The proposed ICD-10 code changes — released with the FY2024 Hospital Inpatient PPS (IPPS) proposed rule on April 10 — include new codes to enhance the tracking and progression of Parkinson’s disease, including codes for Parkinson’s disease with and without dyskinesia and Parkinsonism, unspecified.
The proposed rule includes 395 new codes, 12 revised code descriptors and 25 codes deemed invalid. If finalized, these changes would take effect Oct. 1.
A proposal including several of the Parkinson’s codes was previously discussed during the virtual ICD-10-CM Coordination and Maintenance Committee meetings in Sept. 2021 and March 2022.
The proposed code additions include:
- 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).
Industry experts previously noted that the addition of these codes will be beneficial by more clearly classifying Parkinson’s according to movement disorders with and without fluctuations.
Of the 395 new codes, 123 of them are new W codes to capture accidents and injuries such as W44.8xxA (Other foreign body entering into or through a natural orifice, initial encounter), W44.A1XA (Button battery entering into or through a natural orifice, initial encounter) and W44.C0XA (Glass unspecified, entering into or through a natural orifice, initial encounter).
In Chapter 13, 36 new codes are proposed for osteoporosis with current pathological pelvic fracture. The change gives coders more specific and more accurate codes to report for the fractures.
In the current code set, only codes for “osteoporosis with current pathological fracture, femur” are available, but those are anatomically incorrect. The expansion allows codes specific to the pelvis (not the leg) to be reported for this condition. The new codes also allow practices to code for pathological fractures linked to “age-related osteoporosis” as opposed to “other osteoporosis.”
Additional proposals
- Additions for sickle cell anemia. The proposed rule adds 14 codes for sickle cell anemia and related conditions, including D57.434 (Sickle-cell thalassemia beta zero with dactylitis) and H36.813 (Nonproliferative sickle-cell retinopathy, bilateral).
- New codes for insulin resistance. Insulin resistance will have three distinct codes, according to the proposed rule. Code E88.81 (Metabolic syndrome) would become invalid and be replaced with E88.810 (Metabolic syndrome), E88.811 (Insulin resistance syndrome, Type A), E88.818 (Other insulin resistance) and E88.819 (Insulin resistance, unspecified).
- Migraine with aura. The proposed rule would add chronic migraine with aura to the code set. The four proposed codes follow the same format as the existing G codes for chronic migraine without aura: not intractable or intractable and with or without status migrainosus.
- History of military service. Personal history of military service no longer appears in the documentation guidelines for E/M services, but proposed ICD-10-CM code Z91.85 (Personal history of military service) would make it possible for practices to include this information.
- Caregiver codes. You will also see expansion of the three caregiver’s other noncompliance codes that went into effect Oct. 1, 2022. Proposed changes would create two codes that indicate that the noncompliance is due to financial hardship or another reason. For example, Z91.A4 (Caregiver’s other noncompliance with patient's medication regimen) would become invalid and coders would use Z91.A41 (Caregiver's other noncompliance with patient’s medication regimen due to financial hardship) and Z91.A48 (Caregiver's other noncompliance with patient's medication regimen for other reason).
- Aneurysm codes revised. The code descriptions under I71.51 (Supraceliac aneurysm of the abdominal aorta, ruptured) and I71.52 (Paravisceral aneurysm of the abdominal aorta, ruptured) are proposed to be revised to “Supraceliac aneurysm of the thoracoabdominal aorta, ruptured” and “Paravisceral aneurysm of the thoracoabdominal aorta, ruptured.”
- New code for resistant hypertension. A new code, I1A.0, was added to Chapter 9 for Resistant hypertension, defined as a condition where a patient’s blood pressure remains above goal despite concurrent use of at least three antihypertensive drugs of different pharmacological classes. Nine other codes were also added to the circulatory chapter to describe various conditions related to microvascular dysfunction. For example, I21B (Myocardial infarction with coronary microvascular dysfunction).
- Note invalid codes. Among the 25 codes deemed invalid in the proposed update is G20 (Parkinson’s disease). The code will now be a parent for the above mentioned “children” codes.
- Also on the list of invalid codes are E88.81 (Metabolic syndrome), E20.8 (Other hypoparathyroidism) and I20.8 (Other forms of angina pectoris) – all of which now become parent codes.
| FY 2024 proposed ICD-10-CM code updates |
| |
New |
Revised |
Invalidated |
| Chapter 1: Certain infectious and parasitic diseases (A00-B99) |
2 |
0 |
0 |
| Chapter 2: Neoplasms (C00-D49) |
13 |
0 |
2 |
| Chapter 3: Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89) |
8 |
0 |
0 |
| Chapter 4: Endocrine, nutritional and metabolic diseases (E00-E89) |
18 |
0 |
3 |
| Chapter 5: Mental, Behavioral and Neurodevelopmental disorders (F01-F99) |
0 |
0 |
0 |
| Chapter 6: Diseases of the nervous system (G00-G99) |
24 |
0 |
2 |
| Chapter 7: Diseases of the eye and adnexa (H00-H59) |
34 |
0 |
1 |
| Chapter 8: Diseases of the ear and mastoid process (H60-H95) |
0 |
0 |
0 |
| Chapter 9: Diseases of the circulatory system (I00-I99) |
10 |
5 |
3 |
| Chapter 10: Diseases of the respiratory system (J00-J99) |
7 |
0 |
1 |
| Chapter 11: Diseases of the digestive system (K00-K95) |
17 |
0 |
2 |
| 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) |
36 |
0 |
0 |
| Chapter 14: Diseases of the genitourinary system (N00-N99) |
15 |
1 |
2 |
| Chapter 15: Pregnancy, childbirth and the puerperium (O00-O9A) |
6 |
0 |
1 |
| Chapter 16: Certain conditions originating in the perinatal period (P00-P96) |
0 |
1 |
0 |
| Chapter 17: Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) |
22 |
5 |
2 |
| Chapter 18: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) |
18 |
0 |
0 |
| Chapter 19: Injury, poisoning and certain other consequences of external causes (S00-T88) |
12 |
0 |
0 |
| Chapter 20: External causes of morbidity (V00-Y99) |
123 |
0 |
0 |
| Chapter 21: Factors influencing health status and contact with health services (Z00-Z99) |
30 |
1 |
6 |
| Chapter 22: Codes for special purposes (U00-U85) |
0 |
0 |
0 |
| Total |
395 |
13 |
25 |
This is a breaking news story. Stay tuned to Part B News for additional reporting.