Changes on the Horizon to ICD-10-CM for Fiscal Year 2020

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Does anyone else have trouble believing that Fiscal Year (FY) 2020 is on the horizon? Ready or not, here it comes. The ICD-10-CM diagnosis code additions, deletions, and revisions for FY 2020 have been released and loaded into Vitalware. These code changes will be effective on October 1, 2019.

The number of changes this year is similar to the changes we saw in FY 2019. The total number of changes and a summary of the most significant changes are outlined here for your reading pleasure (or to help with late-night insomnia).

Current active ICD-10-CM codes for 2019 - 71,932

  • Additions for FY 2020 - 273
  • Deletions for FY 2020 - 21
  • Revisions for FY 2020 - 30

Total active ICD-10-CM codes as of 10/1/2019 – 72,184

  • Adenosine deaminase deficiency (D81.3) has been expanded from one code to four codes (D81.30-D81.39) to allow differentiation between type 1 and type 2 since these disorders are quite different clinically. Even though type 2 deficiency may be associated with mild immunodeficiency, it is usually not associated with a significantly increased risk of infection. In contrast, type 1 adenosine deaminase deficiency usually causes a severe combined immunodeficiency.
  • Two new codes have been created to report subsegmental pulmonary embolism (SSPE) (I26.93 and I26.94), which will enable clinical differentiation from other types of pulmonary emboli. Differentiation is important, given the guideline from the American College of Chest Physicians (ACCP) that those with SSPE and without deep venous thrombosis (DVT) should not receive anticoagulation. This differentiation is also helpful for hospitals since the differing clinical treatments might otherwise negatively impact hospital performance on quality measures.
  • The codes for persistent atrial fibrillation (I48.1) and chronic atrial fibrillation (I48.2) have been expanded (I48.11-I48.21) to allow for differentiation between chronic atrial fibrillation, persistent atrial fibrillation, longstanding persistent atrial fibrillation, and permanent atrial fibrillation. Persistent atrial fibrillation describes cases that do not terminate within seven days, or that require repeated pharmacologic or electrical cardioversions. Longstanding persistent atrial fibrillation is persistent and continuous atrial fibrillation lasting longer than one year. Permanent atrial fibrillation is persistent atrial fibrillation where there is a contraindication to cardioversion. The term chronic atrial fibrillation may refer to persistent, longstanding persistent, or permanent atrial fibrillation.
  • Twenty-four (24) new codes have been added to the subsection “Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified.” Specifically, there are eight new codes for reporting phlebitis and thrombophlebitis of the peroneal veins and calf muscular veins (I80.241-I80.259) as well as 16 new codes for reporting embolism and thrombosis of the peroneal veins and calf muscular veins (I82.451-I82.469 and I82.551-I82.569).
  • In 2016, the National Pressure Ulcer Advisory Panel (NPUAP) announced updates to the stages of pressure injury. These changes resulted in minor inconsistencies with ICD-10-CM related to reporting of pressure injuries. Consequently, 25 new codes have been added to describe pressure-induced deep tissue damage. These changes allow for appropriate reporting of deep tissue injury resulting from the pressure that may present with intact skin.
  • There are two new codes to describe a breast lump of overlapping quadrants (N63.15 and N63.25). These new codes will allow for proper code assignment when a lump in the breast overlaps anatomic sites classifiable to different codes.
  • Currently, there is only one code to describe the 13 specific types of Ehlers-Danlos Syndrome (EDS), Q79.6. Effective 10/1/2019, this single code will be expanded to five new codes that will allow users to report the more common forms of EDS since the clinical presentation and prognosis associated with the different types of EDS can vary significantly.
  • There are 60 new codes to expand reporting for orbital bone fractures, which currently is reported using a single code (S02.3-). As of 10/1/2019, there are codes to describe orbital roof fracture (S02.121x-S02.129x), medial orbital wall fracture (S02.831x-S02.839x), lateral orbital wall fracture (S02.841x-S02.849x), and unspecified orbital fracture (S02.85x).
  • Eighteen new codes are being added to the code set for FY 2020 that will allow for reporting of poisoning by multiple drugs that are not further specified in the medical record.
  • At the current time, there are no ICD-10-CM codes to describe an injury resulting from legal intervention when the person injured is not specified in the medical record. At the request of the Massachusetts Injury Surveillance Program (ISP), 63 new codes are being added to the code set, effective 10/1/2019, to rectify this situation.
  • The Massachusetts ISP has also requested the addition of specific codes to describe an injury resulting from legal intervention using a Taser (Y35.831x-Y35.839x).
  • Three new codes have been created to report latent tuberculosis (Z11.7, Z22.7, and Z86.15). ICD-10-CM codes do not currently distinguish between latent tuberculosis and active tuberculosis. However, distinguishing between these two types of tuberculosis is important since they have very different short-term and long-term consequences for both the patient and for public health.
  • At the request of the American Academy of Pediatrics (AAP), there is a new code to report counseling services related to travel (Z71.84), as physicians are seeing an increased number of asymptomatic patients presenting for this type of counseling which is often unrelated to a preventive medical visit.
  • There are six new codes to describe a personal history of in-situ neoplasm (Z86.002-Z86.007), which is not reportable using the current code set.

Happy coding in 2020!