Each year, healthcare providers and their medical billing and coding service providers prepare for updates to the ICD-10 diagnosis code set. The Centers for Disease Control and Prevention (CDC) released the ICD-10 codes and Official Coding and Reporting Guidelines for the fiscal year 2022 on July 12, which will come into effect on October 1, 2022.

Highlights of the proposed ICD-10 code changes

The new ICD-10 update has 159 new codes, 22 revised codes and 30 invalidated codes. The new codes include:

  • 45 new S- and T- codes for injuries and poisonings, including traumatic brain compression and herniation (S06.A0-), and poisoning and adverse effect by cannabis (T40.7-) and synthetic cannabinoids (T40.72-).
  • 23 new M- codes for diseases of the musculoskeletal system, including expansion of Sjogren Syndrome (M35.0-), Non-Radiographic Axial Spondyloarthritis (M45.A-), and Low Back Pain (M54.5-), which has been expanded to distinguish vertebrogenic low back pain (M54.51) from other types.
  • 19 new Z- codes for factors influencing health status, including additions to Social Determinants of Health (Z55.5 – Less than High School Diploma; Z58.6 – Inadequate drinking/water supply; expansion of Z59.0- Homelessness; Z59.4 Lack of food; Z59.8- Other Problems Related to Housing and Economic Circumstances)
  • 14 new R- codes for signs, symptoms, and abnormal clinical laboratory findings, with six new specific codes for coughs (R05), including acute, subacute, chronic, cough syncope, other specified and unspecified. Additional codes have been added for polyuria (R35.8), nonsuicidal self-harm (R45.88) and feeding difficulties (R63.3-) to distinguish pediatric feeding disorder.
  • 13 new K- codes for diseases of the digestive system, including a new subcategory, gastric intestinal metaplasia (K31.A-)
  • 10 new G- codes for diseases of the nervous system, including expansion of toxic encephalopathy (G92)

Re-issue of Recently added COVID-19 Codes

An important aspect of the proposed code changes is the re-issue of the following COVID-19 codes that were added in January this year:

J12.82 Pneumonia due to coronavirus disease 2019
M35.81 Multisystem inflammatory syndrome (MIS)
M35.89 Other specified systemic involvement of connective tissue
Z11.52 Encounter for screening for COVID-19
Z20.822 Contact with and (suspected) exposure to COVID-19
Z86.16 Personal history of COVID-19

FY 2022 Official Guidelines for Coding and Reporting of ICD-10

The Official Guidelines for Coding and Reporting of ICD-10 in 2022 were released on July 12. Notable changes as listed by ICD-10 Monitor include:

  • In Chapter 13: When laterality is not documented by the patient’s provider, code assignment for the affected side may be based on medical record documentation from other clinicians. If there is conflicting medical record documentation regarding the affected side, the patient’s attending provider should be queried for clarification. Codes for “unspecified” side should rarely be used, such as when the documentation in the record is insufficient to determine the affected side and it is not possible to obtain clarification.
  • Addition to General Coding Guideline No. 14 (in bold): Documentation by Clinicians Other than the Patient’s Provider. Code assignment is based on the documentation by the patient’s provider (i.e., physician or other qualified healthcare practitioner legally accountable for establishing the patient’s diagnosis). There are a few exceptions when code assignment may be based on medical record documentation from clinicians who are not the patient’s provider (i.e., physician or other qualified healthcare practitioner legally accountable for establishing the patient’s diagnosis). In this context, “clinicians” other than the patient’s provider refer to healthcare professionals permitted, based on regulatory or accreditation requirements or internal hospital policies, to document in a patient’s official medical record. These exceptions include codes for:
    • Body Mass Index (BMI)
    • Depth of non-pressure chronic ulcers
    • Pressure ulcer stage
    • Coma scale
    • NIH stroke scale (NIHSS)
    • Social determinants of health (SDOH)
    • Laterality
    • Blood alcohol level

    This information may be documented by other clinicians involved in the care of the patient, but associated diagnosis (such as overweight, obesity, acute stroke, pressure ulcer, or a condition classifiable to category F10, Alcohol related disorders) must be documented by the patient’s provider. If there is conflicting medical record documentation, either from the same clinician or different clinicians, the patient’s attending provider should be queried for clarification. The BMI, coma scale, NIHSS, blood alcohol level codes and codes for social determinants of health should only be reported as secondary diagnoses.

  • Addition of the following to Guideline No. 18, Use of Sign/Symptom/Unspecified Codes of the General Coding Guidelines: As stated in the introductory section of these official coding guidelines, a joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. The importance of consistent, complete documentation in the medical record cannot be overemphasized. Without such documentation, accurate coding cannot be achieved. The entire record should be reviewed to determine the specific reason for the encounter and the conditions treated.

Changes to Guidelines for COVID-19 Coding

COVID-19 Coding Guideline Changes include the following Changes (in bold):

  • Signs and symptoms without definitive diagnosis of COVID-19. For patients presenting with any signs/symptoms associated with COVID-19 (such as fever, etc.), but a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms, such as:
    • R05.1, Acute cough, or R05.9, Cough, unspecified
    • R06.02 Shortness of breath
    • R50.9 Fever, unspecified
  • A new “post-COVID-19” guideline has been added which includes:
    • Post-COVID-19 Condition. For sequela of COVID-19, or associated symptoms or conditions that develop following a previous COVID-19 infection, assign a code(s) for the specific symptom(s) or condition(s) related to the previous COVID-19 infection, if known, and code U09.9, Post COVID-19 condition, unspecified.
    • Code U09.9 should not be assigned for manifestations of an active (current) COVID-19 infection.
    • If a patient has a condition(s) associated with a previous COVID-19 infection and develops a new active (current) COVID-19 infection, code U09.9 may be assigned in conjunction with code U07.1, COVID-19, to identify that the patient also has a condition(s) associated with a previous COVID-19 infection. Code(s) for the specific condition(s) associated with the previous COVID-19 infection and code(s) for manifestation(s) of the new active (current) COVID-19 infection should also be assigned.

ICD-10 Monitor highlighted other guidelines that need careful review as:

  • Revisions relating to diabetes and the use of insulin, oral hypoglycemics, and injectable non-insulin drugs
  • Revisions pertaining to Mental, Behavioral, and Neurodevelopmental Disorders regarding psychoactive substance use, unspecified; medical conditions due to psychoactive substance use, abuse and dependence; and blood alcohol level, and
  • Guidelines for reporting social determinants of health (SDoH).

This blog provides only a indication of the proposed ICD-10 changes for FY 2022. Accurate and compliant coding requires review of the complete code and guideline changes. Medical coding outsourcing to an experienced service provider is the best way to ensure this.