ICD-10-CM Updates General guideline updates - ICD-10-PCS Updates
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ICD-10-CM Updates General guideline updates By chapter: Guidelines Expanded ICD-10-PCS Updates
ICD-10-CM Overview
360 Additions
142 Deletions
226 Revisions
71,704 valid ICD-10-
CM codes for 2018
FYI 2018 CM Guidelines Section I: Conventions
Chapter 1-Certain Infectious and
Parasitic Diseases
Chapter 1 • A04.7 Enterocolitis due to Clostridium difficile – A04.71 recurrent – A04.72 not specified as recurrent ACG defines recurrence as “episode of CDI that occurs 8 weeks after the onset of a previous episode, provided the symptoms from the previous episode resolved” C-diff is on e of the most common HAI’s (healthcare-associated infection) Significant cause of morbidity and mortality Recurrence is associated with greater morbidity and is managed differently
Chapter 4: Endocrine, Nutritional and
Metabolic Diseases
Guideline updates:
• Use of insulin or oral hypoglycemic drugs
– If these drugs are routinely used the Z79 code(s) should be
assigned
– If the patient routinely uses both, only the long term use of
insulin Z79.4 should be reported
– Do not assign Z79.4 if insulin is given temporarily to control an
event during the encounter
– Applies to secondary diabetes as well
• I.C.4.a.3. and I.C.6.a.
Added DKA in DM Type II • E11.1 Type 2 diabetes mellitus with ketoacidosis – E11.10 Type 2 DM with ketoacidosis without coma – E11.11 Type 2 DM with ketoacidosis with coma •Type 2 DM with DKA is a rare occurrence but it occurs
Ch 5: Mental, Behavioral &
Neurodevelopmental
ICD-10-CM has had dependence in remission
2018 introduces ABUSE in remission
Better aligns ICD-10 CM with DSM-5 classification and terminology
Ch 7: Disease of the Eye and Adnexa
• I.C.7.b. Blindness
– If “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
Ch 9: Disease of the Circulatory System Pulmonary hypertension (PH) I27 is now classified into five groups •Group 1: Pulmonary Arterial Hypertension (PAH) •Group 2: PH due to left heart disease •Group 3: PH due to lung diseases and/or hypoxia •Group 4: Chronic Thromboembolic PH (CTEPH) •Group 5: PH with unclear
Pulmonary HTN • New codes were created to better represent the current clinical classification of PH
MI guideline update and new codes
• I.C.9.e.5. Other types of MI
– Type 1 assigned to I21.0-I21.4 (depending on site)
– Type 2 -due to demand ischemia or ischemic balance
– I21.A1
• Type 2 described as NSTEMI or STEMI assign code I21.A1
– Type 3, 4a, 4b, 4c and 5 – I21.A9 Other MI type
– Acute MI, unspecified I21.9
• Code also and code first notes should be followedMI
Types of MI
Other Forms of Heart Failure added
•New codes allocated to:
Right heart failure
• Acute right heart failure
• Chronic right heart failure
• Acute on chronic right heart failure
• Right heart failure due to left heart failure
Biventricular heart failure
High output heart failure
End stage heart failure
• Also known as Stage D heart failureOther forms of heart failure New codes provide additional information about heart failure characteristics Code also notes instruct us to use these codes in addition to traditional heart failure codes
Ch 10 Respiratory
• Tabular change impacts sequencing of COPD with…
• The change to the COPD and PNA is in the wording
at the instructional note for COPD.
– J44.0 use to read “use additional code" meaning the COPD had to be
the coded first with PNA as a secondary code but the new
instructional note says "CODE ALSO" meaning either the PNA or the
COPD can be PDX - depending on the reason for admit and the
treatment.Ch 11: Disease of the Digestive system
• Expanded Intestinal obstruction categories
(cc)---4 codes expanded to 12 (2017 did not describe
the severity)
K56.5 Adhesions (bands) 5th character
K91.3 Postprocedural 0- unspecified
1-partial
2-complete
K56.60 Unspecified 6th character
K56.69 Other specified 0-partial
1-complete
2-unspecifiedCh 12: Disease of the Skin and
Subcutaneous Tissue
• I.C.12.b. Non-pressure Chronic Ulcers
– Documented as healed = no code
– Documented as healing = appropriate severity based
on documentation
– POA but healed on d/c = site and severity at the time
of admission
– Progresses to another severity during the same
encounter = two codes, one on admission and one for
the highest severity reported during the stayNew codes for Non-pressure ulcers
(cc)
• Non-pressure chronic ulcer severity
– Expansion within L97 and L98.4 to accommodate
non-pressure chronic ulcers WITHOUT necrosis
New 6th character for lower extremities
5 – muscle involvement w/o necrosis
6 – bone involvement w/o necrosis
8- other specified severityNew chronic ulcer codes…
Ch 13: Musculoskeletal & Connective
Tissue
• Expanded M48.06 Lumbar Stenosis
– Without neurogenic claudication – M48.061
– With – M48.062Ch 14 Genitourinary
• Specific location of breast lump(s)
•Proposed by ACOG (American College of Obstetricians)
•New codes provide information about laterality and
quadrantCh 15: Pregnancy, Childbirth and the
Puerperium
• Maternal care for abnormalities of the fetal heart rate or
rhythm
Previous option only allowed for coding of fetal heart rate/rhythm
abnormalities occurring in labor and delivery
Follows 7th character conventions for affected fetus
O368330 Maternal care for abnormalities of the fetal heart rate or
rhythm, third trimester, not applicable or unspecifiedEctopic pregnancy
• Ectopic pregnancy laterality
•Expansion allows for coding of laterality of ectopic
pregnancy (e.g. right ovary)
•Increased incidence of coexisting intrauterine and
ectopic pregnanciesCh 18: Symptoms, Signs and Abnormal
Clinical and Lavatory findings
• Added R06.03-Acute Respiratory Distress
– Remains a CDI opportunity if clinically supportedRevised Z Codes • Z68.1 Body mass index (BMI) 19 or less, adult –changed to 19.9 or less • Z79.890 Hormone replacement therapy (postmenopausal) – removed (postmenopausal)
New Additions to the MCC List
Code Description
• E11.10 Type 2 diabetes mellitus with ketoacidosis without coma
• E11.11 Type 2 diabetes mellitus with ketoacidosis with coma
• I21.9 Acute myocardial infarction, unspecified
• I21.A1 Myocardial infarction type 2
• I21.A9 Other myocardial infarction type
• P29.30 Pulmonary hypertension of newborn
• P29.38 Other persistent fetal circulationNew additions to the CC list
Code Description
• A04.71 Enterocolitis due to Clostridium difficile, recurrent
• A04.72 Enterocolitis due to Clostridium difficile, not specified as recurrent
• C96.20 Malignant mast cell neoplasm, unspecified
• C96.21 Aggressive systemic mastocytosis
• C96.22 Mast cell sarcoma
• C96.29 Other malignant mast cell neoplasm
• D47.01 Cutaneous mastocytosis
• D47.02 Systemic mastocytosis
• D47.09 Other mast cell neoplasms of uncertain behavior
• E85.81 Light chain (AL) amyloidosis
• E85.82 Wild-type transthyretin-related (ATTR) amyloidosis
• E85.89 Other amyloidosis
• G12.23 Primary lateral sclerosis
• G12.24 Familial motor neuron disease
• G12.25 Progressive spinal muscle atrophyNew additions to the CC list
Code Description
• K56.50 Intestinal adhesions [bands], unspecified as to partial versus
complete obstruction
• K56.51 Intestinal adhesions [bands], with partial obstruction
• K56.52 Intestinal adhesions [bands] with complete obstruction
• K56.600 Partial intestinal obstruction, unspecified as to cause
• K56.601 Complete intestinal obstruction, unspecified as to cause
• K56.609 Unspecified intestinal obstruction, unspecified as to partial versus
complete obstruction
• K56.690 Other partial intestinal obstruction
• K56.691 Other complete intestinal obstruction
• K56.699 Other intestinal obstruction unspecified as to partial versus
complete obstruction
• K91.30 Postprocedural intestinal obstruction, unspecified as to partial
versus complete
• K91.31 Postprocedural partial intestinal obstructionNew additions to the CC list
Code Description
• L97.**5 Non-pressure chronic ulcer of (lower extremity)with
muscle involvement without evidence of necrosis
• L97.**6 Non-pressure chronic ulcer of (lower extremity)with
bone involvement without evidence of necrosis
• L97.**8 Non-pressure chronic ulcer of (lower extremity)with
other specified severity
• L98.4*5 Non-pressure chronic ulcer of skin NEC with muscle
involvement without evidence of necrosis
• L98.4*6 Non-pressure chronic ulcer of skin NEC with bone
involvement without evidence of necrosis
• L98.4*8 Non-pressure chronic ulcer of skin NEC with
other specified severity
Note: All ulcers classifiable to category L97 are designated CCs
Note: Only ulcers classifiable to 6th character 5, 6, or 8 in subcategory L98.4 are
designated CCs!New additions to the CC list
CODE DESCRIPTION
• M33.03 Juvenile dermatomyositis without myopathy
• M33.13 Other dermatomyositis without myopathy
• M33.93 Dermatopolymyositis, unspecified without myopathy
• O00.101 Right tubal pregnancy without intrauterine pregnancy
• O00.102 Left tubal pregnancy without intrauterine pregnancy
• O00.109 Unspecified tubal pregnancy without intrauterine pregnancy
• O00.111 Right tubal pregnancy with intrauterine pregnancy
• O00.112 Left tubal pregnancy with intrauterine pregnancy
• O00.119 Unspecified tubal pregnancy with intrauterine pregnancy
• O00.201 Right ovarian pregnancy without intrauterine pregnancy
• O00.202 Left ovarian pregnancy without intrauterine pregnancy
• O00.209 Unspecified ovarian pregnancy without intrauterine pregnancy
• O00.211 Right ovarian pregnancy with intrauterine pregnancy
• O00.212 Left ovarian pregnancy without intrauterine pregnancy
• O00.219 Unspecified ovarian pregnancy with intrauterine pregnancyICD-10 PCS CHANGES • 3562 new codes • 1821 revised codes • 646 deleted codes
Update to general guidelines
• B4.1c body part
– If a procedure is performed on a continuous
section of a tubular body part, code the body part
value corresponding to the furthest anatomical
site from the point of entry.
• Example: A procedure performed on a continuous
section of artery from the femoral artery to the
external iliac artery with the point of entry at the
femoral artery is coded to the external iliac body part.Guideline B4.1c Application • Read the documentation to determine the point of entry • Determine the direction in which procedure performed such as distal from entry, proximal from entry, or both • Locate the furthest anatomical site from the point of entry in each direction. Use an anatomical drawing of body parts if needed • Select the code for each of the furthest anatomical sites
Update to general guidelines
• B6.1a
– A device is coded only if a device remains after the
procedure is completed. If no device remains, the
device value No Device is coded. In limited root
operations, the classification provides the
qualifier values Temporary and Intraoperative,
for specific procedures involving clinically
significant devices, where the purpose of the
device is to be utilized for a brief duration during
the procedure or current inpatient stay.Guideline Changes • Short term external heart assist system is a device found in the 02H and 02P tables – New qualifier for J, Intraoperative – New qualifier for S, Biventricular
Example
Section 0 Medical and Surgical
Body System 2 Heart and Great Vessels
Operation H Insertion: Putting in a nonbiological appliance that monitors, assists,
performs, or prevents a physiological function but does not
physically take the place of a body part
Body Part Approach Device Qualifier
A Heart 0 Open Q Implantable Heart Assist System Z No Qualifier
3 Percutaneous Y Other device
4 Perc endoscopic
A Heart 0 Open R Short-term external Heart Assist J Intraoperative
3 Percutaneous System S Biventricular
4 perc endoscopic Z No QualifierIMPACTFUL CHANGES
(root operation)
EXTRACTION PROCEDURES
(ASPIRATIONS AND BRUSH BIOPSY)
• CMS added the root operation
Extraction to the lymphatic,
respiratory and gastrointestinal
body systems to capture additional
detail, including percutaneous
aspiration biopsies and brush
biopsies FY 2018 Example: FNA of right cervical LN and Endoscopic brush biopsy of lower esophagus
• Will supersede CC guidance
advising the use of other root
operations (e.g. Excision) for
these types of proceduresIMPACTFUL CHANGES
(device)
• OXIDIZED ZIRCONIUM ON POLYETHYLENE
BEARING SURFACE FOR HIP & KNEE
ARTHROPLASTY
• Oxidized zirconium on polyethylene is a
type of ceramic bearing surface
Fracture resistance benefits of a
traditional metal implant
Reduced friction of ceramic implants
• Distinct from conventional ceramic
• Used in over 90K hip and knee replacements
annuallyIMPACTFUL CHANGES
(body part)
• COMMON HEPATIC DUCT PROCEDURES
– Body part value 7, Common Hepatic Duct was
added to 15 Root Operations in the Hepatobiliary
System and Pancreas Body SystemIMPACTFUL CHANGES
body part
• LOWER ARTERY BYPASS
– Allows for coding of arterial bypass procedures performed
on distal lower extremities
– Decreases need to refer to Body Part Key
– Much less common than bypass procedures on proximal
lower extremities
• B3.6a Bypass procedures are coded by identifying the body part
bypassed “from” and the body part bypassed “to.” The fourth
character body part specifies the body part bypassed from, and the
qualifier specifies the body part bypassed to.IMPACTFUL CHANGES
(approach)
• PERCUTANEOUS HEART VALVE PROCEDURES
– Allows for coding of trans-catheter
tricuspid valve replacements
– Tricuspid valve is least treated of the
four heart valves
– Allows for coding of trans-catheter
valve revisionsIMPACTFUL CHANGES
(body part)
• EXTIRPATION FROM SPINALCANAL
– Added Body Part value U, Spinal Canal
– Allows for coding of spinal epidural hematoma evacuation
– SHE/PSEH usually the consequence of surgical intervention of the
spine
– Evacuation involves re-exploring the operative site and removing
clot/hematomaIMPACTFUL CHANGES
(body part)
• CRANIAL MENINGEAL SPACE
• Revised the title of the body part values:
– 3, Epidural Space to Epidural Space, Intracranial
– 4, Subdural Space to Subdural Space, Intracranial
– 5, Subarachnoid Space to Subarachnoid Space, IntracranialIMPACTFUL CHANGES
(device)
• VASCULAR ACCESS RESERVOIR
– Device title revisions make PCS terminology more
consistent with clinical terminology
– Codes describe proximal aspect of CVC
– TIVAD = no part of CVC is external to bodyIMPACTFUL CHANGES
(qualifier)
DRUG-COATED BALLOON DILATION OF LOWER ARTERIES
• Expanded use of Qualifier ‘Drug Coated Balloon’ across additional lower
arteries
FDA approved drug-coated balloons (DCB)
Lutonix® (CR Bard) Drug-coated Balloon (DCB) Percutaneous Transluminal
Angioplasty (PTA) Catheter
In.Pact™ Admiral (Medtronic), Paclitaxel Coated Percutaneous Transluminal
Angioplasty (PTA) Balloon
StellarexTM Drug-coated Angioplasty Balloon arteriesIMPACTFUL CHANGES
(qualifier)
• TIPS PROCEDURE
– Transjugular intrahepatic portosystemic shunt
– Reduces portal HTN and associated complications
– Performed by interventional radiologists
– Added qualifier for “hepatic vein”
– Added device “synthetic substitute”IMPACTFUL CHANGES
(qualifer)
• SUPRACERVICAL HYSTERECTOMY
– Created new qualifier value L Supracervical within Root Operation
Resection
– Allows for code level differentiation of hysterectomy procedures
independent of other procedure codesIMPACTFUL CHANGES
(qualifier)
• INSERTION OF EXTERNAL HEART ASSIST DEVICES
– Device title change reflects short term nature of these external
devices
– Qualifier ‘Intraoperative’ allows for identification of procedures where
procedure is removed at the
conclusion of the procedure
– Qualifier ‘Biventricular’ added to coding path for Removal
and Revision for short term external heart assist systemsIMPACTFUL CHANGES
(qualifier)
• TRAM FLAP
– Added new qualifier values for Latissimus Dorsi Myocutaneous Flap,
Deep Inferior Epigastric Artery Perforator Flap, Superficial Inferior
Epigastric Artery Flap, and Gluteal Artery Perforator Flap, for root
operation Transfer
– Provides additional information about pedicled breast
reconstruction flaps using trunk musclesIMPACTFUL CHANGES
(qualifier)
• The HeRO Graft is a hemodialysis access graft for patients who are failing
fistulas or grafts or are catheter-dependent due to the blockage of veins
leading to the heart
• Addition of Body Part Value V, Superior Vena Cava allows for appropriate
coding of the venous outflow componentIMPACTFUL CHANGES
(qualifer)
ADMINISTRATION OF INFLUENZA VACCINE
• Added Qualifier value 0, Influenza Vaccine
• Allows for influenza vaccinations to be coded (and tracked)
separately
• Provides another data point to help understand vaccination efficacy
and ideal vaccinationIMPACTFUL CHANGES
(qualifer)
• MANUAL REMOVAL OF RETAINED POC
– Allows for differentiation of manual removal of
products of conception (e.g. placenta) vs other
techniquesIMPACTFUL CHANGES
(administration)
• MEDICAL INDUCTION OF LABOR
• Added Substance value V, Hormone
• Captures detail for administration of substances for medical induction of
labor
• Dinoprostone (Cervidil) and Misoprostol (Cytotec, more commonly used
in the US) are two types of prostaglandins used for labor induction***
• Administered in gel form or as a pessaryIMPACTFUL CHANGES
(new technology)
SPINAL FUSION WITH RADIOLUCENT INTERBODY FUSION
DEVICE
Added multiple codes to describe spinal fusion using a
radiolucent porous interbody fusion device
Examples: COHERE by Vertera Spine, COALESCE by Vertera SpineIMPACTFUL CHANGES
(performance)
• RENAL PLACEMENT THERAPY
New Duration Values allow for the coding and
specification of RRT type
• 7, Intermittent, Less than 6 Hours Per Day: This is your routine
dialysis, normally performed 3-4 hours per treatment, every other
day
• 8, Intermittent, 6-18 hours Per Day: Used to code PIRRT or
Prolonged Intermittent Renal Replacement Therapy, is administered
between 8-12 hours per day on several or all days of the week
• 9, Continuous, Greater than 18 Hours Per Day: Used to code CRRT
or Continuous Renal Replacement-administered 24 hrs per dayIMPACTFUL CHANGES
(simplification)
• Diaphragm-laterality no longer needed
Section 0 Medical and Surgical
Body System B Respiratory System
Operation B Excision: Cutting out or off, without replacement, a portion of a body part
Body Part Approach Device Qualifier
T Diaphragm 0 Open Z No Device X Diagnostic
3 Percutaneous Z No Qualifier
4 Percutaneous EndoscopicIMPACTFUL CHANGES
(simplification)
• Omentum – laterality no longer needed
Section 0 Medical and Surgical
Body System D Gastrointestinal System
Operation 5 Destruction: Physical eradication of all or a portion of a body part
by the direct use of energy, force, or a destructive agent
Body Part Approach Device Qualifier
U Omentum 0 Open Z No Device Z No Qualifier
3 Percutaneous
4 Percutaneous EndoscopicIMPACTFUL CHANGES
(simplification)
• Saphenous - no longer need to specify greater or lesser
saphenous vein
Section 0 Medical and Surgical
Body System 6 Lower Veins
Operation B Excision: Cutting out or off, without replacement, a portion of a
body part
Body Part Approach Device Qualifier
P Saphenous vein, right 0 Open Z No Device X Diagnostic
Q Saphenous vein, left 3 Percutaneous Z No Qualifier
4 Percutaneous EndoscopicReferences • Center for Medicare and Medicaid Services (CMS) • MedLearn Media, INC. • ICD University • Optum 360 • ICD-10-PCS Official Coding Guidelines FY2018 • ICD-10-CM Official Coding Guidelines FY2018 • ICD-10 Coding Clinic
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