It’s again time to review what has changed with the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) effective October 1, 2017 through September 30, 2018. There are 360 new, 142 deleted, and 226 revised diagnosis codes in the final update.
We will review the changes most relevant to urgent care, but the examples shown here are not all-inclusive. You can find all updates in the Centers for Medicare and Medicaid Services (CMS) website at https://www.cms.gov/Medicare/Coding/ICD10/2018-ICD-10-CM-and-GEMs.html.
Enterocolitis
Code A04.7 was deleted to make room for two new codes that further specify if the episode of enterocolitis is recurrent or not:
- 71, “Enterocolitis due to Clostridium difficile, recurrent”
- 72, “Enterocolitis due to Clostridium difficile, not specified as recurrent”
Malignant Mast Cell Tumor
Code C96.2 was deleted, and the category was expanded to further specify findings for malignant mast cell tumors:
- 20, “Malignant mast cell neoplasm, unspecified”
Diabetes
Two codes were added for type 2 diabetes:
- 10, “Type 2 diabetes mellitus with ketoacidosis without coma”
- 11, “Type 2 diabetes mellitus with ketoacidosis with coma”
Amyloidosis
Code E85.8 was deleted, and the category was expanded to further specify the type of amyloidosis, such as:
- 81, “Light chain (AL) amyloidosis”
Drug and Alcohol Abuse
You will now have the ability to report when a patient is in remission from abuse of each of a variety of substances:
- 11, “Alcohol abuse, in remission”
- 11, “Opioid abuse, in remission
- 11, “Cannabis abuse, in remission”
- 11, “Sedative, hypnotic or anxiolytic abuse, in remission”
- 11, “Cocaine abuse, in remission”
- 11, “Other stimulant abuse, in remission”
- 11, “Hallucinogen abuse, in remission”
- 11, “Inhalant abuse, in remission”
- 11, “Other psychoactive substance abuse, in remission”
Degenerative Myopia
See changes in code group H44.2 when reporting degenerative myopia with:
- Choroidal neovascularization
- Macular hole
- Retinal detachment
- Foveoschisis
- Other maculopathy
Blindness and Low Vision
Changes in code group H54 will allow providers to track rapid deterioration in vision and correlate each eye with the other. For example, one could report blindness in one eye and low vision in the other while specifying the category of effect on each eye:
- 1131, “Blindness right eye category 3, low vision left eye category 1”
- 2X12, “Low vision right eye category 1, low vision left eye category 2”
Hypertension
New codes in the I27.2 category offer specificity to “Pulmonary hypertension NOS,” so reporting secondary pulmonary hypertension can be more precise. Eisenmenger’s syndrome was given its own code of I27.83. (Prior to the change, we used the more generic code I27.89, “Other specified pulmonary heart diseases.”)
Gingivitis
Those offices offering the occasional periodontal services will see the new gingival recession code category K06.01, basing your selection on whether the condition is localized or generalized, and then the level of severity. For example, code K06.0, “Gingival recession,” was deleted and replaced with codes such as:
- 011, “Localized gingival recession, minimal”
- 023, “Generalized gingival recession, severe”
Intestinal Obstructions
Intestinal obstruction is frequently described as partial or complete. New codes were created in category K56 to aid in accurately reporting the obstruction. A few examples are:
- 51, “Intestinal adhesions [bands], with partial obstruction”
- 52, “Intestinal adhesions [bands], with complete obstruction”
- 600, “Partial intestinal obstruction, unspecified as to cause”
- 601, “Complete intestinal obstruction, unspecified as to cause”
Non-Pressure Ulcers
New codes in the L97 and L98 categories allow you to report non-pressure chronic ulcers with muscle or bone involvement but without evidence of necrosis. ICD-10-CM guidelines include the following definitions for non-pressure ulcers:
- Chronic ulcer of skin of lower limb
- Non-healing ulcer of skin
- Non-infected sinus of skin
- Trophic ulcer
- Tropical ulcer
- Ulcer of skin of lower limb
Some examples of the new codes to choose from are:
- 215, “Non-pressure chronic ulcer of right calf with muscle involvement without evidence of necrosis”
- 216, “Non-pressure chronic ulcer of right calf with bone involvement without evidence of necrosis”
Spinal Stenosis
Code M48.06 has been deleted and replaced with:
- 061, “Spinal stenosis, lumbar region without neurogenic claudication”
- 062, “Spinal stenosis, lumbar region with neurogenic claudication”
Breast Lumps
New codes in the N63 category allow you to code laterality and quadrant location for unspecified breast lumps. Code N63 is deleted and replaced with more specific codes. Two of those are:
- 11, “Unspecified lump in the right breast, upper outer quadrant”
- 12, “Unspecified lump in the right breast, upper inner quadrant”
Tubal and Ovarian Pregnancy
Laterality has been added to tubal and ovarian pregnancy codes in order to allow more efficient patient management during subsequent pregnancies. Look for these additions in categories O00.1and O00.2.
Thumb Joint
All codes in categories that reference “proximal interphalangeal joint thumb” and “distal interphalangeal joint thumb” have been removed. Some example code category deletions are:
- 51–, “Fracture of proximal phalanx of thumb…”
- 52–, “Fracture of distal phalanx of thumb…”
- 13–, “Subluxation and dislocation of proximal interphalangeal joint of thumb…”
- 14–, “Subluxation and dislocation of distal interphalangeal joint of thumb…”
No replacement codes are being offered, so you would bill using codes for “unspecified joint of thumb.”
Noteworthy Revisions
References to the “medial phalanx” were changed to “middle phalanx.”