October 1, 2018 will bring 279 new codes to ICD-10-CM. Combined with 51 deactivated codes (and 143 revised codes), that brings the total number of ICD-10-CM codes to 71,932. We identified a few examples that are especially important for urgent care coders to be aware of; a complete list of ICD-10-CM changes can be found on the CMS website at https://www.cms.gov/Medicare/Coding/ICD10/2019-ICD-10-CM.html.
Chapter 2: Neoplasms (C00-D49)
Melanoma and other malignant neoplasms of the skin
The codes addressing carcinoma, melanoma, and neoplasm of the eyelid have been split into separate codes to indicate upper and lower eyelid. For example:
- 11, “Malignant melanoma of right eyelid, including canthus” has been deactivated
- 111, “Malignant melanoma of right upper eyelid, including canthus” has been added
- 112, “Malignant melanoma of right lower eyelid, including canthus” has been added
Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E00-E89)
Metabolic disorders
In addition to a couple of deactivations, new characters have been added to two codes (E72 and E78), allowing greater specificity:
- 8, “Other specified disorders of amino-acid metabolism” has been deactivated
- 81, “Disorders of gamma aminobutyric acid metabolism” has been added
- 89, “Other specified disorders of amino-acid metabolism” has been added
- 4, “Other hyperlipidemia” has been deactivated
- 41, “Elevated lipoprotein(a)” has been added
- 489, “Other hyperlipidemia” has been added
Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01-F99)
Mental and behavioral disorders due to psychoactive substance use
Additional codes were added to report cannabis use with withdrawal:
- 23, “Cannabis dependence with withdrawal”
- 93, “Cannabis use, unspecified with withdrawal”
Chapter 6: Diseases of the Nervous System (G00-G99)
Diseases of myoneural junction and muscle
The more generic code G71.0, “Muscular dystrophy” was deactivated to make room for more specific codes:
- 00, “Muscular dystrophy, unspecified”
- 01, “Duchenne or Becker muscular dystrophy”
- 02, “Facioscapulohumeral muscular dystrophy”
- 09, “Other specified muscular dystrophies”
Chapter 7: Diseases of the Eye and Adnexa (H00-H59)
Options to code blepharitis of upper and lower eyelids have been created so that one code will cover the condition of both the upper and lower eyelid. For example, code H01.00A, “Unspecified blepharitis right eye, upper and lower eyelids” can be assigned now, whereas before, the coder would assign a code for blepharitis of the right upper eyelid and another code for blepharitis of the right lower eyelid. Code subcategory H02.151 through H02.159 was added in order to diagnose paralytic ectropion of the eyelid. Subcategory H10.8, “Other conjunctivitis” was added in order to code rosacea conjunctivitis. The new codes are:
- 821, “Rosacea conjunctivitis, right eye”
- 822, “Rosacea conjunctivitis, left eye”
- 823, “Rosacea conjunctivitis, bilateral”
- 829, “Rosacea conjunctivitis, unspecified eye”
Chapter 11: Diseases of the Digestive System (K00-K95)
Diseases of appendix
Some changes were made to codes for acute appendicitis with peritonitis. Codes K35.2, “Acute appendicitis with generalized peritonitis” and K35.89, “Other acute appendicitis” have been deactivated. Several new codes can be found in category K35. Some examples are:
- 20, “Acute appendicitis with generalized peritonitis, without abscess”
- 30, “Acute appendicitis with localized peritonitis, without perforation or gangrene”
- 890, “Other acute appendicitis without perforation or gangrene”
- 891, “Other acute appendicitis without perforation, with gangrene”
Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)
Other and unspecified soft tissue disorders not elsewhere classified
The code for myalgia, M79.1, has been deactivated and four new codes have been added:
- 10, “Myalgia, unspecified site”
- 11, Myalgia of mastication muscle”
- 12, “Myalgia of auxiliary muscles, head and neck”
- 18, “Myalgia, other site”
Chapter 14: Diseases of the Genitourinary System (N00-N99)
Other diseases of the urinary system
Code N35.8, “Other urethral structure” was deactivated and the subcategory expanded in order to specify codes for male and female. You will now see codes such as these in this section:
- 819, “Other urethral stricture, male, unspecified site”
- 82, “Other urethral stricture, female”
Chapter 18: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99)
Abnormal findings on examination of urine, without diagnosis
Code R82.99, “Other abnormal findings in urine” was deactivated and the code expanded to six digits, where the following codes were added:
- 991, “Hypocitraturia”
- 992, “Hyperoxaluria”
- 993, “Hyperuricoscuria”
- 994, “Hypercalciuria”
- 998, “Other abnormal findings in urine”
Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88)
(As an unfortunate result of hospitals seeing an increase in human trafficking cases, the majority of new codes added are codes describing exploitation of children and adults.)
Other and unspecified effects of external causes
To help differentiate human trafficking victims from other abuse victims, the codes in categories T74 and T76 were expanded, making room for 24 new codes, such as:
- 51XA, “Adult forced sexual exploitation, confirmed, initial encounter”
- 662XA “Child forced labor exploitation, suspected, initial encounter”
In addition, code subcategory T43.64 has been expanded to allow 12 new codes to identify when the drug ecstasy was used, and the circumstance, such as T43.641A, “Poisoning by ecstasy, accidental (unintentional), initial encounter.”
Subcategory T81.4 was expanded to incorporate 18 new codes that help identify postprocedural infection and sepsis. For example, T81.41XA, “Infection following a procedure, superficial incisional surgical site, initial encounter” is among one of those new code choices.
The seventh character options, A (initial), B (subsequent), and D (sequela) apply to all the codes in this section.
Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00-Z99)
Persons encountering health services for examination
Examination code Z04.8, “Encounter for examination and observation for other reasons” was deactivated to make room for exploitation codes:
- 81, “Encounter for exam and observation of victim following forced sex exploitation”
- 82, “Encounter for exam and observation of victim following forced labor exploitation”
- 89, “Encounter for examination and observation for other reasons”
Subcategory Z13.3 was created so that more specific screening codes could be assigned. A few of those are:
- 31, “Encounter for screening for depression”
- 32, “Encounter for screening for maternal depression”
- 41, “Encounter for autism screening”
ICD-10 codes are updated annually, and are effective from October 1 through September 30.