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Coordination and Maintenance Committee Addresses More Changes to Diagnosis Codes for 2018

April 27, 2017:

Attendees at the March 7-8, 2017, Coordination and Maintenance Committee meeting discussed changes to ICD-10-CM that could become effective October 1 of this year. While most of the updates had been talked about at previous meetings, a few were new this time around.

For changes proposed for fiscal 2018, comments must have been submitted by April 7. The new proposed changes are as follows:

Myocardial infarction: In addition to the changes to MI codes discussed at previous meetings, the committee proposes creating a new code, I21.9, to describe acute MI, and “Myocardial infarction (acute) NOS” would be deleted as an inclusion term from code I21.3. In addition, a note would be added to I21.A1 Other type of myocardial infarction, instructing the coder to “Code also the underlying cause, if known and applicable.”

Heart failure: Based on input received on previously proposed changes to these codes, the Committee is suggesting various additions to codes and notes. All the proposals aim to create codes that describe specific types of heart failure. Below are the latest proposed changes, in bold:

[new code for 2017] I50.810   Right heart failure, unspecified

Right heart failure without mention of left heart failure

Right ventricular failure NOS

[new code] I50.811   Acute right heart failure

Acute isolated right heart failure

Acute (isolated) right ventricular failure

[new code] I50.812   Chronic right heart failure

Chronic isolated right heart failure

Chronic (isolated) right ventricular failure

[new code] I50.813   Acute on chronic right heart failure

Acute on chronic isolated right heart failure

Acute on chronic (isolated) right ventricular failure

decompensation of chronic (isolated) right ventricular failure

Acute exacerbation of chronic (isolated) right ventricular failure

[new code] I50.814   Right heart failure due to left heart failure

Right ventricular failure secondary to left ventricular failure

Code also the type of left ventricular failure, if known (I50.2-I50.43)

Excludes1: Right heart failure with but not due to left heart failure (I50.82)

[new code] I50.82   Biventricular heart failure

Code also the type of left ventricular failure as systolic, diastolic, or combined, if known (I50.2-I50.43)

[new code] I50.83   High output heart failure

[new code] I50.84   End stage heart failure

Stage D heart failure

Code also the type of heart failure as systolic, diastolic, or combined, if known (I50.2-I50.43)

[new code] I50.89   Other heart failure

I50.9  Heart failure, unspecified

[delete “Biventricular (heart) failure NOS” and “Right ventricular failure (secondary to left heart failure)” notes]

Antenatal screening: At the request of the American Congress of Obstetricians and Gynecologists (ACOG), the committee is proposing to add new codes and notes to describe antenatal screening. The current one code—Z36 Encounter for antenatal screening of mother—would gain 18 subcategory codes that pinpoint what the screening was for. For instance, Z36.1 would specify a screening for raised alphafetoprotein levels, and Z36.81 would describe antenatal screening for hydrops fetalis.

Electronic nicotine delivery system (ENDS): The American Thoracic Society (ATS) has pointed out that the rapidly growing popularity of electronic cigarettes, coupled with their significant health effects, demands that there be ICD-10-CM codes to report their use and effects to ensure adequate health data collection. In particular, research on ENDS use in veteran, youth, and chronic obstructive pulmonary disease (COPD) populations would benefit greatly from code reporting.

The code changes being proposed would affect category codes F17 Nicotine dependence, T65 Toxic effect of other and unspecified substances), and Z72 Problems related to lifestyle, subcategory code Z72.0 Tobacco use.

Orbital roof and wall fracture: The American Academy of Ophthalmology is proposing to expand the number of codes describing these types of fractures from the current one (S02.3-). The additional codes would specify which side the orbital roof fracture affected (codes S02.121, S02.122, and S02.129), and whether the orbital wall fracture was unspecified, lateral, or medial and which side it was on (S02.A subcategory codes, and S02.B).

Pediatric Glasgow coma scale: Although the Glasgow coma scale has been modified for children, the American Academy of Pediatrics is requesting inclusion terms under two subcategories of coma scales to accurately reflect patients aged 5 years and younger. Terms such as “Incomprehensible sounds (2-5 years of age)” and “Cooing or babbling or crying appropriately (< 2 years of age)” would be added to codes under category code R40 (Somnolence, stupor and coma).

Substance use disorders, in remission: There currently are no codes describing substance abuse in remission, although this information is important both for treatment and for data gathering. Kaiser Permanente is asking that new diagnosis codes be added under category codes F10–F19 for substance abuse in remission, references to whether the remission is “early” or “sustained” be included, and terminology be added in ICD-10-CM that better reflects DSM-5 terminology for substance use disorder severity.


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