Recent updates to the ICD-10-CM guidelines and codes apply to discharges and patient encounters occurring from October 1, 2022, through September 30, 2023 with four exceptions, which were effective April 1, 2022.
There are 1,176 new diagnoses codes for FY2023—including three codes that were added in April 2022—288 deletions—including one deletion in April 2022—and 28 revisions. 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 2023.
Guideline I.A.19 has been updated. The guideline states that the assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists. The provider’s statement that the patient has a particular condition is sufficient. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis. The Centers for Medicare & Medicaid Services (CMS) added the verbiage on the end, stating that if there is conflicting medical record documentation to query the provider.
In guideline I.B.14, Underimmunization Status joins Body Mass Index (BMI), depth of non-pressure chronic ulcers, pressure ulcer staging, coma and stroke scales, social determinants of health (SDOH), laterality, and blood alcohol level, as elements of documentation that can be coded from non-provider documentation. Specifically, unvaccinated and partially vaccinated (i.e., underimmunized) for COVID-19 can be documented by others and picked up by the coding professional.
Guideline I.B.16 is about the documentation of complications of care. It states, “Code assignment is based on the provider’s documentation of the relationship between the condition and the care or procedure, unless otherwise instructed by the classification.” The guideline extends to any complications of care, regardless of the chapter in which the code is located. It is important to note that not all conditions that occur during or following medical care or surgery are classified as complications. There must be a cause-and-effect relationship between the care provided and the condition, ending with updated additional verbiage: “The documentation must support that the condition is clinically significant. It is not necessary for the provider to explicitly document the term ‘complication.’ For example, if the condition alters the course of the surgery as documented in the operative report, then it would be appropriate to report a complication code.” Query the provider for clarification is updated with “if the documentation is not clear as to the relationship between the condition and the care or procedure.”
There is new information added in guideline I.C.1.2.(a), i that specifies in the case of HIV-related conditions and sepsis, if the reason for admission is this infection-associated hemolytic-uremic syndrome (HUS), it is sequenced as the principal diagnosis.
Under guideline I.C.1.(a), if a patient is admitted for an HIV-related condition, the principal diagnosis should be B20, Human immunodeficiency virus [HIV] disease, followed by additional diagnosis codes for all reported HIV-related conditions. An update that has been added is “An exception to this guideline is if the reason for admission is hemolytic-uremic syndrome associated with HIV disease. Assign code D59.31, Infection-associated hemolytic-uremic syndrome, followed by code B20, Human immunodeficiency virus [HIV] disease.”
A new guideline I.C.2.t. has been added on secondary malignant neoplasm of the lymphoid tissue. When a malignant neoplasm of lymphoid tissue metastasizes beyond the lymph nodes, a code from categories C81-C85 with a final character “9” should be assigned, identifying “extranodal and solid organ sites” rather than a code for the secondary neoplasm of the affected solid organ. For example, for metastasis of B-cell lymphoma to the lung, brain, and left adrenal gland, assign code C83.39, Diffuse large B-cell lymphoma, extranodal and solid organ sites.
I.C.15.a.7) is a new paragraph stating that “In ICD-10-CM, ‘completed’ weeks of gestation refers to full weeks. For example, if the provider documents gestation at 39 weeks and 6 days, the code for 39 weeks of gestation should be assigned, as the patient has not yet reached 40 completed weeks.”
Dementia underwent a significant expansion indicating severity. Guideline I.C.5.d. reveals that if a patient is admitted at one severity and progresses, only the higher level is reported.
For hemorrhage post-elective abortion, the new guideline instructions say, “For hemorrhage post elective abortion, assign code O04.6, Delayed or excessive hemorrhage following (induced) termination of pregnancy. Do not assign code O72.1, Other immediate postpartum hemorrhage, as this code should not be assigned for post-abortion conditions. Do not assign code Z33.2, Encounter for elective termination of pregnancy, when the patient experiences a complication post-elective abortion.” This is the newest update for post-abortion coding.
There’s also an update for underdosing. This was added as an addition, “Documentation of a change in the patient’s condition is not required to assign an underdosing code. Documentation that the patient is taking less of a medication than is prescribed or discontinued the prescribed medication is sufficient for code assignment.”
Finally, in Chapter 21: Factors influencing health status and contact with health services for Social Determinants of Health (SDOH), the guidance is that these codes are used only when the documentation specifies there are problems arising from the SDOH or if it poses a risk. It states to assign as many SDOH codes as are necessary to describe all of the problems or risk factors.
According to guideline I.21.c.10), the newest code, “Code Z71.87, Encounter for pediatric-to-adult transition counseling, should be assigned when pediatric-to-adult transition counseling is the sole reason for the encounter or when this counseling is provided in addition to other services, such as treatment of a chronic condition. If both transition counseling and treatment of a medical condition are provided during the same encounter, the code(s) for the medical condition(s) treated and code Z71.87 should be assigned, with sequencing depending on the circumstances of the encounter.”
Some updated code highlights have been expanded to help further specify coding:
Chapter 1 - Certain infectious and parasitic diseases (A00-B99)
- B37.31 and B37.32 have been expanded to allow separate codes for acute and chronic
Chapter 3 – Diseases of the Blood and Blood-forming Organs and Certain Disorders Involving the Immune Mechanism (D50-D89)
- D59.30 have been expanded to five characters
Chapter 4 – Endocrine, Nutritional, and Metabolic Diseases (E00-E89)
Code E34.3 Short stature due to endocrine disorder is being deleted and replaced by 7 new codes to provide more specificity as to the type of short stature:
- E34.30 Short stature due to endocrine disorder, unspecified
- E34.31 Constitutional short stature
- E34.321 Primary insulin-like growth factor-1 (IGF-1) deficiency
- E34.322 Insulin-like growth factor-1 (IGF-1) resistance
- E34.328 Other genetic causes of short stature
- E34.329 Unspecified genetic causes of short stature
- E34.39 Other short stature due to endocrine disorder
Chapter 5 – Mental, Behavioral, and Neurodevelopmental Disorders (F01-F99)
For FY 2023, this section is being expanded to 23 codes in each category to specify severity and types of behavioral disturbance such as agitation, psychotic disturbance, mood disturbance, or without behavioral disturbances. Those codes without behavioral disturbances are not considered CCs. Visit CMS files to see the four deletions, 83 new, and nine revisions in this area.
Chapter 9 – Diseases of the Circulatory System (I00-I99)
Nine codes being added to this chapter are specific to refractory angina pectoris, all of which are classified as CCs. Refractory angina is a chronic angina that does not respond to medical or other interventional therapy. Code I20.2 is refractory angina pectoris, while the other eight codes are specific to the atherosclerosis codes of coronary arteries either native or bypass grafts with refractory angina pectoris.
- I25.112 Atherosclerosis heart disease of native coronary artery with refractory angina pectoris
- I25.702 Atherosclerosis of coronary artery bypass graft(s), unspecified, with refractory angina pectoris
- I25.712 Atherosclerosis of autologous vein coronary artery bypass graft(s) with refractory angina pectoris
- I25.722 Atherosclerosis of autologous artery coronary artery bypass graft(s) with refractory angina pectoris
- I25.732 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with refractory angina pectoris
- I25.752 Atherosclerosis of native coronary artery of transplanted heart with refractory angina pectoris
- I25.762 Atherosclerosis of bypass graft of coronary artery of transplanted heart with refractory angina pectoris
- I25.792 Atherosclerosis of other coronary artery bypass graft(s) with refractory angina pectoris
- All have been expanded to include “refractory angina.”
This was just a highlight of some of the FY 2023 ICD-10-CM code updates; not all changes were covered. It is imperative that you review both the guidelines and the new, revised, and deleted codes to ensure you are assigning the most appropriate codes.
Azia (Powell) Harry is the inpatient coding coordinator at Tenethealthcare.
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