The recent updates to the ICD-10-CM guidelines and codes, which were effective starting April 1, 2022, apply to discharges and patient encounters occurring from October 1, 2022 through September 30, 2023. Below, we’ve outlined some of the major changes to help you assign the appropriate codes with confidence and accuracy.DIAGNOSIS CODE UPDATES FOR FY 2023
There are 1,176 new diagnosis codes for FY 2023, including:
- 3 codes added in April 2022
- A total of 288 deletions, including 1 in April 2022
- 28 code revisions
GUIDELINE UPDATES FOR FY 2023
There were several updates to the General Guidelines, as well.
Guideline I.A.19 now says that the provider’s statement of a patient’s particular condition is sufficient because code assignment isn’t based on clinical criteria used by the provider to establish the diagnosis. CMS added the verbiage on the end, stating that if there is conflicting medical record documentation to query the provider.
Guideline I.B.14 now encompasses the following elements of documentation that can be coded from non-provider documentation: Underimmunization Status, Body Mass Index (BMI), depth of non-pressure chronic ulcers, pressure ulcer staging, coma and stroke scales, social determinants of health (SDOH), laterality, and blood alcohol level. Specifically, unvaccinated and partially vaccinated (i.e., underimmunized) for COVID-19 can be documented by others and picked up by the coding professional.
Guideline I.B.16 is about the documentation of complications of care and states, “Code assignment is based on the provider’s documentation of the relationship between the condition and the care or procedure, unless otherwise instructed by the classification.” It’s important to remember that not all conditions that occur during or following medical care or surgery should be classified as complications. The documentation of a complication must reflect a cause-and-effect relationship between the care provided and the condition. The new guideline ends with updated additional verbiage: “The documentation must support that the condition is clinically significant. If it doesn’t, then contact the provider for clarification on the relationship between the condition and the care or procedure.”
Guideline I.C.1.a now states that if a patient is admitted for an HIV-related condition, the principal diagnosis should be B20, Human immunodeficiency virus [HIV] disease, followed by additional diagnosis codes for all reported HIV-related conditions. The update adds, “An exception to this guideline is if the reason for admission is hemolytic-uremic syndrome associated with HIV disease. Assign code D59.31, Infection-associated hemolytic-uremic syndrome, followed by code B20, Human immunodeficiency virus [HIV] disease.”
Guideline I.C.1.2.a.i adds that in the case of HIV-related conditions and sepsis, if the reason for admission is HUS, infection-associated hemolytic-uremic syndrome, it must be the principal diagnosis.
Guideline I.C.2.t is new and adds that when a malignant neoplasm of lymphoid tissue metastasizes beyond the lymph nodes, a code from categories C81-C85 with a final character “9” should be assigned, identifying “extranodal and solid organ sites” rather than a code for the secondary neoplasm of the affected solid organ.
Guideline I.C.15.a.7 is a new paragraph stating that “In ICD-10-CM, ‘completed’ weeks of gestation refers to full weeks.”
Guideline I.C.5.d reveals that when a patient is admitted with dementia at 170 and progresses, only the higher level should be reported.
For hemorrhage post-elective abortion, the new guideline instructions say, “For hemorrhage post elective abortion, assign code O04.6, Delayed or excessive hemorrhage following (induced) termination of pregnancy. Do not assign code O72.1, Other immediate postpartum hemorrhage, as this code should not be assigned for post-abortion conditions. Do not assign code Z33.2, Encounter for elective termination of pregnancy, when the patient experiences a complication post-elective abortion.” This is the newest update for post-abortion coding.
There’s also an update for underdosing, which states, “Documentation that the patient is taking less of a prescribed medication or discontinued the prescribed medication is sufficient for code assignment.”
Finally, in Chapter 21: Factors influencing health status and contact with health services for Social Determinants of Health (SDOH), the guidance is that these codes are used only when the documentation specifies there are problems arising from the SDOH or if it poses a risk. It states to assign as many SDOH codes as are necessary to describe all the problems or risk factors.
Guideline I.21.c.10 states that “Code Z71.87, Encounter for pediatric-to-adult transition counseling, should be assigned when pediatric-to-adult transition counseling is the sole reason for the encounter or when this counseling is provided in addition to other services, such as treatment of a chronic condition. If both transition counseling and treatment of a medical condition are provided during the same encounter, the code(s) for the medical condition(s) treated and code Z71.87 should be assigned, with sequencing depending on the circumstances of the encounter.”
For FY 2023, Chapter 5 for Mental, Behavioral, and Neurodevelopmental Disorders (F01-F99) was expanded to 23 codes in each category to specify severity and types of behavioral disturbance such as agitation, psychotic disturbance, mood disturbance, or without behavioral disturbances. Visit CMS files to see the four deletions, 83 new, and nine revisions in this area.
This was just a highlight of some of the FY 2023 ICD-10-CM code updates, and not all changes were covered. It is imperative that you review both the guidelines and the new, revised, and deleted codes to ensure you are assigning the most appropriate codes. For more information, visit the CMS website.