ICD-10 Coding Changes Effective Oct. 1, 2016

With the delay of International Classification of Diseases, Tenth Revision, Procedural Code Set (ICD-10-PCS) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) implementation until October 1, 2015, there was also a delay in updating the codes. It’s been four years since the last annual update, meaning that lots of changes are to be expected. Most of these changes will affect ICD-10-PCS with 3,651 new codes and 487 revised codes, where the majority of changes can be found in the cardiovascular system section. These changes can be found at the Centers for Medicare and Medicaid Services (CMS) website here.

ICD-10-CM will see 1,943 new codes, 313 deletions, and 350 revised codes. The codes and changes are posted on the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics website here.

Diabetes

Added laterality to eye diseases associated with diabetes encompasses most of the additional codes found in code range E08 through E13 in the Endocrine, Nutritional, and Metabolic Diseases section, to give more detail to underlying conditions. For example, E08.321, “Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema” will be deleted and replaced with codes:

• 3211, “Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye”
• 3212, “Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye”
• 3213, “Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral”
• 3219, “Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye”

 Hypercholesterolemia

Code E78.0, “Pure hypercholesterolemia,” was deleted and replaced with two new codes:

• 00, “Pure hypercholesterolemia, unspecified;”
• 01, “Familial hypercholesterolemia.”

Carpel Tunnel Syndrome

A single code for specific mononeuropathies affecting bilateral limbs in the Diseases of the Nervous System section has also been added to codes in the G56 through G57 code range. Instead of coding G56.01 and G56.02 when a patient is diagnosed with carpel tunnel syndrome in the right and left upper limbs, you will use code G56.03, “Carpal tunnel syndrome, bilateral upper limbs.”

Retinal Diseases/Disorders

The Diseases of the Eye and Adnexa section will also reflect changes to add laterality. A seventh digit has been added to codes in range H34 through H35 to add even more specificity to retinal disorders. For example, code H34.811, “Central retinal vein occlusion, right eye” will be deleted and replaced with codes:

• 8110, “Central retinal vein occlusion, right eye, with macular edema”
• 8111, “Central retinal vein occlusion, right eye, with retinal neovascularization”
• 8112, “Central retinal vein occlusion, right eye, stable”

Glaucoma

Laterality codes 1, 2, 3, and 9 representing right, left, bilateral, and unspecified, respectively, have taken the place of the sixth-digit X-placeholder for glaucoma codes in the H40.1 range. Currently, you can report H40.11X1, “Primary open-angle glaucoma, mild stage,” but not the laterality. With the new codes, you will be able to report the laterality by using code H40.1111, “Primary open-angle glaucoma, right eye, mild state,” as well as adding laterality to other codes in this range. Codes in this range with the X-placeholder have been deleted to make way for the more specific codes.

Gastroenteritis and Colitis

Changes to the Diseases of the Digestive System section see the deletion of code K52.2, “Allergic and dietetic gastroenteritis and colitis,” and replaced with codes K52.831 through K52.839 to report specificity for colitis:

• 831, “Collagenous colitis”
• 832, “ Lymphocytic colitis”
• 838, “Other microscopic colitis”
• 839, “Microscopic colitis, unspecified”

Pancreatitis

Codes K85.0, “Idiopathic acute pancreatitis,” K85.1, “Biliary acute pancreatitis,” and K85.2, “Alcohol induced acute pancreatitis” were deleted and replaced with codes in range K85.00 through K85.92 to accommodate idiopathic, biliary, acute, with and without necrosis or infection, and alcohol or drug induced pancreatitis. Some examples of the new codes are:

• 00, “Idiopathic acute pancreatitis without necrosis or infection”
• 01, “Idiopathic acute pancreatitis with uninfected necrosis”
• 02, “Idiopathic acute pancreatitis with infected necrosis”
• 10, “Biliary acute pancreatitis without necrosis or infection”
• 22, “Alcohol induced acute pancreatitis with uninfected necrosis”
• 32, “Drug induced acute pancreatitis with infected necrosis”

Foot Deformities

Look for new codes in Musculoskeletal System and Connective Tissue section as well. Code range M21.6 will no longer include the X-placeholder in order to report more specific coding options for other acquired deformities of the foot, such as M21.611, “Bunion of right foot” or M21.621, “Bunionette of right foot.”

Hand Joint Pain

Codes M25.541 through M25.549 have been added in order to code joint pain in the hands:

• 541, “Pain in joints of right hand”
• 542, “Pain in joints of left hand”
• 549, “Pain in joints of unspecified hand”

Temporomandibular Joint Disorder

A sixth digit has been added to temporomandibular joint disorder codes in range M26.60 through M26.63 in order to report laterality. For example, you will now be able to specifically report the disorder in the right jaw by reporting code M26.601, “Right temporomandibular joint disorder.”

Cervical Disc Disorders

Sixth digits have also been added to codes in range M50.12 through M50.92 to add the cervical level (e.g., C4-C5) specificity to cervical disc disorders. For example, you will see the deletion of code N50.22, “Other cervical disc displacement, mid-cervical region” that will make room for the more specific codes:

• 121, “Cervical disc disorder at C4-C5 level with radiculopathy”
• 122, “Cervical disc disorder at C5-C6 level with radiculopathy”
• 123, “Cervical disc disorder at C6-C7 level with radiculopathy”

Femoral Fractures

Code range M84.75 has been added to incorporate 59 new codes to use when diagnosing femoral fractures. You will see new codes for atypical type fractures such as:

• 750A, “Atypical femoral fracture, unspecified, initial encounter for fracture”
• 751A, “Incomplete atypical femoral fracture, right leg, initial encounter for fracture”
• 754A, “Complete transverse atypical femoral fracture, right leg, initial encounter for fracture”
• 757A, “Complete oblique atypical femoral fracture, right leg, initial encounter for fracture”

Ovaries and Fallopian Tube

The Genitourinary System will also see some changes in code selections. Laterality will now be coded with the addition of a fifth-digit requirement for follicular cyst of the ovaries. Codes N83.0 through N83.52 have been deleted and replaced with 29 new codes in code range N83.00 through N83.529. For example, N83.0, “Follicular cyst of ovary” will be deleted and replaced with:

• 00, “Follicular cyst of ovary, unspecified side”
• 01, “Follicular cyst of right ovary”
• 02, “Follicular cyst of left ovary”

National Institutes of Health Stroke Scale (NIHSS) Scores/Glasgow Coma Scale Scores

The Symptoms, Signs, and Abnormal Clinical and Laboratory Findings section will report new codes R29.700 through R29.742 to report the NIHSS scores and codes R40.2410 through R40.2434 to report Glasgow coma scale scores at specific occurrences.

Skull Fractures

Laterality has been added to fracture and dislocation codes of the skull and head in code range S02.1 through S03.9. The general codes have been deleted and replaced with 261 more specific codes. For example, code S02.10XA, “Unspecified fracture of base of skull, initial encounter” will be deleted and replaced with:

• 101A, “Fracture of base of skull, right side, initial encounter for closed fracture”
• 102A, “Fracture of base of skull, left side, initial encounter for closed fracture”
• 109A, “Fracture of base of skull, unspecified side, initial encounter for closed fracture”

Foot Fractures

New sections of codes were added to report 20 new codes for “other” fractures of the foot beginning with code S92.811A, 125 new codes to report fractures of the calcaneus beginning with code S99.001A, 125 new codes to report fractures of the metatarsal beginning with code S99.101A, and 125 new codes to report fractures of the phalanx of the toe beginning with code S99.201A.