September 2016

October Brings Code Adjustments
By Judy Sturgeon, CCS, CCDS
For The Record
Vol. 28 No. 9 P. 6

It's that time of year again when thoughts turn to colorful foliage, cooler temperatures, pigskin madness, and revised codes.

Next month marks the beginning of the fiscal year, accompanied by a plethora of new codes for coders to identify, prioritize, and memorize. Now that the industry has had a year to test ICD-10, the October update for ICD-10-CM includes 1,974 new codes, 311 deleted codes, and 425 code title revisions to allow for the addition of the new ones. While it's more difficult to count out the new ICD-10 procedure codes because of their inherent structure, some of the most obvious issues have been resolved by adding more operations, body part identifiers, and new technology codes.

Coders who wish to see each updated code can visit the Centers for Medicare & Medicaid Services (CMS) websites listed at the end of the article. In the meantime, the most significant changes and additions are covered here in more detail.

From A to Zika
While the first new diagnosis code starts with an A, it covers everything from A to Z. The mosquito-borne Zika virus infection now has a unique identifier: A925. That's the one and only code change in the entire Infectious Disease chapter.

Neoplasms received a little more attention this year. The former codes for gastrointestinal stromal tumors were originally assigned to connective and soft tissue tumors, but the condition is now clearly defined exactly as its name implies. There are site-specific codes, including ones for the esophagus, stomach, and small or large intestine, as well as the usual unspecified and other site. Carcinoid tumors, formerly labeled NOS (not otherwise specified), are now unspecified. Also, some of the Hodgkin's lymphoma codes have had the adjective "classical" removed from their titles for what is presumably an important reason.

Coders will see changes across nearly all of the chapters for postprocedural hemorrhage and hematoma of various organs and structures. The codes are being split out separately into hemorrhage, hematoma, hematoma and seroma, and seroma alone. One might expect this detail to be significant in future quality of care issues, so it will be important to code them correctly when documented by the provider and query when needed for clarification.

It's clear that eye complications were not nearly as complicated as they need to be. Diabetic retinopathy codes are expanding to identify more detail in type, macular edema involvement, and laterality of the involved eye or eyes. Other ophthalmological problems, including those for retinal vein occlusion, macular degeneration, and glaucoma, are getting an eye-popping number of new codes to cover details such as laterality, stage, and severity.

In case the October update causes your blood pressure to rise, there's good news: Hypertensive emergencies, crises, and urgencies now have specific descriptions and codes in the I16 category. With the many code changes for cerebral infarctions, expanded codes to describe their sequelae, and new aneurysm and arterial dissection codes, cerebrovascular codes may actually cause coders to have a stroke.

Digestive, skin, respiratory, and genitourinary chapters have several new codes and title changes, most notably in site laterality and urinary complications. The musculoskeletal codes added some significant new options to accurately describe periprosthetic and atypical femoral fractures. Attention deficit disorder is present in both the psychiatric and nervous system chapters because they have been relatively neglected for 2017.

For coders who regularly review patients with diagnoses from the obstetrics chapter, the code descriptions are multiplying like rabbits. Be sure to familiarize yourself with the new codes for ectopic pregnancies, pregnancy as a cause of edema, proteinuria, hypertension, preeclampsia, and eclampsia. The description for preexisting diabetes in a pregnant patient has changed from diabetes, type 1 or diabetes, type 2 to type 1 diabetes or type 2 diabetes. (It has not yet been announced whether the commercials with Wilford Brimley will be similarly rewritten.) There are more code changes for placental complications and severity levels for third degree obstetric lacerations, so be prepared to supply more detail in order to code the moms.

Sepsis Changes
There's a welcome homage to ICD-9 in the newborn diagnosis codes. When an infant had a suspected condition such as sepsis that was suspected but ruled out, a V-code explained the care but didn't report the infant as having the condition. In ICD-10, however, there was no way to report separately that a condition had been suspected but ruled out. Instead, the coder was required to report the sepsis as if it existed because suspected newborn conditions are assigned to the same code as those that were confirmed.

This change gave birth to a pile of elevated MS-DRG (Medicare severity diagnosis-related group) payments that did not truly reflect an increased severity of illness in the babies. Thankfully, there are new corresponding codes in the Z05 category for a newborn with a suspected condition that was subsequently ruled out and the nonessential modifier (suspected to be) has been removed from the code titles in the corresponding category. A new code for "light-for-dates newborns over 2,500 g" corrects defaulting them to an unspecified category. This will provide more accuracy in regard to larger infants whose code, not weight, was unspecified.

Heart, Fractures, and Silly Matters
A few new codes have been created for specific congenital anomalies of the aorta. There is now a way to report the National Institute of Health Stroke Scale scores, as well as some expansion of the Glasgow Coma Scale scores. In addition, there are a few more abnormal radiological finding codes and a new code for elevated prostate-specific antigen following treatment for malignant neoplasm of the prostate.

ICD-10 has broken out an entire splinter group of fracture codes, adding more detail, including previously unavailable sites and types. Each new injury code is tripled—one for initial, one for subsequent visit, and one for sequela of the original injury.

Another notable change is the deletion of codes for concussion in cases in which the loss of consciousness lasts 31 minutes or longer. This seems like a sound clinical decision—if the patient is unconscious for more than 30 minutes, it's likely the diagnosis will be more serious than a concussion.

Also be alert for more ways to report problems caused by catheters, stents, devices, and implants, as well as new codes for stenosis of coronary arteries and peripheral vascular stents.

In keeping with the public fascination over the odd injuries—such as being bitten by a shark while swimming in a tidal wave caused by an erupting volcano—covered by ICD-10, let's end this short tour of the October update with two final changes that will surely enhance the national database of health statistics.

In case you get injured while holding a yoga pose or standing in line for Super Bowl tickets, there is now a code group for reporting "overexertion from prolonged static or awkward postures." The coup de grace of code alterations, however, may very well be the description change from "paper entering through skin" to "contact with stiff edge of paper." Presumably, this will make patients feel less embarrassed about seeking medical treatment for a lowly paper cut.

If you would like to become more intimate with the details and new codes, visit the following CMS websites:

• www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-PCS-and-GEMs.html; and

• www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-CM-and-GEMs.html.

— Judy Sturgeon, CCS, CCDS, is the clinical coding/reimbursement compliance manager at Harris County Hospital District in Houston and a contributing editor at For The Record. While her initial education was in medical technology, she has been in hospital coding and compliance for 26 years.