2020 ICD-10-CM Updates - Lynn Handy, CPC, CPC-I, COC, CCS-P, LPN Vice President of Education & Consulting Services - Managed Resources
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2020 ICD-10-CM Updates
Lynn Handy, CPC, CPC-I, COC, CCS-P, LPN
September 12, 2019
Vice President of Education & Consulting Services
Lynn Handy, COC, CPC, CPC-I, CCS-P, LPN lynn.handy@managedresourcesinc.com
AGENDA
01 2020 Official ICD-10-CM Guidelines
05 Guideline Sections II, III and IV updates
02 Coding Guideline Structure
06 ICD-10-CM 2020 code updates
03 Section I Coding Conventions &
General Guideline Changes 07 ICD-11 News!
04 Chapter Specific Guideline Changes 08 Q&A
Coding Guideline Structure
• Section I: Conventions, general guidelines and chapter-specific guidelines
• Section II: Guidelines for selection of principal diagnosis for non-outpatient settings
• Section III: Guidelines for reporting additional diagnoses in non-outpatient settings
• Section IV: Outpatient coding and reporting
5
ICD-10-CM Official Guidelines for Coding and Reporting
Identify the changes:
• Bold text indicates narrative changes
• Underlined items have been moved within the guidelines since the FY
2019 version
• Italics are used to indicate revisions to heading changes
Effective date for these changes will be Oct 1, 2019 - Sept 30, 2020
6
Section I:
Coding Convention & General Coding Guideline Changes
A. Convention #15. “With”
Added narrative change to the second paragraph
The word “with” in the Alphabetic Index is sequenced immediately
following the main term or subterm, not in alphabetical order.
B. General Coding Guidelines:
No changes
7
Section I (C)
Chapter Specific Guidelines
8
Chapter 1: Certain Infectious and Parasitic Diseases A00-B99
(D. #4) Sepsis – Heading revision
Sepsis and severe sepsis with a localized infection
changed to
Sepsis or severe sepsis with a localized infection
(F. #1) Zika virus infections
• Code only a confirmed diagnosis of Zika virus (A92.5, Zika virus disease) as
documented by the provider. This is an exception to the hospital inpatient
guideline Section II, H. In this context, “confirmation” does not require
documentation of the type of test performed; the provider’s diagnostic
statement that the condition is confirmed is sufficient.
9Chapter 2: Neoplasms C00-D49
(D) Primary malignancy previously excised
• When a primary malignancy has been previously excised or eradicated from its site
and there is no further treatment directed to that site and there is no evidence of
any existing primary malignancy at that site, a code from category Z85, Personal
history of malignant neoplasm, should be used to indicate the former site of the
malignancy. Any mention of extension, invasion, or metastasis to another site is
coded as a secondary malignant neoplasm to that site. The secondary site may be
the principal or first-listed diagnosis with the Z85 code used as a secondary code.
10Chapter 3: Diseases of blood and blood-forming organs and certain
disorders involving the immune mechanism D50-D89
(E. #5) Other 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 (myocardial infarction due to demand ischemia or
secondary to ischemic imbalance) is assigned to code I21.A1, Myocardial infarction
type 2 with the underlying cause coded first. Do not assign code I24.8, Other forms
of acute ischemic heart disease, for the demand ischemia. If a type 2 AMI is
described as NSTEMI or STEMI, only assign code I21.A1.
11Chapter 12: Diseases of the Skin and Subcutaneous Tissue L00-L99
Narrative additions and changes took place in this chapter:
(A. #1) Pressure ulcer stage codes -
• Codes in category L89, Pressure ulcer, identify the site and stage of the
pressure ulcer. The ICD-10-CM classifies pressure ulcer stages based on
severity, which is designated by stages 1-4, deep tissue pressure injury,
unspecified stage, and unstageable.
(A. #4) Patients admitted with pressure ulcers documented as healed
• No code is assigned if the documentation states that the pressure ulcer is
completely healed at the time of admission.
Continued…
12Chapter 12 cont…
(A. #7) Pressure-induced deep tissue damage
• For pressure-induced deep tissue damage or deep tissue pressure injury, assign only
the appropriate code for pressure-induced deep tissue damage (L89.--6).
(B. #1) Non-Pressure Chronic Ulcers
• Patients admitted with non-pressure ulcers documented as healed No code is
assigned if the documentation states that the nonpressure ulcer is completely
healed at the time of admission.
13Chapter 15: Pregnancy, Childbirth and the Puerperium O00-O9A
(N. #1) Normal Delivery, Code O80
• Encounter for full term uncomplicated delivery Code O80 should be
assigned when a woman is admitted for a full-term normal delivery and
delivers a single, healthy infant without any complications antepartum,
during the delivery, or postpartum during the delivery episode. Code O80 is
always a principal diagnosis. It is not to be used if any other code from
chapter 15 is needed to describe a current complication of the antenatal,
delivery, or postnatal period.
(Q. #2) Termination of Pregnancy and Spontaneous abortions
• …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 code (e.g.,
O03.-, O04.-, O07.-) instead of code O03.4 or O07.4.
14Chapter 19: Injury, poisoning and certain other consequences
of external causes S00-T88
(B. #3) Iatrogenic injuries
Injury codes from Chapter 19 should not be assigned for injuries that
occur during, or as a result of, a medical intervention. Assign the
appropriate complication code(s).
(C. #3) Physeal fractures
For physeal fractures, assign only the code identifying the type of physeal
fracture. Do not assign a separate code to identify the specific bone that
is fractured.
Continued…
15Chapter 19 cont…
(E.#4) If two or more drugs, medicinal or biological substances
• If two or more drugs, medicinal or biological substances are taken, code
each individually unless a combination code is listed in the Table of Drugs
and Chemicals.
• If multiple unspecified drugs, medicinal or biological substances were taken,
assign the appropriate code from subcategory T50.91, Poisoning by, adverse
effect of and underdosing of multiple unspecified drugs, medicaments and
biological substances.
Continued…
16Chapter 19 cont…
(G.#5) Complications of care codes within the body system chapters
• Intraoperative and postprocedural complication codes are found
within the body system chapters with codes specific to the organs and
structures of that body system. These codes should be sequenced first,
followed by a code(s) for the specific complication, if applicable.
• Complication codes from the body system chapters should be assigned
for intraoperative and postprocedural complications (e.g., the
appropriate complication code from chapter 9 would be assigned for a
vascular intraoperative or postprocedural complication) unless the
complication is specifically indexed to a T code in chapter 19.
17Chapter 21: Factors influencing health status and contact with
health services Z00-Z99
(C. #3) Z68 Body mass index (BMI)
• BMI codes should only be assigned when there is an associated,
reportable diagnosis (such as obesity). Do not assign BMI codes during
pregnancy.
(C. #10) Z71 Persons encountering health services for other counseling
and medical advice, not elsewhere classified
Note: Code Z71.84, Encounter for health counseling related to travel, is to
be used for health risk and safety counseling for future travel purposes.
18Section II: Selection of Principal Diagnosis
(H) Uncertain Diagnosis
• If the diagnosis documented at the time of discharge is qualified as
“probable,” “suspected,” “likely,” “questionable,” “possible,” or “still to
be ruled out,” “compatible with,” “consistent with,” or other similar
terms indicating uncertainty, code the condition as if it existed or was
established. The bases for these guidelines are the diagnostic workup,
arrangements for further workup or observation, and initial
therapeutic approach that correspond most closely with the
established diagnosis.
Note: This guideline is applicable only to inpatient admissions to short-
term, acute, long-term care and psychiatric hospitals.
19Section III: Reporting Additional Diagnoses
(C) Uncertain Diagnosis
• If the diagnosis documented at the time of discharge is qualified as “probable,”
“suspected,” “likely,” “questionable,” “possible,” or “still to be ruled out,”
“compatible with,” “consistent with,” or other similar terms indicating uncertainty,
code the condition as if it existed or was established. The bases for these
guidelines are the diagnostic workup, arrangements for further workup or
observation, and initial therapeutic approach that correspond most closely with
the established diagnosis.
• Note: This guideline is applicable only to inpatient admissions to short-term, acute,
long-term care and psychiatric hospitals.
20Section IV: Diagnostic Coding and Reporting Guidelines for
Outpatient Services
(G) ICD-10-CM code for the diagnosis, condition, problem, or other reason for
encounter/visit
• List first the ICD-10-CM code for the diagnosis, condition, problem, or other reason for
encounter/visit shown in the medical record to be chiefly responsible for the services
provided. List additional codes that describe any coexisting conditions. In some cases, the
first-listed diagnosis may be a symptom when a diagnosis has not been established
(confirmed) by the provider.
(H) Uncertain diagnosis
• Do not code diagnoses documented as “probable”, “suspected,” “questionable,” “rule
out,” “compatible with,” “consistent with,” or “working diagnosis” or other similar terms
indicating uncertainty. Rather, code the condition(s) to the highest degree of certainty for
that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for
the visit.
• Please note: This differs from the coding practices used by short-term, acute care, long-
term care and psychiatric hospitals.
212020 ICD-10-CM Code Changes
• 273 New Codes
• 21 Deletions
• 30 Revisions
https://www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-CM.html
222020 ICD-10-CM Updates by Chapter
Code Code Code
Chapter Code Description
Additions Revised Deletions
1 Certain Infectious and Parasitic Diseases 0 3 0
2 Neoplasms 0 0 0
3 Diseases of Blood and Blood Forming Organs & Certain 5 0 0
Immune Disorders
4 Endocrine, Nutritional and Metabolic Diseases 0 0 0
5 Mental and Behavioral Disorders 0 0 0
6 Diseases of the Nervous System 0 2 0
7 Diseases of the Eye and Adnexa 0 0 0
8 Diseases of the Ear and Mastoid Process 0 0 4
9 Diseases of the Circulatory System 36 2 0
10 Diseases of the Respiratory System 0 1 0
11 Diseases of the Digestive System 0 0 0
232020 ICD-10-CM Updates by Chapter
Code Code Code
Chapter Code Description
Additions Revisions Deletions
12 Diseases of the Skin and Subcutaneous Tissue 25 0 0
13 Diseases of the Musculoskeletal System and Connective Tissue 0 7 0
14 Disease of the Genitourinary System 3 1 0
15 Pregnancy, Childbirth and the Puerperium 0 0 0
16 Certain Conditions originating in the Perinatal Period 0 0 0
17 Congenital Malformations, Deformations, and Chromosomal 31 1 0
Abnormalities
18 Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, 3 1 0
Not Elsewhere Classified
19 Injuries, Poisoning and Certain Consequences of External Causes 23 3 0
20 External Cause of Morbidity 26 1 0
21 Factors Influencing Health Status and Contact with Health 14 2 0
Services
24Chapter 1:
Certain infectious and parasitic diseases (A00-B99)
B96.2 Escherichia coli [E. coli ] as the cause of diseases classified elsewhere
Revise from B96.21 Shiga toxin-producing Escherichia coli [E. coli] (STEC) O157 as the cause of
diseases classified elsewhere
Revise to B96.21 Shiga toxin-producing Escherichia coli [E. coli] [STEC] O157 as the cause of
0 New Codes diseases classified elsewhere
3 Revisions
Revise from B96.22 Other specified Shiga toxin-producing Escherichia coli [E. coli] (STEC) as the
0 Deleted cause of diseases classified elsewhere
Revise to B96.22 Other specified Shiga toxin-producing Escherichia coli [E. coli] [STEC] as the
cause of diseases classified elsewhere
Revise from B96.23 Unspecified Shiga toxin-producing Escherichia coli [E. coli] (STEC) as the cause
of diseases classified elsewhere
Revise to B96.23 Unspecified Shiga toxin-producing Escherichia coli [E. coli] [STEC] as the cause
of diseases classified elsewhere
25Chapter 1:
Certain infectious and parasitic diseases (A00-B99)
Instructional adjustments
A18.4 Tuberculosis of skin and subcutaneous tissue
Excludes2:
Delete lupus NOS (M32.9)
Revise from systemic (M32.-)
Revise to systemic lupus erythematosus (M32.-)
B97.4 Respiratory syncytial virus as the cause of diseases classified elsewhere
Add RSV as the cause of diseases classified elsewhere
Add Code first related disorders, such as:
Add otitis media (H65.-)
Add upper respiratory infection (J06.9)
Add Excludes2: acute bronchiolitis due to respiratory syncytial virus (RSV) (J21.0)
Add acute bronchitis due to respiratory syncytial virus (RSV) (J20.5)
Add respiratory syncytial virus (RSV) pneumonia (J12.1)
26Chapter 2:
Neoplasms (C00-D49)
C91.0 Acute lymphoblastic leukemia [ALL]
Note:
Revise from Code C91.0 should only be used for T-cell and B-cell precursor leukemia
Revise to Codes in subcategory C91.0- should only be used for T-cell and B-cell precursor leukemia
0 New Codes
D04.0 Carcinoma in situ of skin of lip
0 Revised
Delete Excludes1: carcinoma in situ of vermilion border of lip (D00.01)
0 Deleted
Add Excludes2: carcinoma in situ of vermilion border of lip (D00.01)
D12 Benign neoplasm of colon, rectum, anus and anal canal
Add Excludes1: polyp of colon NOS (K63.5)
D12.6 Benign neoplasm of colon, unspecified
Delete Excludes1: polyp of colon NOS (K63.5)
27Chapter 2:
Neoplasms (C00-D49)
D21.6 Benign neoplasm of connective and other soft tissue of trunk, unspecified
Revise from Benign neoplasm of back NOS
Revise to Benign neoplasm of connective and other soft tissue back NOS
D23 Other benign neoplasms of skin
Delete Excludes1: melanocytic nevi (D22.-)
Add Excludes2: melanocytic nevi (D22.-)
D36.7 Benign neoplasm of other specified sites
Add Benign neoplasm of back NOS
28Neoplasm Table - slight revision
29Chapter 3:
Diseases of blood and blood forming organs and certain
disorders involving the immune mechanism (D50-D89)
5 New Codes
D75 Other and unspecified diseases of blood and blood-forming organs
Add D75.A Glucose-6-phosphate dehydrogenase (G6PD) deficiency without anemia
0 Revised
0 Deleted
D81.3 Adenosine deaminase [ADA] deficiency
Add D81.30 Adenosine deaminase deficiency, unspecified
Add D81.31 Severe combined immunodeficiency due to adenosine deaminase deficiency
Add D81.32 Adenosine deaminase 2 deficiency
Add D81.39 Other adenosine deaminase deficiency
Instructional addition:
D55.0 Anemia due to glucose-6-phosphate dehydrogenase [G6PD] deficiency
Add Excludes1: glucose-6-phosphate dehydrogenase (G6PD) deficiency without anemia
(D75.A)
30Chapter 4:
Endocrine, nutritional and metabolic diseases (E00-E89)
E23.3 Hypothalamic dysfunction, not elsewhere classified
Excludes1:
Revise from Prader-Willi syndrome (Q87.1)
0 New codes Revise to Prader-Willi syndrome (Q87.11)
0 Revised
Revise from Russell-Silver syndrome (Q87.1)
0 Deleted
Revise to Russell-Silver syndrome (Q87.19)
E34.3 Short stature due to endocrine disorder
Excludes1:
Revise from Russell-Silver syndrome (Q87.1)
Revise to Russell-Silver syndrome (Q87.19)
31Chapter 4:
Endocrine, nutritional and metabolic diseases (E00-E89)
E66 Overweight and obesity E79 Disorders of purine and
Excludes1: pyrimidine metabolism
Revise from Prader-Willi syndrome (Q87.1) Excludes1:
Revise to Prader-Willi syndrome (Q87.11) Revise from Ataxia-telangiectasia (Q87.1)
Revise to Ataxia-telangiectasia (Q87.19)
Revise from Cockayne's syndrome (Q87.1)
Revise to Cockayne's syndrome (Q87.19)
Metabolic disorders (E70-E88)
Excludes1:
Revise from Ehlers-Danlos syndrome (Q79.6) E88.0 Disorders of plasma-protein
metabolism, not elsewhere classified
Revise to Ehlers-Danlos syndrome (Q79.6-)
E88.02 Plasminogen deficiency
Delete Use Additional ligneous
conjunctivitis (H10.51)
32Chapter 5:
Mental, Behavioral and Neurodevelopmental disorders (F01-F99)
No code changes!
33Chapter 6:
Diseases of the nervous system (G00-G99)
G43 Migraine
G43.A Cyclical vomiting
Add Excludes1: cyclical vomiting syndrome unrelated to migraine (R11.15)
0 New Codes
2 Revisions
0 Deletions Revise from G43.A0 Cyclical vomiting, not intractable
Revise to G43.A0 Cyclical vomiting, in migraine, not intractable
Revise from G43.A1 Cyclical vomiting, intractable
Revise to G43.A1 Cyclical vomiting, in migraine, intractable
34Chapter 7:
Diseases of the Eye and Adnexa (H00-H59)
No code changes!
35Chapter 8:
Diseases of the ear and mastoid process (H60-H95)
H65 Nonsuppurative otitis media
Use Additional
Revise from code to identify:
Revise to code, if applicable, to identify:
Add infectious agent (B95-B97)
0 New Codes
0 Revised
4 Deleted H81 Disorders of vestibular function
H81.4 Vertigo of central origin
Delete H81.41 Vertigo of central origin, right ear
Delete H81.42 Vertigo of central origin, left ear
Delete H81.43 Vertigo of central origin, bilateral
Delete H81.49 Vertigo of central origin, unspecified ear
36Chapter 9:
Diseases of the circulatory system (I00-I99)
New codes for:
Atrial Fibrillation
36 New Codes
2 Revised
Phlebitis and thrombophlebitis (vein
0 Deleted
specificity)
Acute embolism and thrombosis (vein
specificity)
Chronic embolism and thrombosis (vein
specificity)
37Chapter 9:
Diseases of the circulatory system (I00-I99)
Let’s take a look at the NEW codes first:
I26.9 Pulmonary embolism without acute cor pulmonale
Add I26.93 Single subsegmental pulmonary embolism without acute cor pulmonale
Add Subsegmental pulmonary embolism NOS
Add I26.94 Multiple subsegmental pulmonary emboli without acute cor pulmonale
38Chapter 9:
Diseases of the circulatory system (I00-I99)
I48.1 Persistent atrial fibrillation
Add I48.11 Longstanding persistent atrial fibrillation
Add I48.19 Other persistent atrial fibrillation
Add Chronic persistent atrial fibrillation
Add Persistent atrial fibrillation, NOS
I48.2 Chronic atrial fibrillation
Delete Permanent atrial fibrillation
Add I48.20 Chronic atrial fibrillation, unspecified
Add Excludes1: Chronic persistent atrial fibrillation (I48.19)
Add I48.21 Permanent atrial fibrillation
39Atrial Fibrillation Definitions
• Persistent Atrial Fibrillation
• Usually lasts longer than a week. It could stop on its own, or the patient
may need medicine or treatment to stop it
• Long Standing Persistent Atrial Fibrillation
• Lasts longer than a year and doesn’t go away
• Permanent (Chronic) Atrial Fibrillation
• This can’t be corrected by treatments, but can be controlled with
medication
40Chapter 9:
Diseases of the circulatory system (I00-I99)
I80.1 Phlebitis and thrombophlebitis of femoral vein
Add Phlebitis and thrombophlebitis of common femoral vein
Add Phlebitis and thrombophlebitis of deep femoral vein
I80.21 Phlebitis and thrombophlebitis of iliac vein
Add Phlebitis and thrombophlebitis of common iliac vein
Add Phlebitis and thrombophlebitis of external iliac vein
Add Phlebitis and thrombophlebitis of internal iliac vein
I80.23 Phlebitis and thrombophlebitis of tibial vein
Add Phlebitis and thrombophlebitis of anterior tibial vein
Add Phlebitis and thrombophlebitis of posterior tibial vein
41Chapter 9:
Diseases of the circulatory system (I00-I99)
Add I80.24 Phlebitis and thrombophlebitis of peroneal vein
Add I80.241 Phlebitis and thrombophlebitis of right peroneal vein
Add I80.242 Phlebitis and thrombophlebitis of left peroneal vein
Add I80.243 Phlebitis and thrombophlebitis of peroneal vein, bilateral
Add I80.249 Phlebitis and thrombophlebitis of unspecified peroneal vein
Add I80.25 Phlebitis and thrombophlebitis of calf muscular vein
Add Phlebitis and thrombophlebitis of calf muscular vein, NOS
Add Phlebitis and thrombophlebitis of gastrocnemial vein
Add Phlebitis and thrombophlebitis of soleal vein
Add I80.251 Phlebitis and thrombophlebitis of right calf muscular vein
Add I80.252 Phlebitis and thrombophlebitis of left calf muscular vein
Add I80.253 Phlebitis and thrombophlebitis of calf muscular vein, bilateral
Add I80.259 Phlebitis and thrombophlebitis of unspecified calf muscular vein
42Chapter 9:
Diseases of the circulatory system (I00-I99)
I82.4 Acute embolism and thrombosis of deep veins of lower extremity
I82.41 Acute embolism and thrombosis of femoral vein
Add Acute embolism and thrombosis of common femoral vein
Add Acute embolism and thrombosis of deep femoral vein
I82.42 Acute embolism and thrombosis of iliac vein
Add Acute embolism and thrombosis of common iliac vein
Add Acute embolism and thrombosis of external iliac vein
Add Acute embolism and thrombosis of internal iliac vein
I82.44 Acute embolism and thrombosis of tibial vein
Add Acute embolism and thrombosis of anterior tibial vein
Add Acute embolism and thrombosis of posterior tibial vein
43Chapter 9:
Diseases of the circulatory system (I00-I99)
• Add I82.45 Acute embolism and thrombosis of peroneal vein
• Add I82.451 Acute embolism and thrombosis of right peroneal vein
• Add I82.452 Acute embolism and thrombosis of left peroneal vein
• Add I82.453 Acute embolism and thrombosis of peroneal vein, bilateral
• Add I82.459 Acute embolism and thrombosis of unspecified peroneal vein
• Add I82.46 Acute embolism and thrombosis of calf muscular vein
• Add Acute embolism and thrombosis of calf muscular vein, NOS
• Add Acute embolism and thrombosis of gastrocnemial vein
• Add Acute embolism and thrombosis of soleal vein
• Add I82.461 Acute embolism and thrombosis of right calf muscular vein
• Add I82.462 Acute embolism and thrombosis of left calf muscular vein
• Add I82.463 Acute embolism and thrombosis of calf muscular vein, bilateral
• Add I82.469 Acute embolism and thrombosis of unspecified calf muscular vein
44Chapter 9:
Diseases of the circulatory system (I00-I99)
Add I82.55 Chronic embolism and thrombosis of peroneal vein
Add I82.551 Chronic embolism and thrombosis of right peroneal vein
Add I82.552 Chronic embolism and thrombosis of left peroneal vein
Add I82.553 Chronic embolism and thrombosis of peroneal vein, bilateral
Add I82.559 Chronic embolism and thrombosis of unspecified peroneal vein
Add I82.56 Chronic embolism and thrombosis of calf muscular vein
Add Chronic embolism and thrombosis of calf muscular vein NOS
Add Chronic embolism and thrombosis of gastrocnemial vein
Add Chronic embolism and thrombosis of soleal vein
Add I82.561 Chronic embolism and thrombosis of right calf muscular vein
Add I82.562 Chronic embolism and thrombosis of left calf muscular vein
Add I82.563 Chronic embolism and thrombosis of calf muscular vein, bilateral
Add I82.569 Chronic embolism and thrombosis of unspecified calf muscular vein
45Chapter 9:
Diseases of the circulatory system (I00-I99)
REVISIONS
I70.23 Atherosclerosis of native arteries of right leg with ulceration
Revise from I70.238 Atherosclerosis of native arteries of right leg with ulceration of
other part of lower right leg
Revise to I70.238 Atherosclerosis of native arteries of right leg with ulceration of
other part of lower leg
I70.24 Atherosclerosis of native arteries of left leg with ulceration
Revise from I70.248 Atherosclerosis of native arteries of left leg with ulceration of
other part of lower left leg
Revise to I70.248 Atherosclerosis of native arteries of left leg with ulceration of
other part of lower leg
46Chapter 10:
Diseases of the respiratory system (J00-J99)
J44 Other chronic obstructive pulmonary disease
0 New Codes
1 Revised
Revise from J44.0 Chronic obstructive pulmonary disease
0 Deleted
with acute lower respiratory infection
Revise to J44.0 Chronic obstructive pulmonary disease
with (acute) lower respiratory infection
47Chapter 11:
Diseases of the Digestive System (K00-K95)
No code changes!
48Chapter 12:
Diseases of the skin and subcutaneous tissue (L00-L99)
25 New Codes for Pressure-induced deep tissue damage
Add L89.006 Pressure-induced deep tissue damage of unspecified elbow
Add L89.016 Pressure-induced deep tissue damage of right elbow
25 New Codes Add L89.026 Pressure-induced deep tissue damage of left elbow
Add L89.106 Pressure-induced deep tissue damage of unspecified part of back
0 Revised
0 Deleted
Add L89.116 Pressure-induced deep tissue damage of right upper back
Add L89.126 Pressure-induced deep tissue damage of left upper back
Add L89.136 Pressure-induced deep tissue damage of right lower back
Add L89.146 Pressure-induced deep tissue damage of left lower back
Add L89.156 Pressure-induced deep tissue damage of sacral region
Add L89.206 Pressure-induced deep tissue damage of unspecified hip
Add L89.216 Pressure-induced deep tissue damage of right hip
Add L89.226 Pressure-induced deep tissue damage of left hip
49Chapter 12:
Diseases of the skin and subcutaneous tissue (L00-L99)
Add L89.306 Pressure-induced deep tissue damage of unspecified buttock
Add L89.316 Pressure-induced deep tissue damage of right buttock
Add L89.326 Pressure-induced deep tissue damage of left buttock
Add L89.46 Pressure-induced deep tissue damage of contiguous site of back, buttock and hip
Add L89.506 Pressure-induced deep tissue damage of unspecified ankle
Add L89.516 Pressure-induced deep tissue damage of right ankle
Add L89.526 Pressure-induced deep tissue damage of left ankle
Add L89.606 Pressure-induced deep tissue damage of unspecified heel
Add L89.616 Pressure-induced deep tissue damage of right heel
Add L89.626 Pressure-induced deep tissue damage of left heel
Add L89.816 Pressure-induced deep tissue damage of head
Add L89.896 Pressure-induced deep tissue damage of other site
Add L89.96 Pressure-induced deep tissue damage of unspecified site
50Chapter 13:
Diseases of the musculoskeletal system and connective tissue
(M00-M99)
M50.12 Cervical disc disorder with radiculopathy, mid-cervical region
Revise from M50.120 Mid-cervical disc disorder, unspecified
Revise to M50.120 Mid-cervical disc disorder, unspecified level
0 New Codes
7 Revised M66.8 Spontaneous rupture of other tendons
0 Deleted Revise from M66.88 Spontaneous rupture of other tendons, other
Revise to M66.88 Spontaneous rupture of other tendons, other sites
M67.83 Other specified disorders of synovium and tendon, wrist
Revise from M67.839 Other specified disorders of synovium and tendon, unspecified forearm
Revise to M67.839 Other specified disorders of synovium and tendon, unspecified wrist
51Chapter 13:
Diseases of the musculoskeletal system and connective tissue
(M00-M99)
M77 Other enthesopathies
Revise from M77.5 Other enthesopathy of foot
Revise to M77.5 Other enthesopathy of foot and ankle
Revise from M77.50 Other enthesopathy of unspecified foot
Revise to M77.50 Other enthesopathy of unspecified foot and ankle
Revise from M77.51 Other enthesopathy of right foot
Revise to M77.51 Other enthesopathy of right foot and ankle
Revise from M77.52 Other enthesopathy of left foot
Revise to M77.52 Other enthesopathy of left foot and ankle
52Chapter 14:
Diseases of the genitourinary system (N00-N99)
3 New Codes N35.81 Other urethral stricture, male
1 Revised Revise from N35.814 Other anterior urethral stricture, male, anterior
0 Deleted Revise to N35.814 Other anterior urethral stricture, male
N63.1 Unspecified lump in the right breast
Add N63.15 Unspecified lump in the right breast, overlapping quadrants
Add N63.25 Unspecified lump in the left breast, overlapping quadrants
N99.8 Other intraoperative and postprocedural complications and disorders of
genitourinary system
Add N99.85 Post endometrial ablation syndrome
53Chapter 15: Pregnancy, childbirth and the puerperium
(O00-O9A)
No code changes!
Chapter 16: Certain conditions originating in the perinatal period
(P00-P96)
No code changes!
54Chapter 17: Congenital malformations, deformations and
chromosomal abnormalities (Q00-Q99)
Q66 Congenital deformities of feet
Q66.0 Congenital talipes equinovarus
Add Q66.00 Congenital talipes equinovarus, unspecified foot
Add Q66.01 Congenital talipes equinovarus, right foot
Add Q66.02 Congenital talipes equinovarus, left foot
31 New codes
1 Revised Q66.1 Congenital talipes calcaneovarus
0 Deleted Add Q66.10 Congenital talipes calcaneovarus, unspecified foot
Add Q66.11 Congenital talipes calcaneovarus, right foot
Add Q66.12 Congenital talipes calcaneovarus, left foot
Q66.2 Congenital metatarsus (primus) varus
Q66.21 Congenital metatarsus primus varus
Add Q66.211 Congenital metatarsus primus varus, right foot
Add Q66.212 Congenital metatarsus primus varus, left foot
Add Q66.219 Congenital metatarsus primus varus, unspecified foot
55Chapter 17: Congenital malformations, deformations and
chromosomal abnormalities (Q00-Q99)
Q66.22 Congenital metatarsus adductus
Add Q66.221 Congenital metatarsus adductus, right foot
Add Q66.222 Congenital metatarsus adductus, left foot
Add Q66.229 Congenital metatarsus adductus, unspecified foot
Q66.3 Other congenital varus deformities of feet
Add Q66.30 Other congenital varus deformities of feet, unspecified foot
Add Q66.31 Other congenital varus deformities of feet, right foot
Add Q66.32 Other congenital varus deformities of feet, left foot
Q66.4 Congenital talipes calcaneovalgus
Add Q66.40 Congenital talipes calcaneovalgus, unspecified foot
Add Q66.41 Congenital talipes calcaneovalgus, right foot
Add Q66.42 Congenital talipes calcaneovalgus, left foot
56Chapter 17: Congenital malformations, deformations and
chromosomal abnormalities (Q00-Q99)
Q66.7 Congenital pes cavus
Add Q66.70 Congenital pes cavus, unspecified foot
Add Q66.71 Congenital pes cavus, right foot
Add Q66.72 Congenital pes cavus, left foot
Q66.9 Congenital deformity of feet, unspecified
Add Q66.90 Congenital deformity of feet, unspecified, unspecified foot
Add Q66.91 Congenital deformity of feet, unspecified, right foot
Add Q66.92 Congenital deformity of feet, unspecified, left foot
57Chapter 17: Congenital malformations, deformations and
chromosomal abnormalities (Q00-Q99)
Q79 Congenital malformations of musculoskeletal system, not elsewhere classified
Revise from Q79.6 Ehlers-Danlos syndrome
Revise to Q79.6 Ehlers-Danlos syndromes
Add Q79.60 Ehlers-Danlos syndrome, unspecified
Add Q79.61 Classical Ehlers-Danlos syndrome
Add Classical EDS (cEDS)
Add Q79.62 Hypermobile Ehlers-Danlos syndrome
Add Hypermobile EDS (hEDS)
Add Q79.63 Vascular Ehlers-Danlos syndrome
Add Vascular EDS (vEDS)
Add Q79.69 Other Ehlers-Danlos syndromes
58Chapter 17: Congenital malformations, deformations and
chromosomal abnormalities (Q00-Q99)
Add Q87.11 Prader-Willi syndrome
Add Q87.19 Other congenital malformation syndromes predominantly associated with short
stature
Add Aarskog syndrome
Add Cockayne syndrome
Add De Lange syndrome
Add Dubowitz syndrome
Add Noonan syndrome
Add Robinow-Silverman-Smith syndrome
Add Russell-Silver syndrome
Add Seckel syndrome
59Chapter 18:
Symptoms, signs and abnormal clinical and laboratory findings,
not elsewhere classified (R00-R99)
R11.1 Vomiting
Add R11.15 Cyclical vomiting syndrome unrelated to migraine
Add Cyclic vomiting syndrome NOS
Add Persistent vomiting
R82.8 Abnormal findings on cytological and histological examination of urine
3 New codes
Add R82.81 Pyuria
1 Revised
0 Deleted Add Sterile pyuria
Add R82.89 Other abnormal findings on cytological and histological examination of urine
R82.99 Other abnormal findings in urine
Revise from R82.993 Hyperuricoscuria
Revise to R82.993 Hyperuricosuria
60Chapter 19:
Injury, poisoning and certain other consequences of
external causes (S00-T88)
S02.1 Fracture of base of skull
Add S02.12 Fracture of orbital roof
Add S02.121 Fracture of orbital roof, right side
Add S02.122 Fracture of orbital roof, left side
Add S02.129 Fracture of orbital roof, unspecified side
23 New codes
Add S02.83 Fracture of medial orbital wall
3 Revised
Add S02.831 Fracture of medial orbital wall, right side
0 Deleted Add S02.832 Fracture of medial orbital wall, left side
Add S02.839 Fracture of medial orbital wall, unspecified side
Add S02.84 Fracture of lateral orbital wall
Add S02.841 Fracture of lateral orbital wall, right side
Add S02.842 Fracture of lateral orbital wall, left side
Add S02.849 Fracture of lateral orbital wall, unspecified side
Add S02.85 Fracture of orbit, unspecified
NOTE: As instructed in the CPT book, the appropriate 7th digit character should be added to category S02: A, B, D, G, K, S
61Orbital Fracture coding cheat sheet
62Chapter 19:
Injury, poisoning and certain other consequences of
external causes (S00-T88)
T40.90 Poisoning by, adverse effect of and underdosing of unspecified psychodysleptics [hallucinogens]
Revise from T40.906 Underdosing of unspecified psychodysleptics
Revise to T40.906 Underdosing of unspecified psychodysleptics [hallucinogens]
T40.99 Poisoning by, adverse effect of and underdosing of other psychodysleptics [hallucinogens]
Revise from T40.996 Underdosing of other psychodysleptics
Revise to T40.996 Underdosing of other psychodysleptics [hallucinogens]
T44.1X Poisoning by, adverse effect of and underdosing of other parasympathomimetics [cholinergics]
Revise from T44.1X6 Underdosing of other parasympathomimetics
Revise to T44.1X6 Underdosing of other parasympathomimetics [cholinergics]
Note: As instructed in the CPT book, the appropriate 7th digit character should be added to T40, T44 codes: A, D, S
63Chapter 19:
Injury, poisoning and certain other consequences of
external causes (S00-T88)
T50.9 Poisoning by, adverse effect of and underdosing of other and unspecified drugs, medicaments and biological substances
Add T50.91 Poisoning by, adverse effect of and underdosing of multiple unspecified drugs, medicaments and biological substances
Add T50.911 Poisoning by multiple unspecified drugs, medicaments and biological substances, accidental (unintentional)
Add T50.912 Poisoning by multiple unspecified drugs, medicaments and biological substances, intentional self-harm
Add T50.913 Poisoning by multiple unspecified drugs, medicaments and biological substances, assault
Add T50.914 Poisoning by multiple unspecified drugs, medicaments and biological substances, undetermined
Add T50.915 Adverse effect of multiple unspecified drugs, medicaments and biological substances
Add T50.916 Underdosing of multiple unspecified drugs, medicaments and biological substances
64Chapter 19:
Injury, poisoning and certain other consequences of
external causes (S00-T88)
T67 Effects of heat and light
T67.0 Heatstroke and sunstroke
Add T67.01 Heatstroke and sunstroke
Add Heat apoplexy
Add Heat Pyrexia
Add Siriasis
Add Thermoplegia
Add T67.02 Exertional heatstroke
Add T67.09 Other heatstroke and sunstroke
T79.A Traumatic compartment syndrome
Delete Excludes1: traumatic ischemic infarction of muscle (T79.6)
Add Excludes2: traumatic ischemic infarction of muscle (T79.6)
65Chapter 20: External causes of morbidity (V00-Y99)
26 New codes V43.1 Car passenger injured in collision with car, pick-up truck or
1 Revised van in nontraffic accident
0 Deleted
Revise from V43.13 Car passenger injured in collision with
pick-up in nontraffic accident
Revise to V43.13 Car passenger injured in collision with
pick-up truck in nontraffic accident
66Chapter 20: External causes of morbidity (V00-Y99)
Y35.00 Legal intervention involving unspecified firearm discharge
Add Y35.009 Legal intervention involving unspecified firearm discharge, unspecified person injured
Add Y35.019 Legal intervention involving injury by machine gun, unspecified person injured
Add Y35.029 Legal intervention involving injury by handgun, unspecified person injured
Add Y35.039 Legal intervention involving injury by rifle pellet, unspecified person injured
Add Y35.049 Legal intervention involving injury by rubber bullet, unspecified person injured
Add Y35.099 Legal intervention involving other firearm discharge, unspecified person injured
Note: As instructed in the CPT book, the appropriate 7th digit character should be added to Y35 codes: A, D, S
67Chapter 20: External causes of morbidity (V00-Y99)
Y35.10 Legal intervention involving unspecified explosives
Add Y35.109 Legal intervention involving unspecified explosives, unspecified person injured
Add Y35.119 Legal intervention involving injury by dynamite, unspecified person injured
Add Y35.129 Legal intervention involving injury by explosive shell, unspecified person injured
Add Y35.199 Legal intervention involving other explosives, unspecified person injured
Add Y35.209 Legal intervention involving unspecified gas, unspecified person injured
Add Y35.219 Legal intervention involving injury by tear gas, unspecified person injured
Add Y35.299 Legal intervention involving other gas, unspecified person injured
Add Y35.309 Legal intervention involving unspecified blunt objects, unspecified person injured
Add Y35.319 Legal intervention involving baton, unspecified person injured
Add Y35.399 Legal intervention involving other blunt objects, unspecified person injured
Add Y35.409 Legal intervention involving unspecified sharp objects, unspecified person injured
Add Y35.419 Legal intervention involving bayonet, unspecified person injured
Add Y35.499 Legal intervention involving other sharp objects, unspecified person injured
Per CPT, the appropriate 7th digit character should be added to Y35 codes: A, D, S 68Chapter 20: External causes of morbidity (V00-Y99)
Add Y35.819 Legal intervention involving manhandling, unspecified person injured
Add Y35.83 Legal intervention involving a conducted energy device
Add Electroshock device (taser)
Add Stun gun
Add Y35.831 Legal intervention involving a conducted energy device, law enforcement official injured
Add Y35.832 Legal intervention involving a conducted energy device, bystander injured
Add Y35.833 Legal intervention involving a conducted energy device, suspect injured
Add Y35.839 Legal intervention involving a conducted energy device, unspecified person injured
Add Y35.99 Legal intervention, means unspecified, unspecified person injured
Per CPT, the appropriate 7th digit character should be added to Y35 codes: A, D, S
69Chapter 21: Factors influencing health status and contact with
health services (Z00-Z99)
14 New Codes Z01.0 Encounter for examination of eyes and vision
2 Revised Add Z01.02 Encounter for examination of eyes and vision following failed
0 Deleted
vision screening
Add Excludes1: examination for examination of eyes and
vision with abnormal findings(Z01.01)
Add examination for examination of eyes and vision
without abnormal findings(Z01.00)
Add Z01.020 Encounter for examination of eyes and vision following failed
vision screening without abnormal findings
Add Z01.021 Encounter for examination of eyes and vision following failed
vision screening with abnormal findings
Add Use Additional code to identify abnormal findings
70Chapter 21: Factors influencing health status and contact with
health services (Z00-Z99)
Z11 Encounter for screening for infectious and parasitic diseases
Z11.1 Encounter for screening for respiratory tuberculosis
Add Encounter for screening for active tuberculosis disease
Add Z11.7 Encounter for testing for latent tuberculosis infection
Z22 Carrier of infectious disease
Add Z22.7 Latent tuberculosis
Add Latent tuberculosis infection (LTBI)
Add Excludes1: nonspecific reaction to cell mediated immunity measurement
of gamma interferon antigen response without active tuberculosis (R76.12)
Add nonspecific reaction to tuberculin skin test without active tuberculosis (R76.11)
Z45.018 Encounter for adjustment and management of other part of cardiac pacemaker
Add Excludes1: presence of other part of cardiac pacemaker (Z95.0)
71Chapter 21: Factors influencing health status and contact with
health services (Z00-Z99)
Revise from Z45.42 Encounter for adjustment and management of neuropacemaker (brain) (peripheral nerve) (spinal
cord)
Revise to Z45.42 Encounter for adjustment and management of neurostimulator
Add Encounter for adjustment and management of brain neurostimulator
Add Encounter for adjustment and management of gastric neurostimulator
Add Encounter for adjustment and management of peripheral nerve neurostimulator
Add Encounter for adjustment and management of sacral nerve neurostimulator
Add Encounter for adjustment and management of spinal cord neurostimulator
Add Encounter for adjustment and management of vagus nerve neurostimulator
Z45.81 Encounter for adjustment or removal of breast implant
Revise from Encounter removal of tissue expander without synchronous insertion of permanent implant
Revise to Encounter removal of tissue expander with or without synchronous insertion of permanent implant
72Chapter 21: Factors influencing health status and contact with
health services (Z00-Z99)
Z68 Body mass index [BMI]
Note:
• Revise from BMI adult codes are for use for persons 21 years of age or older
• Revise to BMI adult codes are for use for persons 20 years of age or older
• Revise from BMI pediatric codes are for use for persons 2-20 years of age. These
percentiles are based on the growth charts published by the Centers for Disease
Control and Prevention (CDC)
• Revise to BMI pediatric codes are for use for persons 2-19 years of age.
• Add These percentiles are based on the growth charts published by the
Centers for Disease Control and Prevention (CDC)
73Chapter 21: Factors influencing health status and contact with
health services (Z00-Z99)
Z68.4 Body mass index (BMI) 40 or greater, adult
Revise from Z68.43 Body mass index (BMI) 50-59.9, adult
Revise to Z68.43 Body mass index (BMI) 50.0-59.9, adult
Z71.8 Other specified counseling
Add Z71.84 Encounter for health counseling related to travel
Add Encounter for health risk and safety counseling for
(international) travel
74Chapter 21: Factors influencing health status and contact with
health services (Z00-Z99)
Add Z86.002 Personal history of in-situ neoplasm of other and unspecified genital organs
Add Conditions classifiable to D07
Add Personal history of high-grade prostatic intraepithelial neoplasia III [HGPIN III]
Add Personal history of vaginal intraepithelial neoplasia III [VAIN III]
Add Personal history of vulvar intraepithelial neoplasia III [VIN III]
Add Z86.003 Personal history of in-situ neoplasm of oral cavity, esophagus and stomach
Add Conditions classifiable to D00
Add Z86.004 Personal history of in-situ neoplasm of other and unspecified digestive organs
Add Conditions classifiable to D01
Add Personal history of anal intraepithelial neoplasia (AIN III)
Add Z86.005 Personal history of in-situ neoplasm of middle ear and respiratory system
Add Conditions classifiable to D02
Add Z86.006 Personal history of melanoma in-situ
Add Conditions classifiable to D03
Add Excludes2: sites other than skin - code to personal history of in-situ neoplasm of the site
75Chapter 21: Factors influencing health status and contact with
health services (Z00-Z99)
Add Z86.007 Personal history of in-situ neoplasm of skin
Add Conditions classifiable to D04
Add Personal history of carcinoma in situ of skin
Z86.1 Personal history of infectious and parasitic diseases
Add Z86.15 Personal history of latent tuberculosis infection
Z96.8 Presence of other specified functional implants
Add Z96.82 Presence of neurostimulator
Add Presence of brain neurostimulator
Add Presence of gastric neurostimulator
Add Presence of peripheral nerve neurostimulator
Add Presence of sacral nerve neurostimulator
Add Presence of spinal cord neurostimulator
Add Presence of vagus nerve neurostimulator
76How can you prepare?
Review and become familiar with the new ICD-10-CM codes that are used
by your providers.
Add new codes to your “favorites” list. Most practice management systems
allow you to save favorites. While this is a huge time saver, be careful when
using “copy from previous” as many EHR and practice management systems
will copy over removed codes.
Review EHR plans, assessments, and documents that were mapped from
old codes to new codes.
Review and update “code rules” you created in your EHR that are affected
by the new and deleted 2020 codes.
Check with your specialty associations for specific coding changes and
resources.
77at ICD-11!!!
• ICD-10-CM is now 25 years old!!!
• A new system is needed due to:
• Substantial advancements in medicine and the science of disease have
occurred over the past 30 years
• ICD-10 is outdated both clinically and from a classification perspective – Substantial
structural changes were needed to some chapters
• Changes could not be handled under the normal ICD-10 updating mechanism
• Changes needed were well beyond a major update
• Increasing need to operate in an electronic environment
• Need to capture more information, especially for morbidity use cases
• Decision was made in 2007 to begin work on ICD-11
78ICD-11 Revision Goals
• Ensure that ICD-11 will function in an electronic environment
• Digital product
• Link with terminologies (e.g., SNOMED) and other classifications
• Support electronic health records and information systems
• Multi-purpose and coherent classification
• Mortality, morbidity, primary care, clinical care, research, public health…
• Consistency and interoperability across different uses
• International multilingual reference standard for scientific comparability
(Arabic, Chinese, English, French, Russian, Spanish)
79Major Differences
• Codes look different • Some diseases have changed
• Alzheimer disease location
• ICD-10 – G30 • E.g., Cerebrovascular diseases moved
• ICD-11 – 8A20 from circulatory to nervous system
chapter
• Simplified code structure
• Extension codes (e.g., temporality, • 6 new chapters
severity, dimensions of injury and • Diseases of blood and blood forming
external causes) organs
• Clustering of codes – combining 2 or • Disorders of the immune system
more codes to describe a diagnostic • Conditions related to sexual health
entity • Sleep-wake disorders
• Extension codes
• Traditional medicine
80Step 5: Final Stage
• Step 5 is submission of ICD-11 through the EB to the World Health
Assembly in May 2019 to come into effect on 1 January 2022 (earliest
implementation date for mortality)
• When will the US implement ICD-11?
• ICD-10 took 7 years to implement from the publication of the tabular list
• Assuming:
• Sufficient resources in terms of personnel and for changes to IT systems (database and
automated coding)
• International collaboration on revision of decision tables
• Minimum 5 years
• No sooner than 2023
81Questions?
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