CMS has just released ICD-10-CM 2020, and there are both big and subtle changes you won’t want to miss spread out among the seven deleted codes, 328 new subcategories and codes, and 35 revised subcategories and codes.
Here are eight important takeaways from the ICD-10-CM 2020 addenda to help you get ready to implement the changes when they become effective on Oct. 1, 2019.
Adenosine deaminase deficiency, a metabolic disorder that causes immunodeficiency, is currently coded to D81.3 (Adenosine deaminase [ADA] deficiency). Under ICD-10-CM 2020, you will have codes for “unspecified” (D81.30) and “other” (D81.39) forms of the metabolic disorder as well as codes for ADA deficiency with severe combined immunodeficiency (SCID) (D81.31) and ADA type 2 (D81.32).
The big news here is of a small but consequential change to the instructional note that accompanies myocardial infarction (MI) type 2 (I21.A1). Beginning October 1, the note will read that you must Code First, and not Also, any underlying causes for the MI. Additionally, CMS has removed heart failure (I50.-) and renal failure (N17.0-N19) from the list of codes that you will code before I21.A1.
You will also have a large number of new pulmonary embolism, atrial fibrillation, phlebitis and thrombophlebitis, and other venous embolism and thrombosis codes, which we will go over in depth in a future post.
CMS has added a new classification of pressure ulcer injuries to the L89.- (Pressure ulcer) codes: deep tissue damage.
This category of injury is different from the ICD-10-CM stage classifications that are currently in use in that the new category occurs in the deep tissue beneath the skin. Reporting this kind of pressure ulcer will be easy, however, once you understand how pressure ulcers are classified in ICD-10-CM. Simply find the appropriate code for the anatomical site, and instead of using one of the existing sixth digits to document an unstageable (0), stage 1 (1), stage 2 (2), stage 3 (3), stage 4 (4), or unspecified (5) pressure ulcer, you will now have the option to use a new sixth digit, 6, to indicate pressure-induced deep tissue damage.
So, to report a pressure ulcer of the left heel that has caused deep tissue damage, you will use L89.626 (Pressure-induced deep tissue damage of left heel).
In addition to expanding Chapter 17: Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) to add a number of syndromes, which we will again discuss in full in a future post, ICD-10-CM 2020 has also created more granularity in the Q66.- (Congenital deformities of feet) codes. They have added a fifth (or, in the case of Q66.2- [Congenital metatarsus (primus) varus], a sixth) digit for a number of the codes, which will enable you to specify laterality using either 1 (right), 2 (left), or 3 (unspecified). This will bring them in line with Q66.5- (Congenital pes planus) and Q66.8- (Other congenital deformities of feet), which already have that capability.
You’ll soon also have three new signs and symptoms (R00-R99) codes at your disposal:
Beginning October 1, you’ll be able to choose from several new S02.- (Fracture of skull and facial bones) codes, including S02.83- (Fracture of medial orbital wall) and S02.84- (Fracture of lateral orbital wall) along with a new unspecified code, S02.85 (Fracture of orbit, unspecified).
You will also find multiple additions to the T50.9- (Poisoning by, adverse effect of and underdosing of other and unspecified drugs, medicaments and biological substances) and T67.0- (Heatstroke and sunstroke) codes, which we will again cover in another post.
The 2020 code set also gives you the ability to report an unspecified person injured during a legal intervention, which has resulted in numerous additions to the Y35.- (Legal intervention) codes. You can adjust to the new options simply by adding a sixth digit, 9, to any of the existing codes, such as Y35.319 (Legal intervention involving baton, unspecified person injured).
ICD-10-CM also adds a new subcategory to this group Y35.83- (Legal intervention involving a conducted energy device) which synonyms identify as being an electroshock device, such as a taser and/or a stun gun. The codes take sixth digits to identify a law enforcement official injured (1), a bystander injured (2), a suspect injured (3), and the previously mentioned unspecified person injured (9). Don’t forget the established seventh digits to indicate whether the encounter is initial (A), subsequent (D), or for sequela to the injury (S). So, an unspecified person being treated for the first time for injuries received from a taser during an encounter with police would be coded to Y35.839A (Legal intervention involving a conducted energy device, unspecified person injured, initial encounter).
As you would expect, there are number of changes to the encounter codes in this round of revisions, including additions to the tuberculosis encounter codes and the personal history codes, and yet another small but significant change in the way you will report the Body Mass Index (BMI) codes moving forward.
Next month, we’ll look at these ICD-10-CM 2020 changes in greater depth, so stay tuned.
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Nail down correct diagnosis coding with the 2020 ICD‑10‑CM for Physicians & Hospitals, packed with highlighted alerts, detailed anatomical illustrations, a new/revised/deleted codes list as a separate file, and Guideline Tips that walk you through the 2019 Official Guidelines changes in language that is easy to read and understand. Among the many bonus features, you’ll find coding tips and definitions of medical terms throughout the Tabular List.