Gear Up for 2019 ICD-10-CM Code Changes

Posted on 13 Sep, 2018 |comments_icon 0|By Elizabeth Debeasi

Be sure to stay tuned for this four-part series to get up to speed on all the coding details you need to nail down the 2019 ICD-10-CM code changes!

Well folks, it’s that time of year again. October 1st is right around the corner. With new ICD-10-CM codes for 2019 coming your way, we best dive into the details.

As in the past, 2019 will see a significant number of ICD-10 code updates — specifically 450+ code changes consisting of 320 additions, 172 revisions, three deletions, and 48 codes converted to their parent code.

Notable additions include new codes to describe exploitation of children and adults and to address the increase in human trafficking cases, as well as new codes that expand the T81.4- subcategory for infected surgical wounds to accommodate greater specificity in reporting the depth of infection. We’ll look at all of these and more in this series to help you apply the new codes with proficiency.

Here’s to hitting the ground running on October 1st!

Code Updates: Cardiology

Although there were minimal 2019 ICD-10-CM revisions and additions affecting cardiology, it’s always best to review changes relevant to your specialty.

Cerebral Infarction Additions

Category I63- (Cerebral infarction) will add the following new codes:

  • I63.81 — Other cerebral infarction due to occlusion or stenosis of small artery. This code will also include lacunar infarction.
  • 163.89Other c000erebral infarction

An instructional note under category I63- tells you to report an additional code, if applicable, to identify status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to the patient’s admission to the current facility (Z92.82).

Also, if applicable, you should report an additional code to indicate the patient’s National Institutes of Health Stroke Scale (NIHSS) score (R29.7-).

New Subcategory Under Category I67-

Category I67- (Other cerebrovascular diseases) will add the new subcategory I67.85- (Hereditary cerebrovascular diseases) to your coding arsenal. Under this subcategory, you’ll find the following new codes.

  • 167.850Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. This diagnosis will also include CADASIL.
  • 167.858Other hereditary cerebrovascular disease

Under I67.850 (Other cerebrovascular diseases) there’s a new “code also” note that instructs you to report any associated diagnoses, such as: epilepsy and recurrent seizures (G40.-); cerebral infarction (I63.-); and vascular dementia (F01.-).

Miscellaneous Cardiology Code Revisions

  • 122.8Subsequent posterior (true) transmural (Q wave) myocardial infarction (acute)
  • 197.64Postproc seroma of a circ sys org fol a circ sys procedure
  • T46.4X  — Angiotensin-converting-enzyme inhibitors
  • T81.11  — Postprocedural cardiogenic shock
  • T81.11XAPostprocedural cardiogenic shock, initial encounter
  • T81.11XD — Postprocedural cardiogenic shock, subsequent encounter
  • T81.11XS — Postprocedural cardiogenic shock, sequela


Don’t forget to check for revisions to coding notes. For example, categories I60- (Nontraumatic subarachnoid hemorrhage) through I69- (Sequelae of cerebrovascular disease), involve a slight change to the note “use additional code to identify the presence of hypertension (I10, Essential primary hypertension) through I15, Secondary hypertension).” The revised note adds I16- (Hypertensive crisis), so now the range is I10- through I16-.

Infection and Sepsis Additions

It’s also important to be aware of new codes for post-procedural infections. Watch for Part 2 of this series, as we’ll look more closely at the new T81 codes. In summary:

T81.40- (Infection following a procedure, unspecified) through T81.43XS (Infection following a procedure, organ and space surgical site, sequela) and T81.49XX (Infection following a procedure, other surgical site) are added to category T81- (Complications of procedures, not elsewhere classified), as well as new sepsis code T81.44XX (Sepsis following a procedure).

Code Updates: Emergency Medicine

Every now and again, ED coders wish that more specific diagnostic codes existed. Well, CMS has delivered in the 2019 code set.

New Appendicitis Codes

Effective Oct. 1, you’ll find new codes that accommodate greater specificity in appendicitis coding.

These new codes open up the options for reporting appendicitis with peritonitis depending on whether the patient’s condition involves an abscess, perforation, or gangrene. The changes include eight new codes and almost as many revisions to codes and subcategories in the K35 (Acute appendicitis) range.

Example: The changes expand the current appendicitis codes out to a fifth, and sometimes sixth, character:

  • K35.20Acute appendicitis with generalized peritonitis, without abscess
  • K35.21Acute appendicitis with generalized peritonitis, with abscess
  • K35.30Acute appendicitis with localized peritonitis, without perforation or gangrene
  • K35.31Acute appendicitis with localized peritonitis and gangrene, without perforation
  • K35.32Acute appendicitis with perforation and localized peritonitis, without abscess
  • K35.33Acute appendicitis with perforation and localized peritonitis, with abscess
  • K35.890Other acute appendicitis without perforation or gangrene
  • K35.891Other acute appendicitis without perforation, with gangrene

Emergency departments will need to be increasingly specific in their documentation because coders will now need to know if an appendicitis patient has peritonitis, abscess, perforation, or gangrene to code properly.

Several New Ecstasy Codes

Starting Oct. 1, you’ll also find 17 new codes in the T43.64x (Poisoning by ecstasy) section of the ICD-10 manual that expand on ecstasy poisoning, identifying if the poisoning was accidental, intentional, assault, or undetermined.

The Official ICD-10-CM Guidelines states: “When coding a poisoning or reaction to the improper use of a medication (e.g., overdose, wrong substance given or taken in error, wrong route of administration), first assign the appropriate code from categories T36-T50.”

As you can infer from the above passage, these codes will apply to the ED setting, as they account for most reasons an ED would see an ecstasy patient.

“Use additional code(s) for all manifestations of poisonings,” the ICD-10 Guidelines say. “If there is also a diagnosis of abuse or dependence of the substance, the abuse or dependence is assigned as an additional code.”

New Facial Spasm Coding

Additionally, you’ll find new code G51.31 (Clonic hemifacial spasm, right), followed by additional codes to describe the left side, bilateral, or unspecified location. These codes (G51.31-G51.39) require the coder to assign five characters to describe the location of the spasm.

Coma Scale Code Descriptor Revisions

Revisions to R40.2 coma scale codes now include Glascow scores. See code description revisions below, all of which are in italics and two of which (R40.233 and R40.234) are changed from 0-5 years to 2-5 years of age.

R40.2 Coma

  • R40.21 Coma scale, eyes open
    • R40.211 Coma scale, eyes open, never

    Coma scale eye opening score of 1

    • R40.212 Coma scale, eyes open, to pain

    Coma scale eye opening score of 2

    • R40.213 Coma scale, eyes open, to sound

    Coma scale eye opening score of 3

    • R40.214 Coma scale, eyes open, spontaneous

    Coma scale eye opening score of 4

  • R40.22 Coma scale, best verbal response
    • R40.221 Coma scale, best verbal response, none

    Coma scale verbal score of 1

    • R40.222 Coma scale, best verbal response, incomprehensible words

    Coma scale verbal score of 2

    • R40.223 Coma scale, best verbal response, inappropriate words

    Coma scale verbal score of 3

    • R40.224 Coma scale, best verbal response, confused conversation

    Coma scale verbal score of 4

    • R40.225 Coma scale, best verbal response, oriented

    Coma scale verbal score of 5

  • R40.23 Coma scale, best motor response
    • R40.231 Coma scale, best motor response, none

    Coma scale motor score of 1

    • R40.232 Coma scale, best motor response, extension

    Coma scale motor score of 2

    • R40.233 Coma scale, best motor response, abnormal flexion

    Abnormal flexure posturing to pain or noxious stimuli (2-5 years of age)

    Coma scale motor score of 3

    • R40.234 Coma scale, best motor response, flexion withdrawal

    Coma scale motor score of 4

    Withdraws from pain or noxious stimuli (2-5 years of age)

    • R40.235 Coma scale, best motor response, localizes pain

    Coma scale motor score of 5

    • R40.236 Coma scale, best motor response, obeys commands

    Coma scale motor score of 6

Learn More

Join us for Part 2 in this series later this week, when we continue our ICD-10 review, looking at code updates for gastroenterology, internal medicine, and family/primary care.

Although you have only days to prepare for ICD-10-CM code changes, there’s no need to fret!

Sail into the 2019 code season with the ICD-10-CM for Physicians & Hospitals 2019 — brimming with new and revised ICD-10-CM codes and their descriptors, along with expert guidance and the vital features you need for correct coding and reimbursement. Pick up this best-in-class ICD-10-CM coding book today, which is packed with numerous bonus features you won’t find in any other ICD-10-CM code book.

Also, to receive practical ICD-10 training strategies, answers to your ICD-10 coding and ICD-10-CM Guideline questions, as well as specific examples to help you apply ICD-10 coding fundamentals, check out TCI’s ICD-10 Coding Alert.



Elizabeth Debeasi
Marketing Writer/ Editor

Elizabeth works on an array of projects at TCI, researching and writing about modern reimbursement challenges. Since joining TCI in 2017, she has also covered the nuts and bolts of cybersecurity, compliance with federal laws, and how to tap into the advantages of Telehealth services.

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