ICD-10-CM Update - LIHIMA · LIHIMA-ICD-10-CM Update; October 2018 10/27/2017 LIHIMA-ICD-10-CM Update; October 2018 2 •FY 2018 Updates 360 new codes added 226 code descriptions

LIHIMA-ICD-10-CM Update; October 2018 10/27/2017

LIHIMA-ICD-10-CM Update; October 2018 1

2018 ICD-10-CM Update

Presented by:

John W. Ruth, MBA, RHIADirector, Revenue IntegrityStony Brook University [email protected]

Melissa Minski, RHIA, CCS, CCDS, AHIMA Approved ICD-10-CM/PCS TrainerAssociate Director, Revenue Integrity Staff DevelopmentStony Brook University [email protected]

ICD-10-CM Update

LIHIMA-ICD-10-CM Update; October 2018



• FY 2018 Updates 360 new codes added

226 code descriptions revised

34 codes changed from valid to invalid (deleted)

• FY 2017 Updates 1,974 codes added

425 codes revised

311 codes deleted

ICD-10-CM Updates

ICD-10-CM Updates• The word “with” or “in” should be interpreted to mean “associated with”

or “due to” when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List

• The classification presumes a causal relationship . . .

unless the documentation clearly states the conditions are unrelated or when another guideline exists that specifically requires a documented linkage between two conditions (e.g., sepsis guideline for “acute organ dysfunction that is not clearly associated with the sepsis”)

• Examples:• MD states the patient has polyneuropathy in DM type 2: In this case it would be appropriate to

assign code E11.42 since the word “with” appears in the alphabetical index (see also CC 2Q 2016 pgs. 36-37)

• MD states patient has sepsis due to a UTI and the patient also has acute respiratory failure: In this case the coder should NOT assume severe sepsis with organ dysfunction. A query should be sent to the physician to clarify the underlying cause of the respiratory failure, if it is not already clearly documented in the medical record.

https://www.cdc.gov/nchs/data/icd/10cmguidelines_fy2018_final.pdf pages 12-13

https://www.cdc.gov/nchs/data/icd/10cmguidelines_fy2018_final.pdf



Other ICD-10-CM Changes• Category A04.7 expanded to account for recurrent c-diff

colitis (A04.71) vs. c-diff colitis not specified as recurrent (A04.72)Code selection for recurrence based on provider

documentation

• Category G12.2 has been further subdividedG12.23 Primary lateral sclerosisG12.24 Familial motor neuron diseaseG12.25 Progressive spinal muscle atrophy

ICD-10-CM Updates

“Code Also”

• A “code also” note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction. The sequencing depends on the circumstances of the encounter.

ICD-10-CM Updates

https://www.cdc.gov/nchs/data/icd/10cmguidelines_fy2018_final.pdf page 13




Multiple Coding For a Single Condition

• The sequencing rule is the same as the etiology/manifestation pair, “use additional code” indicates that a secondary code should be added, if known.

• When there is a “code first” note and an underlying condition is present, the underlying condition should be sequenced first, if known.

ICD-10-CM Updates


• 4 new codes have been created for mast cell neoplasms C96.20 Malignant mast cell neoplasm, unspecified

C96.21 Aggressive systemic mastocytosis

C96.22 Mast cell sarcoma

C96.29 Other malignant mast cell neoplasm

• Category D47.0 has been revised D47.01 Cutaneous mastocytosis

D47.02 Systemic mastocytosis

D47.09 Other mast cell neoplasms of uncertain behavior

ICD-10-CM Updates




Chapter 2a:Treatment Directed at the Malignancy

• The only exception to this guideline is if a patient admission/encounter is solely for the administration of chemotherapy, immunotherapy or external beam radiation therapy, assign the appropriate Z51.-- code as the first-listed or principal diagnosis, and the diagnosis or problem for which the service is being performed as a secondary diagnosis.

ICD-10-CM Updates


Chapter 2 Guideline Updates

• Clarified use of code Z51.0, Encounter for antineoplastic radiation therapy, for external beam radiation therapy.

• New: If a patient admission/encounter is for the insertion or implantation of radioactive elements (e.g., brachytherapy) the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis. Code Z51.0 should not be assigned.

ICD-10-CM Updates






Chapter 2 Guideline Update Cont’d

When a patient is admitted for the purpose of insertion or implantation of radioactive elements (e.g., brachytherapy) and develops complications such as uncontrolled nausea and vomiting or dehydration, the principal or first-listed diagnosis is the appropriate code for the malignancy followed by any codes for the complications.

ICD-10-CM Updates


Diabetes Codes• New codesE11.10Type 2 diabetes mellitus with ketoacidosis

without comaE11.11Type 2 diabetes mellitus with ketoacidosis

with coma

• Category E08- Diabetes Mellitus due to Underlying Condition are ALL manifestation codesCannot be sequenced as principal diagnosis

ICD-10-CM Updates




• Category E85.8 further broken outE85.81 Light chain (AL) amyloidosisE85.82 Wild-type transthyretin-related

(ATTR) amyloidosisE85.59 Other amyloidosis

ICD-10-CM Updates

Chapter 4.a.3: Diabetes Mellitus and the Use of Insulin and Oral Hypoglycemics:If the documentation in a medical record does not indicate the type of diabetes but does indicate that the patient uses insulin, code E11-, Type 2 diabetes mellitus, should be assigned. An additional code should be assigned from category Z79 to identify the long-term (current) use of insulin or oral hypoglycemic drugs. If the patient is treated with both oral medications and insulin, only the code for long-term (current) use of insulin should be assigned. Code Z79.4 should not be assigned if insulin is given temporarily to bring a type 2 patient’s blood sugar under control during an encounter.

• Also applies to Guideline 4.a.6 for Secondary Diabetes Mellitus

ICD-10-CM Updates





New Psychiatric Codes (Chapter 5)

• New codes to identify “in remission” for abuse of: Alcohol (F10.11) Opioid (F11.11) Cannabis (F12.11) Sedative, hypnotic or anxiolytic (F13.11) Cocaine (F14.11) Other stimulant (F15.11) Hallucinogen (F16.11) Inhalant (F18.11) Other psychoactive substance (F19.11)

• Prior to this change “in remission” only applied to dependence

ICD10-CM Updates

New Psychiatric Codes (Chapter 5)

• New code F50.82Avoidant/restrictive food intake disorder

• An eating/feeding disorder defined by selective inability to eat or avoidance of consumption of certain foods/food groups…..Patients with this condition may experience adverse reactions to food such as gagging, choking, or vomiting.

ICD-10-CM Updates

2018 ICD-10-CM Coders Desk Reference Optum



New Inclusion Terms for Chapter 5

• New inclusion terms for existing codes for substance dependence in remissionUse disorder, moderate, in early remissionUse disorder, moderate, in sustained remissionUse disorder, severe, in early remission, and Use disorder, severe, in sustained remission

• Inclusion terms added to align with DSM-5

ICD-10-CM Updates

https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm-5/coding-updates/as-ordered-in-the-dsm-5-classification

DSM 5 Criteria for Substance Use Disorder

1. Taking the opioid in larger amounts and for longer than intended

2. Wanting to cut down or quit but not being able to do it

3. Spending a lot of time obtaining the opioid

4. Craving or a strong desire to use opioids

5. Repeatedly unable to carry out major obligations at work, school, or home due to opioid use

6. Continued use despite persistent or recurring social or interpersonal problems caused or made worse by opioid use

7. Stopping or reducing important social, occupational, or recreational activities due to opioid use

8. Recurrent use of opioids in physically hazardous situations

9. Consistent use of opioids despite acknowledgment of persistent or recurrent physical or psychological difficulties from usingopioids

10. *Tolerance as defined by either a need for markedly increased amounts to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount. (Does not apply for diminished effect when used appropriately under medical supervision)

11. *Withdrawal manifesting as either characteristic syndrome or the substance is used to avoid withdrawal (Does not apply when used appropriately under medical supervision)

12. *This criterion is not considered to be met for those individuals taking opioids solely under appropriate medical supervision.

A minimum of 2-3 criteria is required for a mild substance use disorder diagnosis, while 4-5 is moderate, and 6-7 is severe (APA, 2013).

ICD-10-CM Updates

https://www.buppractice.com/node/12351

https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm-5/coding-updates/as-ordered-in-the-dsm-5-classification

https://www.buppractice.com/node/12351



Chapter 5.b.1: Mental and Behavioral Disorders Due to Psychoactive Substance Use- In Remission:Selection of codes for “in remission” for categories F10-F19, Mental and behavioral disorders due to psychoactive substance use (categories F10-F19 with -11, -.21) requires the provider’s clinical judgment. The appropriate codes for “in remission” are assigned only on the basis of provider documentation (as defined in the Official Guidelines for Coding and Reporting), unless otherwise instructed by the classification. Mild substance use disorders in early or sustained remission are classified to the appropriate codes for substance abuse in remission, and moderate or severe substance use disorders in early or sustained remission are classified to the appropriate codes for substance dependence in remission.

ICD-10-CM Update


Chapter 5.b.3: Mental and Behavioral Disorders Due to Psychoactive Substance Use- Disorders:

As with all other diagnoses, the codes for psychoactive substance use disorders (F10.9-, F11.9-, F12.9-, F13.9-, F14.9-, F15.9-, F16.9-) should only be assigned based on provider documentation and when they meet the definition of a reportable diagnosis (see Section III, Reporting Additional Diagnoses). The codes are to be used only when the psychoactive substance use is associated with a physical, mental or behavioral disorder, and such a relationship is documented by the provider.

ICD-10-CM Guideline Update






• Category H44.2 has been expanded H44.2A Degenerative myopia with choroidal

neovascularizationH44.2B Degenerative myopia with macular

holeH44.2C Degenerative myopia with retinal

detachmentH44.2D Degenerative myopia with foveoshcisisH44.2E Degenerative myopia with other

maculopathy

ICD-10-CM Code Updates

• Category H54 has been further expanded H54.0X Blindness, both eyes different category levels

H54.11 Blindness, right eye, low vision left eye

H54.12 Blindness, left eye, low vision right eye

H54.2X Low vision, both eyes, different category levels

H54.41 Blindness, right eye, normal vision left eye

H54.42 Blindness, left eye, normal vision right eye

H54.51 Low vision, right eye, normal vision left eye

H54.52 Low vision, left eye, normal vision right eye





Chapter 7.b: BlindnessIf “blindness” or “low vision” of both eyes is documented but the visual impairment category is not documented, assign code H54.3, Unqualified visual loss, both eyes. If “blindness” or “low vision” in one eye is documented but the visual impairment category is not documented, assign a code from H54.6-, Unqualified visual loss, one eye. If “blindness” or “visual loss” is documented without any information about whether one or both eyes are affected, assign code H54.7, Unspecified visual loss.

ICD-10-CM Updates





• Category I27.2 has been further expanded I27.20 Pulmonary hypertension, unspecified

I27.21 Secondary pulmonary arterial hypertension

I27.22 Pulmonary hypertension due to left heart disease

I27.23 Pulmonary hypertension due to lung diseases and hypoxia

I27.24 Chronic thromboembolic pulmonary hypertension

I27.29 Other secondary pulmonary hypertension

• Code also other associated disorders, if known

ICD-10-CM Updates

Chapter 9.a.11: Pulmonary Hypertension

Pulmonary hypertension is classified to category I27, Other pulmonary heart diseases. For secondary pulmonary hypertension (I27.1, I27.2-), code also any associated conditions or adverse effects of drugs or toxins. The sequencing is based on the reason for the encounter.

ICD-10-CM Updates





Type 1 and Type 2 AMI

• Code I21.A1 has been created to differentiate Type 1 from Type 2 AMIs

• Code I21.A9 was created for AMIs types 3-5

ICD-10-CM Updates

Chapter 9.e: AMI

Type 1 ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) The ICD-10-CM codes for type 1 acute myocardial infarction (AMI) identify the site, such as anterolateral wall or true posterior wall. Subcategories I21.0-I21.2 and code I21.3 are used for type 1 ST elevation myocardial infarction (STEMI). Code I21.4, Non-ST elevation (NSTEMI) myocardial infarction, is used for type 1 non ST elevation myocardial infarction (NSTEMI) and nontransmural MIs. If a type 1 NSTEMI evolves to STEMI, assign the STEMI code. If a type 1 STEMI converts to NSTEMI due to thrombolytic therapy, it is still coded as STEMI.

ICD-10-CM Updates





Chapter 9.e: AMI Continued

I21.9, Acute myocardial infarction, unspecified, is the default for unspecified acute myocardial infarction or unspecified type. If only type 1 STEMI or transmural MI without the site is documented, assign code I21.3, ST elevation (STEMI) myocardial infarction of unspecified site.

ICD-10-CM Updates


Chapter 9.e: AMI ContinuedA code from category I22, Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction, is to be used when a patient who has suffered a type 1 or unspecified AMI has a new AMI within the 4 week time frame of the initial AMI. A code from category I22 must be used in conjunction with a code from category I21. The sequencing of the I22 and I21 codes depends on the circumstances of the encounter. Do not assign code I22 for subsequent myocardial infarctions other than type 1 or unspecified. For subsequent type 2 AMI assign only code I21.A1. For subsequent type 4 or type 5 AMI, assign only code I21.A9.

ICD-10-CM Updates






Chapter 9.e: AMI ContinuedOther Types of Myocardial Infarction: The ICD-10-CM provides codes for different types of myocardial infarction. Type 1 myocardial infarctions are assigned to codes I21.0-I21.4. Type 2 myocardial infarction, and myocardial infarction due to demand ischemia or secondary to ischemic balance, is assigned to code I21.A1, Myocardial infarction type 2 with a code for the underlying cause. Do not assign code I24.8, Other forms of acute ischemic heart disease for the demand ischemia. Sequencing of type 2 AMI or the underlying cause is dependent on the circumstances of admission. When a type 2 AMI code is described as NSTEMI or STEMI, only assign code I21.A1. Codes I21.01-I21.4 should only be assigned for type 1 AMIs. Acute myocardial infarctions type 3, 4a, 4b, 4c and 5 are assigned to code I21.A9, Other myocardial infarction type. The "Code also" and "Code first" notes should be followed related to complications, and for coding of post procedural myocardial infarctions during or following cardiac surgery.

ICD-10-CM Updates


Heart Failure Updates

Category I50.1 is now for LEFT sided heart failure

Category I50.81 is for RIGHT sided heart failure

Code I50.82 created for BIVENTRICULAR heart failure

Code I50.83 created for HIGH OUTPUT heart failure

I50.84 created for END STAGE heart failure





Heart Failure Updates Continued

• These codes can be used with the codes for systolic/diastolic heart failure With exception of codes I50.810-I50.813 for

right sided failure only and code I50.83 for high output heart failure

• The CC/MCC status is still on type of heart failure specified as systolic/diastolicNew codes are NOT CCs nor MCCs

ICD-10-CM Updates

Code I27.83 added for Eisenmenger syndrome

• Eisenmenger syndrome is a complication of a heart defect that is congenital.

• This heart defect that causes a shunt to develop between two chambers of the heart and is the most common cause of Eisenmenger syndrome. This shunt causes blood to circulate abnormally in the heart and lungs. Increased blood flow returns to the lungs instead of going to the rest of the body. The blood vessels in the lung arteries become stiff and narrow, increasing the pressure in the lungs' arteries. This permanently damages the blood vessels in the lungs.

• Eisenmenger syndrome occurs when the increased pressure of the blood flow in the lung becomes so great that the direction of blood flow through the shunt reverses. Oxygen-poor (blue) blood from the right side of the heart flows into the left ventricle and is pumped to the body so it doesn't receive enough oxygen to all organs and tissues.

ICD-10-CM Updates

https://www.mayoclinic.org/diseases-conditions/eisenmenger-syndrome/symptoms-causes/syc-20350580

https://www.mayoclinic.org/diseases-conditions/eisenmenger-syndrome/symptoms-causes/syc-20350580



Digestive System Changes

• Category K06.0 has been further expanded K06.01 Gingival recession, localized K06.02 Gingival recession, generalized

• Codes under categories K56 & K91.3 have been added to differentiate between partial and complete bowel obstructions

• Three anorectal abscess codes for horseshoe, ischiorectal, and supralevator abscesses were issued in the proposed code set but were not included with the final codes.

ICD-10-CM Updates

• New codes have been added to category L97 & L98 Non-pressure chronic ulcers These new codes provide detail for ulcers with:

Muscle involvement without evidence of necrosisBone involvement without evidence of necrosisOther specified severity

Prior to these additions all ulcers that went down to this layer defaulted to having necrosis without and option for no necrosis

• Chapter 12.b Non-Pressure Chronic Ulcers1) Patients admitted with non-pressure ulcers documented as healed:

No code is assigned if the documentation states that the non-pressure ulcer is completely healed.

ICD-10-CM Updates





Chapter 12.b Non-Pressure Chronic Ulcers2) Patients admitted with non-pressure ulcers documented as healing:

Non-pressure ulcers described as healing should be assigned the appropriate non-pressure ulcer code based on the documentation in the medical record. If the documentation does not provide information about the severity of the healing non-pressure ulcer, assign the appropriate code for unspecified severity.

If the documentation is unclear as to whether the patient has a current (new) non-pressure ulcer or if the patient is being treated for a healing non-pressure ulcer, query the provider. For ulcers that were present on admission but healed at the time of discharge, assign the code for the site and severity of the non-pressure ulcer at the time of admission.

ICD-10-CM Updates


Chapter 12.b Non-Pressure Chronic Ulcers3) Patient admitted with non-pressure ulcer that progresses to another severity level during the admission:

If a patient is admitted to an inpatient hospital with a nonpressure ulcer at one severity level and it progresses to a higher severity level, two separate codes should be assigned: one code for the site and severity level of the ulcer on admission and a second code for the same ulcer site and the highest severity level reported during the stay.

ICD-10-CM Updates






Musculoskeletal Code Updates

• Category M33 was further subdivide M33.03 Juvenile dermatomyositis without myopathy

M33.13 Other dermatomyositis without myopathy M33.93 Dermatopolymyositis, unspecified without

myopathy

• New codes M48.061Spinal stenosis, lumbar region without

neurogenicclaudication

M48.062Spinal stenosis, lumbar region with neurogenicclaudication

ICD-10-CM Updates

Chapter 14 Updates

• Category N63 has been further expanded N63.0 Unspecified lump in unspecified breast

N63.1 Unspecified lump in right breast N63.2 Unspecified lump in left breast

N63.3 Unspecified lump in axillary tail

N63.4 Unspecified lump in breast, subareolar

Each one of these expansions is further subdivided to identify the breast quadrant

ICD-10-CM Updates



• Categories O00.1 & O00.2 have been further subdivided for laterality of tubal and ovarian pregnancies

• Category P29.3 has been further subdivided P29.30 Pulmonary hypertension of newborn

(persistent pulmonary hypertension of newborn)

P29.38 Other persistent fetal circulation (delayed closure of ductus arteriosus

ICD-10-CM Updates

Chapter 15.q.2: Retained Products of Conception Following an AbortionSubsequent encounters for retained products of conception following a spontaneous abortion or elective termination of pregnancy, without complications are assigned O03.4, Incomplete spontaneous, abortion without complication, or codes O07.4, Failed attempted termination of pregnancy without complication. This advice is appropriate even when the patient was discharged previously with a discharge diagnosis of complete abortion. If the patient has a specific complication associated with the spontaneous abortion or elective termination of pregnancy in addition to retained products of conception, assign the appropriate complication in category O03 or O07 instead of code O03.4 or O07.4

ICD-10-CM Updates





• Code P78.84 has been created for Gestational alloimmune liver disease Includes GALD and Neonatal hemochromatosis

• Category P83.8 has been expandedP83.81 Umbilical granulomaP83.88 Other specified condition of integument

specific to newbornIncludes Bronze baby syndrome,

neonatal scleroderma, and urticarial neonatorum

ICD-10-CM Updates

• Category P91.8 has been further subdivided P91.81 Neonatal encephalopathy (which is further

subdivided for “in diseases classified elsewhere” and “unspecified”

P91.88 Other specified disturbances of cerebral status of newborn

• Categories Q53.1 and Q53.2 for undescended testicle(s) has been further expanded for site: Intra-abdominal

Inguinal

Ectopic perineal

High scrotal

ICD-10-CM Updates



• Code R06.03 has been created for acute respiratory distress

• Codes R06.83 and R06.84 created for unilateral and bilateral non-palpable testicles

• Category V86 Occupant of special all-terrain or other off-road motor vehicle injured in traffic accidents has been further expanded to identify: 3 or 4 wheeled all-terrain vehicle (ATV) injured in traffic

accident

Dirt bike or motor/cross bike injured in traffic accident

ICD-10-CM Updates

Chapter 18.f: Functional Quadriplegia

Functional quadriplegia (code R53.2) is the lack of ability to use one’s limbs or to ambulate due to extreme debility. It is not associated with neurologic deficit or injury, and code R53.2 should not be used for cases of neurologic quadriplegia. It should only be assigned if functional quadriplegia is specifically documented in the medical record.

ICD-10-CM Update





Chapter 19 Code Changes

• 36 thumb subluxation and dislocation codes have been deleted. The codes represent initial and subsequent

encounters, as well as sequela.

• The head injury section of Chapter 19 will lose 68 subsequent encounter and sequela codes.

ICD-10-CM Updates

• The instructional notes under category Z05 (encounter for observation of newborn for suspected diseases and conditions ruled out) have been revised:

ICD-10-CM Updates



• Category Z36, Encounter for antenatal screening of mother, has been expanded Z36.0 screening for chromosomal anomalies

Z36.1 screening for raised alphafetoprotein level

Z36.2 screening follow-up

Z36.3 screening for malformations

Z36.4 screening for fetal growth retardation

Z36.5 screening for isoimmunization

Z36.8 screening for other

• Further subdivided for conditions such as hydrops fetalis, nuchal translucency, cardiac abnormalities, fetal lung maturity, GBS status, cervical length, fetal macrosomia, other genetic defects

ICD-10-CM Updates

• Code Z04.03 has been added for prophylactic removal of fallopian tube(s)

ICD-10-CM Updates



Admissions/Encounters for Rehabilitation

• If the condition for which the rehabilitation service is being provided is no longer present, report the appropriate aftercare code as the first-listed or principal diagnosis, unless the rehabilitation service is being provided following an injury.

• For rehabilitation services following active treatment of an injury, assign the injury code with the appropriate seventh character for subsequent encounter as the first-listed or principal diagnosis.

ICD-10-CM Updates

• For example, if a patient with severe degenerative osteoarthritis of the hip, underwent hip replacement and the current encounter/admission is for rehabilitation, report code Z47.1, Aftercare following joint replacement surgery, as the first-listed or principal diagnosis.

• If the patient requires rehabilitation post hip replacement for right intertrochanteric femur fracture, report code S72.141D, Displaced intertrochanteric fracture of right femur, subsequent encounter for closed fracture with routine healing, as the first-listed or principal diagnosis.

ICD-10-CM Updates



LIHIMA-ICD-10-CM Update; October 2018

Documents

ICD-10-CM Update - LIHIMA · LIHIMA-ICD-10-CM Update; October 2018 10/27/2017 LIHIMA-ICD-10-CM Update; October 2018 2 •FY 2018 Updates 360 new codes added 226 code descriptions