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January 25, 2018

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Medical Coding News Archives

Highlights of the ICD-10-CM Final Changes Effective October 1

July 27, 2017:

There are 360 new, 226 revised, and 142 deleted ICD-10-CM diagnosis codes finalized for fiscal 2018. These changes take effect for services provided on or after October 1, 2017. Below are highlights of the changes in chapter order.

Neoplasms (C00-D49) (chapter 2): Malignant mast cell tumor (C96.2) was renamed to malignant mast cell neoplasm and expanded into four codes for further specificity. Three codes were added for D47.0, which is now “Mast cell neoplasms of uncertain behavior.” These codes contain many new inclusion notes that help to report these complex conditions appropriately.

Endocrine, nutritional and metabolic diseases (E00-E89) (chapter 4): Two new codes that specify “with ketoacidosis” (E11.10, E11.11) are welcome additions to Type 2 diabetes mellitus category E11. These codes also specify whether coma was present or not.

Diseases of the eye and adnexa (H00-H59) (chapter 7): Out of the 55 new codes, 20 are combination codes that describe conditions that may occur with degenerative myopia (codes under H44.2A-H44.2E), and 35 were added in the “Visual disturbances and blindness (H53-H54)” section to expand blindness categories using visual impairment categories 1 through 5 developed by the World Health Organization (WHO). This expansion rendered eight codes invalid.

Diseases of the circulatory system (I00-I99) (chapter 9): Nineteen codes were added to this chapter: MI clinical classifications type 1-5 , as defined by the Task Force for the Universal Definition of Myocardial Infarction, have been added as inclusion notes and/or codes to this category. Codes I21.0-I21.4 are considered type 1, new code I21.A1 is type 2, and new code I21.A9 includes types 3-5. This change should help align MI codes with current documentation. Secondary pulmonary hypertension was expanded from one to six new codes, and a new code for Eisenmenger’s syndrome (I27.83) was added under the code for other specified pulmonary heart diseases. A large new subcategory describing other heart failures (I50.8) was added, along with nine new codes, including those for acute and chronic right heart failure, biventricular, high output, and end stage failure.

Diseases of the digestive system (K00-K95) (chapter 11): Eight codes were added to describe the different stages of localized or generalized gingival recession (K06.011-K06.013 and K06.020-K06.023). Codes from intestinal adhesions with obstruction (K56.5), unspecified and other intestinal obstruction (K56.6), and postprocedural intestinal obstruction (K91.3) were expanded into 12 codes that include partial or complete obstruction. The includes note for postprocedural was also removed from K56.5.

Diseases of the skin and subcutaneous tissue (L00-L99) (chapter 12): A total of 72 codes under category codes L97 and L98 were added to describe non-pressure chronic ulcers that involve muscle or bone without the presence of necrosis.

Pregnancy, childbirth, and the puerperium (O00-O9A) (chapter 15): In this chapter, including seven different seventh-character designations, 28 codes were added under O36.83 for maternal care for abnormalities in fetal heart rate or rhythm, and 12 codes under O00.10, O00.11, O00.20, and O00.21 to specify laterality of tubal and ovarian pregnancies.

Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) (chapter 18): The most interesting change in this chapter was not the addition of any new codes, but rather the new inclusion notes in the verbal and motor response of the Glasgow coma scale codes (category R40.2), which will help determine pediatric Glasgow coma scale scores. For example, code R40.222 (Coma scale, best verbal response, incomprehensible words) has two new inclusion notes: “Incomprehensible sounds (2-5 years of age)” and “Moans/grunts to pain; restless (< 2 years old).”

Injury, poisoning, and certain other consequences of external causes (S00-T88) (chapter 19): With 300 changes overall, this chapter has the most revisions, but they are fairly minor. Only 12 codes are new, all related to unspecified injuries and suicides, but 176 codes were revised and 112 deleted. Some of the revisions involve small tweaks, such as changing a period to a comma, but some are more substantial. For instance, since there is only one joint in the thumb, 36 code descriptions for proximal and distal subluxation and dislocation of interphalangeal joint of the thumb (S63.131-S63.146) were deleted. Corresponding with this correction denoting only one joint, the remaining codes (S63.121-S63.126) were revised from “unspecified interphalangeal joint” to just “interphalangeal joint.” Eighteen descriptions for cortical injuries (subcategory codes for S04.03 and S04.04) were revised from “eye” to “side.” One minor change repeated in the finger and toe phalanx and phalangeal fracture codes was a change in wording from medial to middle, which resulted in 112 code changes.

External causes of morbidity (V00-Y99) (chapter 20): Fifty-four V codes were added to include three- or four-wheeled ATVs and dirt or motor/cross bikes to the category of all-terrain or other off-road vehicles. Three code descriptions were revised by deleting “powered” from contact with “powered” hand tools and household machinery.

Factors influencing health status and contact with health services (Z00-Z99) (chapter 21): Code Z36 (Encounter for antenatal screening of mother) was expanded with 17 new antenatal screening codes covering a multitude of conditions such as chromosomal anomalies, nuchal translucency, congenital cardiac abnormalities, and many more. Four codes (Z91.841-Z91.843, and Z91.849) were added to describe levels of risk for dental caries, and three new codes were created to describe encounters for prophylactic removal of fallopian tube(s) (Z40.03), exercise counseling (Z71.82), and encounters for nonprocreative genetic counseling (Z71.83). Four revisions involved adding “procreative” before “genetic counseling” for code Z31.5, adding an “s” after “ovary” in code Z40.02, changing the body mass index from 19 or less to 19.9 or less for code Z68.1, and deleting “(postmenopausal)” from hormone replacement therapy code Z79.81.


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