Because it has been 4 years since the last annual update of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) and because 2016 is the first year for the Centers for Medicare & Medicaid Services (CMS) to make updates to ICD-10-CM, CMS made many edits to the classification’s code set. On October 1, 2016, International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) will include 3651 new codes and 487 revisedcodes,1 and ICD-10-CM will include 1943 new codes, 313 deletions, and 350 revised codes.2

Diabetes
Most of the changes associated with codes for diabetes involve adding laterality to ophthalmologic complications—code range E08 through E13 in the “Endocrine, Nutritional, and Metabolic Diseases” section. For example, E08.321, “Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema,” will be deleted and replaced with these codes:

  • E08.3211: “Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye”
  • E08.3212: “Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye”
  • E08.3213: “Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral”
  •  E08.3219: “Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye”

Hypercholesterolemia
Code E78.0, “Pure hypercholesterolemia,” was deleted and replaced with two new codes:

  • E78.00: “Pure hypercholesterolemia, unspecified”
  • E78.01: “Familial hypercholesterolemia”

Carpel Tunnel Syndrome
A single code for specific mononeuropathies affecting bilateral limbs in the “Diseases of the Nervous System” section has also been added to code range G56 through G57. Instead of coding both G56.01 and G56.02 when the diagnosis is carpel tunnel syndrome in the right and left upper limbs, you will use code G56.03, “Carpal tunnel syndrome, bilateral upper limbs.”

Retinal Diseases and Disorders
The “Diseases of the Eye and Adnexa” section will also reflect changes to add laterality. A seventh digit has been added to code range H34 through H35 to allow even more specificity for retinal disorders. For example, code H34.811, “Central retinal vein occlusion, right eye,” has been replaced with these codes:

  • H34.8110: “Central retinal vein occlusion, right eye, with macular edema”
  • H34.8111: “Central retinal vein occlusion, right eye, withretinal neovascularization”
  • H34.8112: “Central retinal vein occlusion, right eye, stable”

Glaucoma
Laterality codes 1, 2, 3, and 9, representing right, left, bilateral, and unspecified, respectively, have taken the place of the sixth-digit X-placeholder for glaucoma codes in the H40.1 range. Currently, you can report H40.11X1, “Primary openangle glaucoma, mild stage,” but not the laterality. With the new codes, you will be able to report the laterality by using code H40.1111, “Primary open-angle glaucoma, right eye, mild state”; similarly, you will be able to add laterality to other codes in this range. Codes in this range with the Xplaceholder have been deleted to make way for the more specific codes.

Gastroenteritis and Colitis
Changes to the “Diseases of the Digestive System” section involve the deletion of code K52.2, “Allergic and dietetic gastroenteritis and colitis,” and its replacement with codes

  • K52.831 through <st
  • rong>K52.839 to report specificity for colitis:
  • K52.831: “Collagenous colitis”
  • K52.832: “ Lymphocytic colitis”
  • K52.838: “Other microscopic colitis”
  • K52.839: “Microscopic colitis, unspecified”

Pancreatitus
Codes K85.0 (“Idiopathic acute pancreatitis”), K85.1 (“Biliary acute pancreatitis”), and K85.2 (“Alcohol induced acute pancreatitis”) were deleted and replaced with code range K85.00 through K85.92 to accommodate idiopathic, biliary, acute, with and without necrosis or infection, and alcohol-induced or drug-induced pancreatitis. These are some examples of the new codes:

  • K85.00: “Idiopathic acute pancreatitis without necrosis or infection”
  • K85.01: “Idiopathic acute pancreatitis with uninfected necrosis”
  • K85.02: “Idiopathic acute pancreatitis with infected necrosis”
  • K85.10: “Biliary acute pancreatitis without necrosis or infection”
  • K85.22: “Alcohol induced acute pancreatitis with uninfected necrosis”
  • K85.32: “Drug induced acute pancreatitis with infected necrosis”

Foot Deformnities
Look for new codes in the “Musculoskeletal System and Connective Tissue” section as well. Code range M21.6 will no longer include the X-placeholder but will instead offer more specific coding options for other acquired deformities of the foot, such as M21.611, “Bunion of right foot,” and M21.621, “Bunionette of right foot.”

Hand Joint Pain
Codes M25.541 through M25.549 have been added to allow reporting of joint pain in the hands:

  • M25.541: “Pain in joints of right hand”
  • M25.542: “Pain in joints of left hand”<l/i>
  • M25.549: “Pain in joints of unspecified hand”

Temporomandibular Joint Disorder
A sixth digit has been added to temporomandibular joint disorder codes in the range M26.60 through M26.63 to allow reporting of laterality. For example, you will now be able to specifically account for the disorder in the right jaw by reporting code M26.601, “Right temporomandibular joint disorder.”

Cervical Disc Disorders
Sixth digits have also been added to codes in the range M50.12 through M50.92 to add the cervical level (e.g., C4–C5) specificity to cervical disc disorders. For example, you will find that code N50.22, “Other cervical disc displacement, mid-cervical region,” has now replaced with the more specific codes:

  • M50.121: “Cervical disc disorder at C4–C5 level with radiculopathy”
  • M50.122: “Cervical disc disorder at C5–C6 level with radiculopathy”
  • M50.123: “Cervical disc disorder at C6–C7 level with radiculopathy”

Femoral Fractures
Sixth digits have also been added to codes in the range M50.12 through M50.92 to add the cervical level (e.g., C4–C5) specificity to cervical disc disorders. For example, you will find that code N50.22, “Other cervical disc displacement, mid-cervical region,” has now replaced with the more specific codes:

  • M84.750A: “Atypical femoral fracture, unspecified, initial encounter for fracture”
  • M84.751A: “Incomplete atypical femoral fracture, right leg, initial encounter for fracture”
  • M84.754A: “Complete transverse atypical femoral fracture, right leg, initial encounter for fracture”
  • M84.757A: “Complete oblique atypical femoral fracture, right leg, initial encounter for fracture”

Ovaries and Fallopian Tubes
The “Genitourinary System” section also has some changes in code selections. Laterality will now be coded with the addition of a fifth-digit requirement for follicular cyst of the ovaries. Codes N83.0 through N83.52 have been deleted and replaced with 29 new codes in the range N83.00 through N83.529. For example, N83.0, “Follicular cyst of ovary,” has been replaced with the following:

  • N83.00: “Follicular cyst of ovary, unspecified side”
  • N83.01: “Follicular cyst of right ovary”
  • N83.02: “Follicular cyst of left ovary

National Institutes of Health Stroke Scale Scores and Glasgow Coma Scale Scores
The “Symptoms, Signs, and Abnormal Clinical and Laboratory Findings” section incorporates new codes R29.700 through R29.742 to report the National Institutes of Health Stroke Scale (NIHSS) scores, and codes R40.2410 through R40.2434 to report Glasgow coma scale scores at specific occurrences.

Skull Fractures
Laterality has been added to fracture and dislocation codes of the skull and head in code range S02.1 through S03.9. The general codes have been deleted and replaced with 261 more specific codes. For example, code S02.10XA, “Unspecified fracture of base of skull, initial encounter,” has been replaced with these codes:

  • S02.101A: “Fracture of base of skull, right side, initial encounter for closed fracture”
  • S02.102A: “Fracture of base of skull, left side, initial encounter for closed fracture”
  • S02.109A: “Fracture of base of skull, unspecified side, initial encounter for closed fracture”

Foot Fractures
New sections of codes were added to report 20 new codes for other fractures of the foot beginning with code S92.811A, 125 new codes to report fractures of the calcaneus beginning with code S99.001A, 125 new codes to report fractures of the metatarsal beginning with code S99.101A, and 125 new codes to report fractures of the phalanx of the toe beginning with code S99.201A

Note: CPT codes, descriptions, and other data only are © 2011, American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

Disclaimer: JUCM and the author provide this information for educational purposes only. The reader should not make any application of this information without consulting with the particular payors in question and/or obtaining appropriate legal advice.

DAVID STERN, MD (Practice Velocity)

ICD-10-CM and ICD-10-PCS Changes Effective October 1, 2016

David Stern, MD

Chief Executive Officer at Practice Velocity Urgent Care Solutions, Founding Member of the Urgent Care Association of America, Publishing Staff for The Journal of Urgent Care Medicine
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