Each October, the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) gets an update. This update includes additions, deletions, and revisions. Since incorrect diagnosis coding sometimes affects payment as much as incorrect procedure coding, it’s important to look at the update, especially as it relates to the codes your practice uses most often.
A sample of some of the changes that may be relevant to family medicine includes the following:
- B37.3, “Candidiasis of vulva and vagina,” is being subdivided into two new codes — one for acute cases (B37.31) and another for chronic cases (B37.32).
- D75.82-, “Heparin-induced thrombocytopenia (HIT)," is being subdivided into four new codes, ranging from D75.821 for non-immune HIT through D75.829 for HIT unspecified; you’ll need to use an additional code, if applicable, for adverse effect of heparin (T45.515-).
- E34.3, “Short stature due to endocrine disorder,” is being subdivided into seven new codes, ranging from E34.30, “Short stature due to endocrine disorder, unspecified,” to E34.39, “Other short stature due to endocrine disorder.”
- F01.5-, “Vascular dementia,” is being relabeled as “Vascular dementia, unspecified severity.” This will distinguish it from a long series of codes starting with F01.A- that describe specific levels of severity:
- F01.A- Vascular dementia, mild,
- F01.B- Vascular dementia, moderate,
- F01.C- Vascular dementia, severe.
- In the F02.- and F03.- code families, similar revisions are being made:
- F02.8- will become "Dementia in other diseases classified elsewhere, unspecified severity" with the addition of F02.A- through F02.C- that describe specific levels of severity,
- F03.9- will become “Unspecified dementia, unspecified severity” with the addition of F03.A- through F03.C- that describe specific levels of severity.
- The F10.- through F19.- code families include new codes that facilitate reporting various substance use disorders, unspecified, that are in remission. This makes the impacted code families more parallel throughout. For example, F11 (Opioid-related disorders) currently includes remission codes for opioid abuse (F11.11) and opioid dependence (F11.21) but not for unspecified opioid use (F11.9-). The addition of F11.91, “Opioid use, unspecified, in remission,” corrects that.
- F43.8, "Other reactions to severe stress," is being subdivided into two new codes — one to capture prolonged grief disorder (F43.81) and another to capture the rest of what was otherwise reported under F43.8 (F43.89, “Other reactions to severe stress”).
- Under M62.5A-, “Muscle wasting and atrophy, not elsewhere classified, back,” four new codes are being created. The sixth character will identify the relevant part of the back, when specified.
- Under M96.A-, “Fracture of ribs, sternum, and thorax associated with compression of the chest and cardiopulmonary resuscitation,” a set of codes is being added. The sixth character will identify the nature and extent of the fracture.
- Endometriosis codes (N80.-) are being expanded to provide more granularity regarding depth and/or laterality.
- A new code, S06.0XA, is being added for “Concussion with loss of consciousness status unknown.”
- Under T43.65-, a new set of codes is being added for “Poisoning by, adverse effect of, and underdosing of methamphetamines.”
- The growing popularity of electric bicycles has found its way into Chapter 20 of ICD-10-CM, which addresses external causes of morbidity. For example, new code V20.01 describes “Electric (assisted) bicycle driver injured in collision with pedestrian or animal in nontraffic accident.”
- Also in Chapter 20, there’s also a new code, W23.2, for being “Caught, crushed, jammed or pinched between a moving and stationary object.” Previously, ICD-10-CM only allowed you to report such injuries when caught between two moving objects or two stationary objects and not one of each.
Lastly, there are multiple additions among the “Z” codes, which describe factors influencing health status and contact with health services. Among them are the following:
- Z03.83, “Encounter for observation for suspected conditions related to home physiologic monitoring device ruled out.”
- Three new codes under Z59.8-, “Other problems related to housing and economic circumstances”:
- Z59.82, “Transportation insecurity,”
- Z59.86, “Financial insecurity,”
- Z59.87, “Material insecurity” (which includes the inability to obtain such things as childcare, clothing, utilities, and other basic needs).
- Two new codes for types of other specified counseling:
- Z71.87, “Encounter for pediatric-to-adult transition counseling,”
- Z71.88, “Encounter for counseling for socioeconomic factors.”
- A new family of codes, Z79.6-, for “Long term (current) use of immunomodulators and immunosuppressants” and a new code, Z79.85, for “Long-term (current) use of injectable non-insulin antidiabetic drugs.”
- Subdivision of two codes describing patient noncompliance: Z91.11-, “Patient's noncompliance with dietary regimen,” and Z91.19-, “Patient's noncompliance with other medical treatment and regimen.”
As noted, this is just a sample of the changes taking effect on Oct. 1, 2022. Full information is available on the Centers for Medicare & Medicaid Services’ website. Download the "2023 Addendum (ZIP)" and then view the file named "icd10cm_tabular_addenda_2023.pdf."
— Kent Moore, AAFP Senior Strategist for Physician Payment
Posted on September 26, 2022