The Coding Corner

ICD-10 Clinical Modification (CM) 2020 Updates

The ICD-10 CM changes and updates will be effective on October 1, 2019.

The new changes include the following updates:

  • 273 new codes
  • 30 revised codes
  • 21 deleted codes
  • 1500 changes to complication or comorbidity/major complication or comorbidity (CC/MMC) designation
  • Most severity changes are downgrades

Areas that have significant changes include; pressure-induced deep tissue damage, acute versus chronic embolism and thrombosis, fractures of the facial bones around the eye, among other changes highlighted below:

2020 ICD-10 CM Coding Highlights:

  • Eye wall fractures. Sixty new acute fracture codes for closed and open fractures of the orbital wall surrounding the eye, specific to laterality and position around the eye. Example: New code S02.831B will report fracture of medial orbital wall right side, initial encounter for open fracture.
  • Deep tissue injuries. A total of 25 new codes are proposed to be added to specifically capture deep tissue injuries, such as L89.026 (Pressure-induced deep tissue damage of left elbow) and L89.156 (Pressure-induced deep tissue damage of sacral region). Deep tissue injuries currently are coded as unstageable pressure ulcers, which is incorrect by definition, according to the proposal.
  • Atrial fibrillation. Four new codes in the I48.- category are proposed to capture different forms of persistent and chronic atrial fibrillation, such as I48.11 (Longstanding persistent atrial fibrillation) and I48.21 (Permanent atrial fibrillation).
  • Phlebitis and thrombophlebitis. Eight new codes for phlebitis and thrombophlebitis that will allow more specific coding for laterality and location, such as I80.241 (Phlebitis and thrombophlebitis of right peroneal vein).
  • Embolism and thrombosis. New codes to allow reporting of chronic embolism and thrombosis of the peroneal vein and calf muscular vein as well as new codes for acute embolism and thrombosis of those veins. The codes will also be selected based on laterality. For example: Code I82.451 describes acute embolism of right peroneal vein, while I82.562 describes chronic embolism and thrombosis of left calf muscular vein.
  • Poisoning, adverse effects and underdosing. The proposed update includes 18 new T codes for poisoning, adverse effects or underdosing of multiple unspecified drugs, medicaments and biological substances. You’ll use the appropriate seventh character to describe the encounter: initial, subsequent or sequela. The new poisoning codes are divided into four causes: accidental, intentional, assault and undetermined. For example, T50.913S (Poisoning by multiple unspecified drugs, medicaments and biological substances, assault, sequela).
  • Heatstroke. Summer will be over when the new codes go live, but you’ll have options for heatstroke and sunstroke (T67.01X-), exertional heatstroke (T67.02X-), and other heatstroke and sunstroke (T67.09X-).
  • Legal intervention. There will be 75 new codes for injuries sustained during a legal intervention. Many of the additions are to be used to indicate that an unspecified person was injured. For example, Y35.319A (Legal intervention involving baton, unspecified person injured, initial encounter). The current code set describes injuries to law enforcement officers, bystanders or suspects. In addition, there are new codes for injuries caused by conducted energy devices, such as tasers. Codes Y35.831A-Y35.839S describe injuries to law enforcement officials, bystanders, suspects or unspecified individuals.
  • New Z codes. You’ll find a handful of new codes for factors influencing health status and contact with health services. Proposed codes include Z01.020 (Encounter for examination of eyes and vision following failed vision screening without abnormal findings), Z22.7 (Latent tuberculosis), six new personal history of in-situ neoplasms codes (Z86.002-Z86.007) and one code for the presence of a neurostimulator (Z96.82).

Revisions:

  • Codes under T40.906– (Underdosing of unspecified psychodysleptics) and T40.996– (Underdosing of other psychodysleptics) were revised to include the term “[hallucinogens]” in the title.
  • Codes under T44.1×6– (Underdosing of other parasympathomimetics) were revised to include the term “cholinergics” in the title.
  • Codes M77.51 (Other enthesopathy of right foot) and M77.52 (Other enthesopathy of left foot) were revised to include the terms “and ankle” in the title.
ICD-10-CM chapter New Revised Invalid
Chapter 1: Certain infectious and parasitic diseases (A00-B99) 0 3 0
Chapter 2: Neoplasms (C00-D49) 0 0 0
Chapter 3: Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89) 5 0 1
Chapter 4: Endocrine, nutritional and metabolic diseases (E00-E89) 0 0 0
Chapter 5: Mental, Behavioral and Neurodevelopmental disorders (F01-F99) 0 0 0
Chapter 6: Diseases of the nervous system (G00-G99) 0 2 0
Chapter 7: Diseases of the eye and adnexa (H00-H59) 0 0 4
Chapter 8: Diseases of the ear and mastoid process (H60-H95) 1 0 0
Chapter 9: Diseases of the circulatory system (I00-I99) 30 2 2
Chapter 10: Diseases of the respiratory system (J00-J99) 0 1 0
Chapter 11: Diseases of the digestive system (K00-K95) 0 0 0
Chapter 12: Diseases of the skin and subcutaneous tissue (L00-L99) 25 0 0
Chapter 13: Diseases of the musculoskeletal system and connective tissue (M00-M99) 0 6 0
Chapter 14: Diseases of the genitourinary system (N00-N99) 3 1 0
Chapter 15: Pregnancy, childbirth and the puerperium (O00-O9A) 0 0 0
Chapter 16: Certain conditions originating in the perinatal period (P00-P96) 0 0 0
Chapter 17: Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) 31 0 10
Chapter 18: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) 3 1 1
Chapter 19: Injury, poisoning and certain other consequences of external causes (S00-T88) 87 9 3
Chapter 20: External causes of morbidity (V00-Y99) 75 3 0
Chapter 21: Factors influencing health status and contact with health services (Z00-Z99) 13 2 0
Total 273 30 21

Please contact Shawn Bromley at  Shawn.M.Bromley@Lahey.org or 978-236-1704 with questions regarding new ICD-10 CM changes and updates or if you would like to schedule an onsite overview meeting.

2019 OIG Workplan

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