Physicians need to know and understand diagnosis codes to ensure proper reimbursement for claims. Practices and providers of coding and medical billing services are ready to implement the ICD-10 code updates that will come into effect in fiscal year 2020. These codes are for use from October 1, 2019 through September 30, 2020. These updates include 273 new codes, 21 deleted codes, and 30 code title revisions.

According to the American Health Information Management Association (AHIMA), there are 72,184 ICD-10-CM codes for fiscal year 2020 compared to 71,932 for fiscal year 2019.

  • Diseases of the circulatory system: There are 30 new codes in the chapter Diseases of the circulatory system (I00-I99). These changes include four five-character options for atrial fibrillation:
    • I48.11 Longstanding persistent atrial fibrillation
    • I48.19 Other persistent atrial fibrillation.
    • I48.20 Chronic atrial fibrillation, unspecified
    • I48.21 Permanent atrial fibrillation.

Eight new codes have been added to subcategory I80.2, Phlebitis and thrombophlebitis of other and unspecified deep vessels of lower extremities, to identify thrombophlebitis or thrombosis involving the peroneal vein or muscular branch veins. The new 2020 codes under category I80 Phlebitis and thrombophlebitis for specific vein thrombosis in the distal lower limb allow better capture these diagnoses and avoid current limitations with capturing patient safety-related events, according to the Agency for Healthcare Research and Quality (AHRQ). Code options include:

    • I80.24- (Phlebitis and thrombophlebitis of peroneal vein)
    • I80.25- (Phlebitis and thrombophlebitis of calf muscular vein)
    • I82.45- (Acute embolism and thrombosis of peroneal vein)
    • I82.46- (Acute embolism and thrombosis of calf muscular vein)
    • I82.55- (Chronic embolism and thrombosis of peroneal vein)
    • I82.56- (Chronic embolism and thrombosis of calf muscular vein).
  • Category L89 Pressure ulcer: There are new ICD-10 codes for pressure ulcers. Deep tissue injury” is indexed to Ulcer, pressure, unstageable, and then by site. AHRQ noted that “unstageable ulcers can ONLY be Stage 3 or 4 by definition (‘full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar. If slough or eschar is removed, a Stage 3 or Stage 4 pressure injury will be revealed.’). By contrast, deep tissue injury may resolve without tissue loss. In addition, deep tissue injuries often have a combined etiology involving both ischemia and pressure.” Based on AHRQ’s request, several new codes for deep pressure-induced tissue damage go into effect Oct. 1, 2019, which will change ICD coding for pressure ulcers and non-pressure ulcers.
  • Combined immunodeficiencies D81: There are new codes under category D81 Combined immunodeficiencies to differentiate between the types of adenosine deaminase deficiency:
    • Adenosine deaminase deficiency, unspecified
    • Severe combined immunodeficiency due to adenosine deaminase deficiency
    • Adenosine deaminase 2 deficiency
    • Other adenosine deaminase deficiency

These changes allow Type 2 which generally involves mild immunodeficiencies to be differentiated from Type 1 which causes severe combined immunodeficiency (SCID).

  • Breast Lump in Overlapping Quadrants: The American College of Obstetricians and Gynecologists (ACOG) reviewed and supported new codes that align the structure with the current codes for malignant neoplasm of breast (subcategory C50.8). New codes N63.15 Unspecified lump in the right breast, overlapping quadrants and N63.25 Unspecified lump in the left breast, overlapping quadrants allow for proper code assignment when an unspecified lump in the breast overlaps anatomic sites classifiable to different codes.
  • Factors Influencing Health Status and Contact with Health Services (Z00-Z99): There are 13 new codes in Chapter 21 Factors Influencing Health Status and Contact with Health Services (Z00-Z99), which will impact anesthesiology medical billing. ICD-10 2020 changes the inclusion terms for the sub-category Z45.42 as well as the title of this sub-category. The title of the sub-category from (Encounter for Adjustment and Management of Neuropacemaker (brain) (peripheral nerve) (spinal cord)) has changed to (Encounter for Adjustment and Management of Implanted Nervous System Device). The American Academy of Pain Medicine notes the addition of the following inclusion terms to the sub-category:
    • Encounter for adjustment and management of brain neurostimulator
    • Encounter for adjustment and management of gastric neurostimulator
    • Encounter for adjustment and management of peripheral nerve neurostimulator
    • Encounter for adjustment and management of sacral nerve neurostimulator
    • Encounter for adjustment and management of spinal cord neurostimulator
    • Encounter for adjustment and management of vagus nerve neurostimulator

A recent AAPC article also lists the following ICD-10 changes for FY 2020:

  • Cyclical Vomiting Syndrome: Beginning Oct. 1, 2019, there is new code R11.15 Cyclical vomiting syndrome unrelated to migraine to represent the clinical significance of cyclical vomiting syndrome and the treatment of the disorder not related to migraines. Codes under G43 Migraine and R11 Nausea and vomiting have been revised to accommodate R11.15.
  • Ehlers-Danlos Syndrome (EDS): Code Q79.6 Ehlers-Danlos syndrome has been revised and expanded to include codes for the various types of this heritable connective tissue disorder. Vascular EDS, the most severe EDS type, are associated with early mortality.
  • Latent Tuberculosis Infection (LTBI): LTBI is a condition in which a person is infected with the TB bacteria but does not have signs of active TB disease and does not feel ill (World Health Organization). To distinguish between latent and active TB, ICD-10 2020 has added new codes under categories Z11 Encounter for screening for infectious and parasitic diseases, Z22 Carrier of infectious disease, and Z86 Personal history of certain other diseases.
  • Legal Intervention: While Y35 Legal intervention has many codes to describe modern-day mechanisms of injury to a suspect, bystander, or law enforcement official resulting from a legal intervention, there are no codes for unspecified persons. Beginning Oct. 1, 2019, there are new codes to:
    • specify “unspecified person injured,”
    • differentiate between “manhandling” and “bodily force”
    • specify legal intervention involving injury by a conducted energy device such as a taser
  • Subsegmental Pulmonary Embolism (SSPE): Category I26 Pulmonary embolism has two new codes to improve specificity over existing code I26.99 Other pulmonary embolism without acute corpulmonale. The new codes are:
    • I26.93 (Single subsegmental pulmonary embolism without acute corpulmonale)
    • I26.94 (Multiple subsegmental pulmonary emboli without acute corpulmonale)
  • Travel Health Counseling: In accordance with a request from the American Academy of Pediatrics, a new code has been added to identify travel health-related encounters:
    Z71.84 Encounter for health counseling related to travel
    This code should be used for travel health counseling services provided to patients and caregivers unrelated to a preventive medical care encounter.

These are just a few of the code changes that will take effect on October 1, 2019. Partnering with an experienced medical billing outsourcing company providing coding and medical billing services can help practices ensure accurate ICD-10 coding to prevent claim denials and ensure adequate reimbursement for services rendered.