What You Need to Know: Here’s the Latest Proposed ICD-10 Code Updates
We are pleased to introduce Jodi Stewart, Director, Professional Services/Clinical Coding Integrity at VitalWare. Jodi has over 27 years of experience in healthcare, including experience in Inpatient and Outpatient Coding, as well as Auditing and Coding Education. She is RHIA, CCS, CDIP certified and an AHIMA-Approved ICD-10-CM/PCS Trainer.
The latest ICD-10 Coordination and Maintenance (C&M) Committee meeting was held on March 7 & 8, 2017. During this meeting, federal interdepartmental committees composed of representatives from the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) presented coding changes and suggested other modifications to the ICD-10 code system.
ICD-10-CM Proposed Codes
There were 39 diagnosis topics reviewed at the ICD-10 C&M Committee meeting.
Classification of Types of Myocardial Infarction
Perhaps the most exciting proposal was related to myocardial infarction (MI). For the third time, a proposal to update the types of MI was presented. This time the proposal reflects a separate, new code for MI at I21.9 (Acute myocardial infarction, unspecified). This will restore a World Health Organization (WHO) code included in the original ICD-10-CM code set.
In addition, a new code I21.A1 (Myocardial infarction type 2) was proposed. There was also a revision to the notes under I21.A to indicate to code also the underlying cause, such as anemia or chronic obstructive pulmonary disease (COPD), if known and applicable, rather than having a code first note. Further, new code I21.A9 (Other myocardial infarction type) is being proposed to reflect MIs type 3, 4a, 4b, 4c and 5. Because this code update is being requested with a 10/1/2017 effective date, comments are being requested by 4/7/2017.
Encounter for Rehabilitation Services
With the implementation of ICD-10-CM, hospitals and health systems have lost the ability to track and analyze outcomes for patients receiving care for post-acute rehabilitative care. According to American Hospital Association (AHA) representatives, this is often the most submitted topic for Coding Clinic advice from those working in rehabilitation-related healthcare.
There was a great deal of discussion at the meeting about whether the reason for a rehabilitation admit should be recorded with new code, Z51.82 (Encounter for rehabilitation services) or the physical issue that is resulting in the admit. The C&M committee encourages written comments from stakeholders of this topic.
Heart Failure Classification
An update of previous proposals related to heart failure classification was presented. Most of the current proposal was unchanged from previous presentations, however, there were added notes at subcategories I50.2, I50.3, and I50.4, “Code also end stage heart failure, if applicable (I50.84).” It shows the term being added, “Right heart failure without mention of left heart failure,” for the new code I50.810 (Right heart failure, unspecified). For codes I50.811, I50.812, and I50.813, the word “isolated” was removed from the code title, with the original title being kept as an inclusion term, and the word “isolated” being made a nonessential modifier in certain inclusion terms using the phrase “right ventricular failure.” For new code I50.814 (Right heart failure due to left heart failure), there has been an addition of the note, “Excludes1: Right heart failure with but not due to left heart failure (I50.82).” For new code I50.84 (End stage heart failure), there has been addition of the term, “Stage D heart failure.” There has been an addition of a note specific to index entries related to the heart failure stages A, B, C, and D stating these are based on the American College of Cardiology and American Heart Association stages of heart failure, which complement and should not be confused with the New York Heart Association Classification of Heart Failure, into Class I, Class II, Class III, and Class IV. The C&M committee is requesting comments by 4/7/2017 in anticipation of making these changes effective 10/1/2017.
Here’s a few other ICD-10-CM proposed code set revisions:
- To better distinguish the severity of acute appendicitis, there is a proposal to move the terms “perforated appendix NOS” and “ruptured appendix NOS” from proposed new code K35.20 (Acute appendicitis with generalized peritonitis, without abscess) to proposed new code K35.32 (Acute appendicitis with perforation and localized peritonitis, without abscess)
- A unique code for breakthrough pain (G89.13 Breakthrough pain) will enable identification of individuals with a genuine need and facilitate access
- New codes to indicate a patient is immunocompromised as the result of underlying disease such as certain cancers, genetic disorders, HIV or AIDS, or through medications. There are specific code also, code first and Excludes 1 notes to support these new codes; 21 (Immunocompromised status due to conditions classified elsewhere), Z78.22 (Immunocompromised condition due to drugs and external causes) and Z78.29 (Other specified immunocompromised status)
- New codes documenting cholecystitis with gangrene or perforation of the gallbladder to better communicate the severity of cholecystitis; K82.A1 (Gangrene of gallbladder in cholecystitis) and K82.A2 (Perforation of gallbladder in cholecystitis)
- The removal of Excludes 1 notes from K65 Peritonitis allows the coder to report both diverticulitis and peritonitis to better communicate the severity of diverticulitis
ICD-10-PCS Proposed Codes for Federal Fiscal Year 2018
There were 19 procedures reviewed at the meeting. New ICD-10-PCS codes were requested for numerous procedures, however, options were provided for each procedure which include continuing to code procedures as is being done currently, creating new codes or potential other options from public comments.
- There is no unique ICD-10-PCS code for cerebral embolic protection of innominate, left common carotid and left subclavian arteries, used during transcatheter aortic valve replacement (TAVR) procedures. Currently, the TAVR procedure is represented only with the appropriate values from table 02R, Replacement of Heart and Great Vessels. CMS recommends creating a new code in section X, New Technology, to identify these arteries when they are used during TAVR procedures.
- Creation of distinct ICD-10-PCS codes for oxidized zirconium on polyethylene bearing surfaces used in hip and knee arthroplasties to facilitate data capture. A unique device value for oxidized zirconium on polyethylene devices would allow for clinical comparisons on revision rates of various bearing surfaces.
- Addition of a new technology code to establish a unique device value describing the use of titanium anchor implants to repair the left ventricle internally on the interventricular septum and externally on the left ventricle (LV) following ischemic damage during endovascular cardiac implant. There was discussion during the meeting as to whether the intent of the procedure is to eliminate the aneurysm or restrict the size of the ventricle. While some felt the root operation “restriction” was appropriate, others felt “supplement” would be preferred. Currently, the procedure is coded using the root operation “repair.” Additional discussion noted that most attendees preferred capturing the procedure via the Medical and Surgical tables rather than the New Technology table. CMS will gather comments and bring the topic back at September’s meeting.
- There is not a unique ICD-10-PCS device value to describe spinal fusion using a radiolucent porous interbody fusion device. New code options include (1) revising the body part values in tables 0RG and 0SG, Fusion of Upper Joints and Lower Joints body systems or (2) creating new codes in section X, New Technology.
Review the Webcast
The recorded webcast of the March 7-8, 2017 ICD-10 C&M Committee meeting is posted on CMS’ YouTube channel at the link below:
In addition, the agendas and notes of suggested revisions are located here:
Comments on Code Proposals
Submit your written comments by:
- April 7, 2017 for codes to be implemented on October 1, 2017
- Procedure comments to CMS ICDProcedureCodeRequest@cms.hhs.gov
- Diagnosis comments to Donna Pickett, CDC email@example.com
Register for the September 2017 Meeting
Registration for the September 12-13, 2017 ICD-10 C&M Committee meeting opens on August 4, 2017. If participating by livestream webcast or dialing in, you do not need to register online.
Information on registering online to attend the meeting can be found at http://www.cms.hhs.gov/apps/events/