Revenue Cycle

Diving into the FY 2022 ICD-10-CM Diagnosis Code and Guideline Updates

The fiscal year 2022 ICD-10-CM diagnosis code update was officially released by the Centers for Medicare and Medicaid Services (CMS) on June 24, 2021, effective for discharges and encounters on or after October 1, 2021. This year, unlike FY 2021, has a small number of diagnosis codes being added: 165 as compared to the 485 implemented the previous year. The full list of diagnosis codes that have been added, deleted, and revised can be found in tables 6A, 6C, and 6E of the IPPS Final Rule for FY 2022. Nine of these new codes have been designated as major complication and comorbidity (MCC) codes, and 11 codes have been designated as complication and comorbidity (CC) codes.

In addition, there were updates to the ICD-10-CM Official Guidelines for Coding and Reporting, which are highlighted at the end of this article. It is imperative that you review both the guidelines and the new codes in order to ensure you are assigning the most appropriate codes. This article will touch on some of the more notable changes.

New Code Highlights
COVID-19

This year includes a new code to report sequela related to COVID-19, U09.9 (Post COVID-19 condition, unspecified). In addition, there were six codes introduced on January 1, 2021, related to COVID-19 that are included in this final list for FY 2022:

  • J12.82 Pneumonia due to coronavirus disease 2019 (MCC)
  • M35.81 Multisystem inflammatory syndrome (CC)
  • M35.89 Other specified system involvement of connective tissue (CC)
  • Z11.52 Encounter for screening for COVID-19
  • Z20.822 Contact with and (suspected) exposure to COVID-19
  • Z86.16 Personal history of COVID-19
Chapter 19: Injuries, Poisonings and Certain Other Consequences of External Causes

Chapter 19 has the greatest expansion of codes this year with 45 being added to this chapter. Six codes are being added to describe traumatic brain compression with and without herniation (S06.A0XA-S06.A1XS), and 39 codes being added to describe adverse effects, underdosing, and poisonings due to cannabis and synthetic cannabinoids (T40.711A-T40.716S and T40.721A-T40.726S). Two of the new codes in this chapter will be listed as MCCs: S06.A0XA (Traumatic brain compression without herniation, initial encounter) and S06.A1XA (Traumatic brain compression with herniation, initial encounter).

Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue

Twenty-five new codes are being added to Chapter 13. Sjögren Syndrome codes were expanded with the addition of seven new codes to describe involvement such as inflammatory arthritis, peripheral nervous system, central nervous system, gastrointestinal, glomerular disease, vasculitis, and dental involvement (M35.05-M35.0C). The titles of subcategory M35.0 and codes M35.00-M35.03 were revised from “Sicca syndrome” to “Sjögren syndrome.” Of note, M35.07 (Sjögren syndrome with central nervous system involvement) is classified as a CC. Nine codes are being added to cover non-radiographic axial spondyloarthritis by site (M45.A1-M45.AB) and expansion of low back pain into codes M54.50 (unspecified) and M54.41 (vertebrogenic low back pain). Three new codes in this chapter will be classified as MCCs:

  • M31.10 Thrombotic microangiopathy, unspecified (MCC)
  • M31.11 Hematopoietic stem cell transplantation-associated thrombotic microangiopathy (MCC)
  • M31.19 Other thrombotic microangiopathy (MCC)

Thrombotic microangiopathies are rare, yet life-threatening, disorders that encompass microangiopathic hemolytic anemia, thrombocytopenia, and microthrombi, which, in turn, leads to ischemic tissue injuries. These conditions require urgent treatment.1

Chapter 21: Factors Influencing Health Status and Contact with Health Services

There are 22 new codes that have been added to Chapter 21. Codes have been expanded to further specify homelessness as unspecified, sheltered, and unsheltered (Z59.00, Z59.01, and Z59.02). Food insecurity is broken down into Z59.41 (food insecurity) and Z59.48 (other specified lack of adequate food). Housing instability codes include Z59.811 (housing instability, housed with risk of homelessness), Z59.812 (Housing instability, housed, homelessness in past 12 months), Z59.819 (Housing instability, housed unspecified), and Z59.89 (other problems related to housing and economic circumstances). Additional codes have been added for personal history of suicidal behavior, non-suicidal self-harm, Chimeric Antigen Receptor T-cell therapy, other cellular therapy, and gene therapy.

Chapter 18: Symptoms, Signs and Abnormal Clinical Laboratory Findings

Chapter 18 has 14 new codes for FY 2022. Some notable additions are the expansion of codes for coughs:

  • R05.1 Acute Cough
  • R05.2 Subacute Cough
  • R05.3 Chronic Cough
  • R05.4 Cough syncope
  • R05.8 Other specified cough
  • R05.9 Cough, unspecified

Additional codes were added to report feeding difficulties (R63.30, R63.31, R63.32, and R63.39), nocturnal polyuria (R35.81), nonsuicidal self-harm (R45.88), and abnormal findings of blood amino-acid level (R79.83).

Chapter 11: Diseases of the Digestive System

The digestive system includes the addition of 13 new codes within Chapter 11. This includes 10 codes for reporting of gastric intestinal metaplasia:

  • K31.A0 Gastric intestinal metaplasia, unspecified
  • K31.A11 Gastric intestinal metaplasia without dysplasia, involving the antrum
  • K31.A12 Gastric intestinal metaplasia without dysplasia, involving the body (corpus)
  • K31.A13 Gastric intestinal metaplasia without dysplasia, involving the fundus
  • K31.A14 Gastric intestinal metaplasia without dysplasia, involving the cardia
  • K31.A15 Gastric intestinal metaplasia without dysplasia, involving multiple sites
  • K31.A19 Gastric intestinal metaplasia without dysplasia, unspecified site
  • K31.A21 Gastric intestinal metaplasia with low grade dysplasia
  • K31.A22 Gastric intestinal metaplasia with high grade dysplasia
  • K31.A29 Gastric intestinal metaplasia with dysplasia, unspecified

In addition, there are two codes for polyps—K22.81, esophageal polyp, and K22.82, esophagogastric junction polyp—as well as and K22.89, other specified disease of esophagus.

Chapter 6: Diseases of the Nervous System

There was an addition of 10 codes to this chapter, with several codes being designated as either CCs or MCCs. The codes in this chapter include:

  • G04.82 Acute flaccid myelitis (MCC)
  • G44.86 Cervicogenic headache
  • G92.00 Immune effector cell-associated neurotoxicity syndrome, grade unspecified
  • G92.01 Immune effector cell-associated neurotoxicity syndrome, grade 1
  • G92.02 Immune effector cell-associated neurotoxicity syndrome, grade 2
  • G92.03 Immune effector cell-associated neurotoxicity syndrome, grade 3 (CC)
  • G92.04 Immune effector cell-associated neurotoxicity syndrome, grade 4 (CC)
  • G92.05 Immune effector cell-associated neurotoxicity syndrome, grade 5 (CC)
  • G92.8 Other toxic encephalopathy (MCC)
  • G92.9 Unspecified toxic encephalopathy (MCC)
Chapter 16: Certain Conditions Originating in the Perinatal Period

Neonatal screening gets an additional eight codes this year related to abnormal findings within Chapter 16. Codes P09.1 through P09.9 cover abnormal findings of inborn errors of metabolism, congenital endocrine and hematologic disease, cystic fibrosis, critical congenital heart disease, neonatal hearing loss, and codes for other abnormal findings or unspecified findings. One additional code in this chapter covers newborns affected by (positive) maternal group B streptococcus (GBS) colonization (P00.82).

Other CC Designations

Additional codes that will be designated as CCs include:

  • A79.82 Anaplasmosis [A. phagocytophilum]
  • C56.3 Malignant neoplasm of bilateral ovaries
  • C79.63 Secondary malignant neoplasm of bilateral ovaries
  • C84.7A Anaplastic large cell lymphoma, ALK-negative, breast
  • I5A Non-ischemic myocardial injury (non-traumatic)
FY 2022 ICD-10-CM Official Guidelines for Coding and Reporting Highlights

There are a few updates to the coding guidelines that should also be highlighted.

  • Laterality has been updated to reflect that documentation from other clinicians may be used for laterality if the provider does not document this information. The “unspecified” side should rarely be used, and if there is conflicting documentation of the laterality in the record, then the attending provider should be queried. (I.B.13). Documentation from clinicians who are permitted based on the regulatory or accreditation requirements or internal hospital policies to document in a patient’s official medical record may be used for codes for (I.B.14.):
    • Body mass index (BMI)
    • Depth of non-pressure chronic ulcers
    • Pressure ulcer stage
    • Coma scale
    • NIH stroke scale (NIHSS)
    • Social determinants of health (SDOH)
    • Laterality
    • Blood alcohol level
  • Post-COVID-19 Condition – Assign a code for sequela of COVID-19 or the associated symptom or condition that develops following a previous infection and code U09.9, Post COVID-19 condition, unspecified. If a patient who previously had a COVID-19 infection develops a new active infection, then code U09.9 may be used in conjunction with U07.1 to show a condition associated with the previous infection along with the new infection. (I.C.1.g.1) (m)).
  • Breast Implant associated anaplastic large cell lymphoma – BIA-ALCL describes a type of lymphoma that occurs around breast implants. Assign the new code C84.7A for this condition and not a complication code from Chapter 19. (I.C.2.s).
  • Social Determinants of Health – This section was added to the guidelines to allow for use of these codes when the information is documented. Coding professionals may use documentation related to social information from social workers, community health workers, case managers, or nurses if the documentation is included in the official medical record. In addition, patient self-reporting may be used for code assignment if incorporated into the medical record by a clinician or provider and signed off by the provider/clinician. (I.C.21.c.17).

The continued process to expand the specificity of codes in the evolving healthcare industry will help increase the quality and integrity of reported data. Although the volume of new codes and updated coding guidelines are limited this year, it is imperative that both be reviewed in their entirety prior to the effective date of October 1, 2021, to ensure appropriate reporting.

Christi LeBlanc is a senior coding compliance consultant with HCA Healthcare.

Notes
  1. Arnold, Donald M. “Thrombotic microangiopathies: a general approach to diagnosis and management.” Canadian Medical Association Journal. 2017, Jan 30; 189(4): E153–E159. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266569.
References

https://www.cms.gov/files/document/fy-2022-icd-10-cm-coding-guidelines.pdf

https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2022/

https://www.cms.gov/medicare/acute-inpatient-pps/fy-2022-ipps-final-rule-home-page#Tables

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