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New ICD-10 codes will take effect starting October 1, 2017. Healthcare entities and medical coding companies are preparing for implementation of the finalized 2018 ICD-10-CM classification set, which involves 363 new codes, 226 revised codes and 142 deleted codes. Here are the key ICD-10 codes and changes that will apply for services rendered from October 1, 2017 through September 30, 2018:

  • ICD 10 CodingNew codes for heart failure: There are new codes for various types of right heart failure such as:
    • Acute (I50.811), chronic (I50.812), acute on chronic (I50.813) and unspecified (I50.810)
    • Right heart failure due to left heart failure (I50.814), biventricular heart failure (I50.82), high output heart failure (I50.83) and end-stage heart failure (I50.84) for patients with an advanced form of the disease who no longer respond to medication.
  • Code additions for Myocardial infarction (MI): The new codes for MI include:
    • I21.A1 Myocardial infarction type 2
    • I21.A9 Other myocardial infarction type
      These new codes mean that the type of MI the patient is having has to be considered. A type 2 MI describes a myocardial infarction due to demand ischemia. In addition, notes added under ST-elevation MI codes (I21.0-I21.4) clarify that the condition is a type 1 MI.
  • New codes for diabetes mellitus with ketoacidosis:
    E11.1 Type 2 diabetes mellitus with ketoacidosis
    E11.10 Type 2 diabetes mellitus with ketoacidosis without coma
    E11.11 Type 2 diabetes mellitus with ketoacidosis with coma
  • Changes forNeoplasms (C00-D49):
    • Malignant mast cell tumor (C96.2) has been renamed as malignant mast cell neoplasm and expanded into four codes for further specificity:
      C96.20 Malignant mast cell neoplasm, unspecified
      C96.21 Aggressive systemic mastocytosis
      C96.22 Mast cell sarcoma
      C96.29 Other malignant mast cell neoplasm
    • Three codes have been 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.
  • Expanded reporting options for antenatal screening codes: There are 17 new Z-series codes that allow practices to report specific screening tests administered to pregnant patients such as fetal growth retardation, chromosomal abnormalities, nuchal translucency, congenital cardiac abnormalities, and much more.
  • Substance abuse remission codes revised: Starting October 1, 2017, a medical coding service provider can select a specific ICD-10-CM code when a patient is in remission from abuse of each of a variety of substances, including alcohol, opioids, cannabis and nicotine. Explanatory information included with the substance abuse remission codes will classify the severity of the use as mild, moderate, or severe to better coordinate ICD-10-CM coding with the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
  • New codes for diseases of the skin and subcutaneous tissue (L00-L99): Up to 72 codes under category codes L97 and L98 have been added to describe non-pressure chronic ulcers that involve muscle or bone without the presence of necrosis. A non-pressure chronic ulcer of the left calf in which muscle tissue is evident but not necrotic can be more accurately reported with the addition of L97.225 (Non-pressure chronic ulcer of left calf with muscle involvement without evidence of necrosis).
  • Additions/changes for diseases of the digestive system (K00-K95): These include:
  • Eight codes 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) have been expanded into 12 codes that include partial or complete obstruction.
  • ICD 10 CodingPediatric Glascow coma scale: The Glasgow coma scale codes (R40.2-) can be used in conjunction with traumatic brain injury codes, acute cerebrovascular disease or sequelae of cerebrovascular disease codes. There are new inclusion notes in the verbal and motor response of the coma scale codes, which will help determine pediatric Glasgow coma scale scores. For example:
    • 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)”
    • R40.24, Glasgow coma scale, total score, should be assigned when only the total score is documented in the medical record and not the individual score(s).
  • Factors influencing health status and contact with health services (Z00-Z99): In addition to the expansion of Code Z36 (Encounter for antenatal screening of mother) with 17 new antenatal screening codes covering a multitude of conditions, there are:
    • 4 new codes (Z91.841-Z91.843, and Z91.849) to describe levels of risk for dental caries
    • 3 new codes to describe encounters for prophylactic removal of fallopian tube(s) (Z40.03), exercise counseling (Z71.82), and encounters for nonprocreative genetic counseling (Z71.83)
    • 4 revisions: 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.

Experienced medical billing and coding companies are well equipped to help physician practices, hospitals and other healthcare entities apply these mandated updates and revisions. Their skilled AAPC-certified coders will work with medical service providers to ensure proper documentation and reimbursement. By ensuring utmost specificity in coding, expert medical coders can help physicians ensure billing accuracy for appropriate reimbursement, enhance clinical performance, and improve patient care.