Providers could have 435 code changes to deal with starting Oct. 1 with 247 new codes, 139 revised codes and 49 invalidated codes, according to the hospital inpatient prospective payment system (IPPS)
proposed rule released April 24.
One notable code, T81.4xxA (Infection following a procedure, initial encounter) could become invalid in the new code year. That’s because T81.4xxA, which is the code assigned to capture active treatment provided to a surgical wound infection, is among 49 codes proposed to be invalided from the code set, according to the proposed hospital inpatient prospective payment system rule released April 24.
Other seventh character options for T81.4- (T81.4xxD, Infection following a procedure, subsequent encounter and T81.4xxS, Infection following a procedure, sequela) also are being proposed for deletion.
In their place, 15 new codes for post-procedural infections are proposed to be added to an expanded T81.4- subcategory, adding specificity regarding the location and depth of the infection. You’ll be able to specify that an infected surgical wound is affecting the superficial incisional surgical site (T81.41-), the deep incisional surgical site (T81.42-) and the organ and space surgical site (T81.43-). Other surgical site and unspecified options are also available (T81.49- and T81.40-). Each of these codes requires a seventh character: “A,” “D” or “S.”
Additionally, three new codes are proposed to uniquely capture postprocedural sepsis, T81.44- (Sepsis following a procedure), with seventh character options “A,” “D” or “S.” Currently, post-procedural sepsis is coded to the same code for an infected surgical wound, T81.4-, according to the alphabetic index.
A majority of the new codes are in Chapter 2 (Neoplasms), Chapter 7 (Diseases of the eye and adnexa) and Chapter 19 (Injury, poisoning and certain other consequences of external causes).
Along with new codes for infected surgical wound and skin cancer, here a few other noteworthy additions, revisions and deletions:
- Neoplasms open up. You’ll have 45 new codes to report carcinomas, malignant and benign neoplasms and melanocytic nevii of the eyelids under the proposed code set. In general, the new codes split 20 eyelid codes to specify upper or lower lid. However, squamous cell carcinoma of skin of left eyelid, including canthus (C44.129) will also be divided into squamous cell and sebaceous cell carcinoma.
- New codes distinguish postpartum depression (F53.0) from puerperal psychosis and expand the codes for factitious disorder (F68), which describes falsification of medical or psychological signs and symptoms or induction of injury or disease. Code changes would allow a provider to distinguish between factitious disorder imposed on self and factitious disorder imposed on another, such as Munchausen’s disorder. New codes were added as well for cannabis withdrawal (F12).
- Expansion in the diseases of the nervous system chapter. The codes for clonic hemifacial spasm (G51.3) and muscular dystrophy (G71.0) are slated for replacement in the proposed rule. Effective Oct. 1, you’ll have four choices for clonic hemifacial spasm instead of one based on the location of the condition: right (G51.31), left (G51.32), bilateral (G51.33). The proposed new muscular dystrophy codes will encourage greater specificity with codes for Duchenne or Becker (G71.01), facioscapulohumeral (G71.02) and other specified muscular dystrophies (G71.09). There will be unspecified codes for both conditions, to be used as a last resort.
- Dozens of code changes are proposed for the H codes in Chapter 7, Diseases of the Eye and Adnexa. These add more specific codes for laterality as well as upper and lower lids for conditions such as blepharitis (H01), paralytic ectropion (H02.1), lagophthalmos (H02.2) and meibomian gland dysfunction (H02.88). New lateral codes are added for rosacea conjunctivitis (H10.82) and brow ptosis (H57.81).
- Stroke codes in Chapter 9, Diseases of the Circulatory System, are expanded to allow reporting cerebral infarction due to occlusion or stenosis of a small artery (I63.81) and other hereditary cerebrovascular disease (I67.858).
- Acute appendicitis codes (K35) are expanded to add new codes for acute appendicitis with local or generalized peritonitis with or without abscess, as well as with and without perforation or gangrene. Ischiorectal abscess codes (K61) are added for horseshoe abscess, other ischiorectal abscess and supralevator abscess. And new codes are added to cholecystitis (K82) to allow reporting of gangrene and perforation of the gall bladder.
- More myalgia codes. Your clinicians are already noting the location of a patient’s myalgia (M79.1), but they’ll need to get a bit more specific if the proposed changes come through. The single code will expand into one unspecified code and three location-based codes: myalgia of mastication muscle (M79.11), auxiliary muscles of the head and neck (M79.12) and other site (M79.18).
- Stay tuned for revisions in the chapter for diseases of the musculoskeletal system and connective tissue. We’ll have to wait to see why the proposed code set flagged six cervical disc disorder codes (M26.621, M50.01, M50.11, M50.21, M50.31, M50.81, M50.91) and three other chronic osteomyelitis of the humerus codes (M86.621-M86.629) as revised. The current and proposed descriptors are identical but more details should be forthcoming when the final codes are released.
- New codes allow reporting for triplet, quadruplet and “other specified multiple gestation” when each fetus has its own placenta and amniotic sac (O30).
- More codes for newborn health status. You'll find 16 new codes in the P02 and P04 series that describe a newborn’s status after birth. The codes generally cover a "newborn affected by maternal use of" a drug or substance, such as maternal use of opiates (P04.14), amphetamines (P04.16), sedative-hypnotics (P04.17), hallucinogens (P04.42) and cannabis (P04.81). The new codes also include P02.70 (Newborn affected by fetal inflammatory response syndrome) and P02.78 (Newborn affected by other conditions from chorioamnionitis), among others.
- Look for five new codes for abnormal findings in urine (R82), including hypocitraturia, hyperoxaluria, hyperuricoscuria, hypercalciuria and other abnormal findings. Five new codes will allow reporting of abnormal radiological findings on diagnostic imaging of right, left and bilateral testicles (R93.81), as well as other specified body structures (R93.89).
- Chapter 19, Injury, Poisoning, and Certain Other Consequences of External Causes, adds 12 new codes for poisoning by ecstasy (T43.64) including accidental, intentional, assault and undetermined.
- You'll find multiple new ways to specify your patient encounters with the addition of eight new codes in the Z13 series. The new codes address screenings for conditions including depression (Z13.31), maternal depression (Z13.32), autism (Z13.41) and a short series of codes for the screening of developmental delays (Z13.40, Z13.42, Z13.49). You'll also find an unspecified screening code for mental health and behavioral disorders (Z13.30).
- Add another Zika code to your list. You'll be able to document when a patient has come into contact with the Zika virus with new code Z20.821 (Contact with and [suspected] exposure to the Zika virus). – DecisionHealth staff
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ICD-10-CM chapter
|
New
|
Revised
|
Invalid
|
|
Chapter 1: Certain infectious and parasitic diseases (A00-B99)
|
0
|
0
|
0
|
|
Chapter 2: Neoplasms (C00-D49)
|
45
|
0
|
20
|
|
Chapter 3: Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)
|
0
|
0
|
0
|
|
Chapter 4: Endocrine, nutritional and metabolic diseases (E00-E89)
|
6
|
2
|
2
|
|
Chapter 5: Mental, Behavioral and Neurodevelopmental disorders (F01-F99)
|
5
|
4
|
1
|
|
Chapter 6: Diseases of the nervous system (G00-G99)
|
8
|
0
|
2
|
|
Chapter 7: Diseases of the eye and adnexa (H00-H59)
|
43
|
8
|
1
|
|
Chapter 8: Diseases of the ear and mastoid process (H60-H95)
|
0
|
0
|
0
|
|
Chapter 9: Diseases of the circulatory system (I00-I99)
|
4
|
4
|
1
|
|
Chapter 10: Diseases of the respiratory system (J00-J99)
|
0
|
0
|
0
|
|
Chapter 11: Diseases of the digestive system (K00-K95)
|
13
|
1
|
4
|
|
Chapter 12: Diseases of the skin and subcutaneous tissue (L00-L99)
|
0
|
3
|
0
|
|
Chapter 13: Diseases of the musculoskeletal system and connective tissue (M00-M99)
|
4
|
10
|
1
|
|
Chapter 14: Diseases of the genitourinary system (N00-N99)
|
17
|
1
|
2
|
|
Chapter 15: Pregnancy, childbirth and the puerperium (O00-O9A)
|
18
|
0
|
1
|
|
Chapter 16: Certain conditions originating in the perinatal period (P00-P96)
|
25
|
0
|
6
|
|
Chapter 17: Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
|
7
|
1
|
2
|
|
Chapter 18: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
|
10
|
5
|
2
|
|
Chapter 19: Injury, poisoning and certain other consequences of external causes (S00-T88)
|
30
|
87
|
3
|
|
Chapter 20: External causes of morbidity (V00-Y99)
|
0
|
11
|
0
|
|
Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)
|
12
|
2
|
1
|
|
Total
|
247
|
139
|
49
|