In May the Centers for Medicare and Medicaid Services (CMS) released its fiscal year 2018 ICD-10-CM/PCS updates. This slideshow highlights some of the most noteworthy guideline and coding changes on both the ICD-10-CM and ICD-10-PCS sides. These changes impact visits and discharges beginning October 1, 2017. For a more extensive look at FY 2018 changes, keep an eye out for the Coding Notes articles in the November/December issue of the Journal of AHIMA. Also, click here for the full list from CMS.
Among the new FY 2018 ICD-10-PCS guideline updates was the guideline B3.7, which clarifies the use of Control versus a more definitive root operation. It states: “If an attempt to stop postprocedural or other acute bleeding is initially unsuccessful, and to stop the bleeding requires performing a more definitive root operation, such as Bypass, Detachment, Excision, Extraction, Reposition, Replacement or Resection, then the more definitive root operation is coded instead of Control.” This revision allows for the use of other root operations besides the seven listed in the guideline. An example would be with a patient with epistaxis with nasal packing. A more definitive root operation would be Packing rather than Control.
One of the most appreciated changes in ICD-10-PCS coding is the removal of lesser saphenous vein and greater saphenous vein. There is now just saphenous vein as a body part. This change could come in handy when coding treatments for varicose veins. Saphenous veins can be removed if an individual has large varicose veins, while sclerotherapy, a nonsurgical procedure, can treat smaller varicose veins, according to WebMD.
According to the new ICD-10-CM updates, it is now possible to select a specific ICD-10-CM code when a patient is in remission from abuse of each of a variety of substances such as alcohol, opioids, cannabis, sedative, hypnotic or anxiolytic-related, cocaine, hallucinogen, inhalant, nicotine, and other psychoactive substance related disorders. The new “in remission” codes all end with .11.
There is a new code for acute respiratory distress (R06.03), which is the type of period breathing pattern associated with central sleep apnea. One treatment this is continuous positive airway pressure (CPAP), which requires a mask and a machine.
Under the new ICD-10-CM updates, Diabetes mellitus and the use of insulin and oral hypoglycemics now instructs that an additional code should be assigned from category Z79 to identify the long-term (current) use of insulin or oral hypoglycemic drugs. Also, the guideline further clarifies that if the patient is treated with both oral medications and insulin, only code Z79.4 (long-term (current) use of insulin) should be assigned and that code Z79.4 should not be assigned if insulin is given temporarily to bring a type 2 patient’s blood sugar under control during an encounter. This same clarification was also added to I.C.4.a.6) (a) for Secondary diabetes mellitus. Individuals needing long-term insulin may opt to have an insulin pump implanted.
This guideline clarifies the use of an injury code for admission/encounter for rehabilitation. “If the condition for which the rehabilitation service is being provided is no longer present, report the appropriate aftercare code as the first-listed or principal diagnosis, unless the rehabilitation service is being provided following an injury. For rehabilitation services following active treatment of an injury, the coder is instructed to assign the injury code with the appropriate seventh character for subsequent encounter as the first-listed or principal diagnosis.”