on feet (R26.81) will change from an Excludes 1 to an Excludes2 code. Hyperglycemia NOS (R73.9) will also flip to an Excludes2 code for the R79 (Other abnormal findings of blood chemistry) category.
Updates in this chapter also include a revised Code first note for the subcategory R29.7 (National Institutes of Health Stroke Scale [NIHSS] score). The revision instructs coders to report nontraumatic hemorrhage codes I60.-, I61.- or I62.- first, in addition to cerebral infarction codes I63.- with NIHSS score codes.
Chapter 19: Injury, poisoning and certain other consequences of external causes (S00-T88)
This chapter includes 20 new seventh-character codes for toxic effects of various chemicals, but don’t overlook updates to the instructions for two injury codes. Traumatic midline shift of brain will be added as a clarifying term for codes in the S06.A- (Traumatic brain compression and herniation) subcategory.
You’ll also see a Code note shift for codes in the S22 (Fracture of rib[s], sternum and thoracic spine) category. The Code also instruction for spinal cord injury codes (S24.0-, S24.1-) will be deleted and replaced with a Code first if applicable instruction for the spinal cord injury diagnoses.
Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)
You’ll find new clarifying terms for two Z codes in this chapter. Examples of encounters for specific conditions such as Down syndrome, Patau syndrome and Trisomy 21 will assist with coding Z36.0 (Encounter for antenatal screening for chromosomal anomalies).
Finally, comfort care and hospice care have been added as clarifying terms for Z51.5 (Encounter for palliative care). According to AHA Coding Clinic – I-10, you can assign this code for “patients who are not classified as terminal but are receiving comfort care for a serious illness.” However, you should check Medicare or payer guidelines before you assign this code for patients if the provider has not certified that the patient is eligible for hospice care.
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