This is Part 1 of a 4 part series on the FY2022 changes to ICD-10 and the IPPS. In this part, we discuss some of the new ICD-10-CM diagnosis codes and changes. Here is the breakdown:
72,739 total ICD-10-CM codes for FY2022
- 153 new codes (2021 had 490 new codes)
- 30 deleted codes (2021 had 58 deleted codes)
- 22 revised codes (2021 had 47 revised codes)
Most of the changes occurred in the injuries, poisonings, and consequences of external causes, musculoskeletal system, digestive system, and factors influencing health status and contact with health services and chapters. I have to say that there were really no big earthshattering changes except for maybe expansion of the G92 codes, addition of F32.A for depression, NOS and addition of U09.9 for sequela of COVID-19. If there were any “themes” for this year’s changes, it would be first, “many excludes1 codes changed to excludes2 codes,” and second, “expansion of existing codes to more specific codes.” Also some index entries had codes changed to correct errors and to more appropriately code the condition. An example is atrophy, nutritional, E41 changed to E43, unless with marasmus in which it would be E41. Another example is partial thickness burn is now coded by site, SECOND DEGREE. The major changes will be discussed below. Keep in mind, the below does not include every single change. Our education module addresses the majority of changes.
Chapter 2: Neoplasms (C00-D49)
The first big change involves adding code C84.7A for Anaplastic large cell lymphoma, ALK-negative, breast. Also known as BIA-ALCL. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a very rare cancer of the immune system. It is not breast cancer. May affect women who have the textured (rough) type of implants. Two codes were also added to describe primary and secondary malignant neoplasm of bilateral ovaries. Previously there were no codes for this.
Chapter 3: Diseases of blood and blood forming organs and immune mechanism (D50-D89)
Expanded new codes for D55.21, Anemia due to pyruvate kinase deficiency and anemia due other disorders of glycolytic enzymes.
Also new codes D75.838 other thrombocytosis (includes secondary thrombocytosis) and D75.839, Thrombocytosis, NOS. If patient has primary or essential thrombocytothemia, that is coded to D47.3. Secondary Thrombocytosis is when the body produces too many platelets and accounts for 80-90%) of thrombocytosis. Secondary causes include infection (i.e. COVID) or inflammation and hemorrhage.
There is a new code D89.44 for Hereditary alpha tryptasemia. Hereditary alpha tryptasemia can also be called a biochemical trait. People with this trait have inherited extra copies of the alpha tryptase gene (TPSAB1), and this leads to increased levels of trypase protein detected in the blood, whether a reaction is happening or not.
Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01-F99)
Finally, a new code F32.A for Depression. Unspecified or Depression NOS. Previously coders were stuck with code F32.9, Major depressive disorder, single episode, unspecified when the depression was not further specified in the record. I think this is a good change because many times the depression type is not specified in documentation. There are two new codes F78.A2 for SYNGAP related intellectual disability and F78.A9 Other genetic related intellectual disability. SYNGAP1-related intellectual disability is a neurological disorder characterized by moderate to severe intellectual disability that is evident in early childhood. The earliest features are typically delayed development of speech and motor skills, such as sitting, standing, and walking.
Chapter 6: Nervous System (G00-G99)
There is a new code G04.82, Acute flaccid myelitis. Acute Flaccid Myelitis (AFM) is an uncommon but serious neurologic condition. It affects the nervous system, specifically the area of the spinal cord called gray matter, which causes the muscles and reflexes in the body to become weak. 90% is in children. This code is also an MCC!
There is a new code G44.86 for cervicogenic headache, which come from sudden movement of the neck or when neck remains in the same position a long time.
Code G92 has been further expanded as follows:
G92.00-05, Immune Effector cell-associated neurotoxicity syndrome, (ICANS) Unspecified or GRADE 1-5 Neurotoxicity is a frequent complication of CAR-T (T cell) therapies. ICANS may manifest as delirium, encephalopathy, aphasia, lethargy, difficulty concentrating, seizures and coma. Corticosteroids used to treat it. ICANS Grade 3-5 are CCs! Also there are CODE FIRST notes to follow.
G92.8, Other toxic encephalopathy, includes toxic encephalitis and toxic metabolic encephalopathy
G92.9, Unspecified toxic encephalopathy
Both are still MCCs!
Chapter 9: Circulatory System (I00-I99)
We have a new code I5A for Non-ischemic myocardial injury (non-traumatic) There is a CODE FIRST the underlying cause, if known and applicable, such as: with many conditions listed. Coders are cautioned to review documentation for the underlying cause. This is not an acute MI OR a Type 2 MI (ischemic) which is easily confused with non-ischemic myocardial injury. Myocardial injury is similar to Type2 MI but DOES NOT meet clinical criteria of acute myocardial infarction. Coders will need to watch the abbreviations used by MDs since MI could mean myocardial infarction or injury. Queries are expected. https://jamanetwork.com/journals/jamacardiology/fullarticle/2728384
Chapter 11: Digestive System (K00-K95)
The K22.8 was expanded to K22.81, Esophageal polyp; K22.82, Esophagogastric junction polyp, and K22.89, Other specified disease of esophagus, which includes hemorrhage of esophagus.
There new codes, K31.A0-K31.A29 for Gastric intestinal metaplasia unspecified, without dysplasia and with dysplasia. The codes also identify body parts such as antrum, fundus and for dysplasia, identify low, high or unspecified grade. Dysplasia is abnormal growth of cells whereas metaplasia is when cells that line the stomach are changed or replaced by new type. Considered precancerous and usually found on endoscopy. No specific symptoms are evident.
End stage liver disease was added as a synonymous term under K72.1, Chronic hepatic failure.
Chapter 12: Skin and Subcutaneous Tissue (L00-L99)
New codes L24.A0-A9 were added for Irritant contact dermatitis due to fracture, contact with body fluid, saliva, fecal, urinary or dual incontinence or other body fluids. Another code series of L24.B0-B3 were added for Irritant contact dermatitis RELATED TO unspecified stoma/fistula, digestive stoma/fistula, respiratory stoma/fistula and fecal/urinary stoma/fistula. This will help pinpoint the cause of this dermatitis.
Chapter 13: Musculoskeletal System (M00-M99)
Thrombotic microangiopathy codes have been expanded to accommodate M31.11, HSCT-TMA which is Hematopoietic stem cell transplantation-associated thrombotic microangiopathy. There is a CODE FIRST note to code complications of bone marrow or stem cell transplant as this condition is frequently caused by them. Thrombotic thrombocytopenia purpura (TTP) has it’s own code, M31.19.
The term “Sicca syndrome [Sjögren] has been replaced with Sjögren Syndrome. Codes in this M35.0- series have also been expanded to code Sjögren Syndrome with various system involvement such as inflammatory arthritis, peripheral nervous system, gastrointestinal, glomerular disease, vasculitis and dental involvement. Sjögren’s is a systemic autoimmune disease that affects the entire body. Along with symptoms of extensive dryness, other serious complications include profound fatigue, chronic pain, major organ involvement, neuropathies and lymphomas.
New codes M45.A0-M45.AB for non-radiographic axial spondyloarthritis (nr-axSpA) of various areas were added. With nr-axSpA, even though the patient has symptoms, X-rays don’t show any damage to the joints. Nr-axSpA is a long-term inflammatory disease. The immune system turns on itself and attacks healthy tissue in your joints. Can lead to ankylosing spondylitis (AS) if it gets worse.
The low back pain code has been expanded to M54.50, low back pain unspecified, M54.51, Vertebrogenic low back pain, and M54.59, Other low back pain. Nerve pain within the spine has long been linked to discs that have degenerated—your doctor may refer to this as “discogenic pain.” But a new term has emerged: “vertebrogenic pain.” If your doctor discovers that your endplates are the origin of your chronic low back pain, this is the term they may use to diagnose it.
Chapter 16: Perinatal Period (P00-P96)
Wow, we have a new specific code P00.82, Newborn affected by (positive) maternal group B streptococcus (GBS) colonization! It includes contact with positive maternal group B streptococcus. Also, P04 for Newborn affected by noxious substances transmitted via placenta or breast milk has a new CODE FIRST any current condition in newborn, if applicable. This could be some sort of respiratory or metabolic problem that would be coded first if documented.
Code P09 has been expanded to P09.1-9 Abnormal findings on neonatal screening for specific diagnoses such as inborn errors of metabolism, congenital endocrine disease, hematological disorders or heart disease, cystic fibrosis, or hearing loss. Coders will need to look at the documentation for the disorders that are being screened for.
Chapter 18: Symptoms, sings, abnormal findings (R00-R99)
Cough symptom codes have been expanded to the below:
R05.1, Acute cough
R05.2, Subacute cough
R05.3, Chronic cough
R05.4, Cough syncope (with code first syncope and collapse (R55)
R05.8, Other specified cough
R05.9, Cough, unspecified
This is great that data can now be collected about specific types of cough. But of course the documentation will need to be improved by providers to identify these different acuity and types of coughs. For example, Cough syncope is a well-known entity which results in loss of consciousness during episodes of cough. It commonly occurs in patients with severe chronic obstructive lung disease (COPD) and asthma.
There are new codes, R35.81 for Nocturnal polyuria and R35.89, Other polyuria.
A new code R45.88 was added for non-suicidal self-harm such as self-injury and self-mutilation but WITHOUT suicidal intent. The injury is also coded and principal diagnosis is the reason for admission or encounter.
R63.3 was expanded to R63.30-39 to identify different types of feeding difficulties such as pediatric, acute, pediatric, chronic, other, and unspecified. For acute and chronic pediatric difficulties, code also any associated conditions such as aspiration pneumonia, dysphagia, GERD or malnutrition.
Chapter 19: Injury, Poisoning, Consequences of External Cause (S00-T88)
We have a new code S06.A0 for traumatic brain compression without herniation, and S06.A1, traumatic brain compression WITH herniation. There is a CODE FIRST note at both of these to code underlying traumatic brain injury first such as a subdural hemorrhage focal traumatic brain injury
Poisoning, adverse effect and underdosing of Cannabis has new codes depending if tit is cannabis or derivatives, T40.711-16, or synthetic cannabinoids, T40.721-726. The old codes T40.7X was coded.
We finally have a an new code T80.82, Complication of immune effector cellular therapy such as chimeric antigen receptor (CAR-T) cell therapy. The specific complication such as cytokine release syndrome D89.83- should be coded in addition. We have seen these complications before but had no way to specifically code them.
Chapter 21: Factors Influencing Health Status (Z00-Z99)
New Z codes were added for many new social determinants of health. It is advised that the coder look at these specifically. Codes were added for problems related to education and literacy, Inadequate drinking-water, different reasons for homelessness whether shelter or unsheltered, housed with risk of homelessness or homelessness in past 12 months, lack of adequate food, food insecurity and other specified lack of adequate food. The code list is lengthy and contained in code range Z55, Z58, Z59.
New codes were developed such as Z71.85, Encounter for immunization safety counseling, This is actually, per the OCG, is to be used for counseling of the patient or caregiver regarding the safety of a vaccine. This code should NOT be used for the provision of general information regarding risks and potential side effects during routine encounters for the administration of vaccines. This is addressing vaccine safety, and may have come about due to “vaccine hesitancy” regarding the COVID-19 vaccines.
Also new codes Z91.014, Allergy to mammalian meats, Z91.51, personal history of suicidal behaviour, Z91.52, Personal history of non-suicidal self-harm, Z92.850, personal history of Chimeric Antigen Receptor T cell therapy (CAR-T), and Z92.858, Z92.859 for personal history of other or unspecified cellular therapy.
The Excludes1 note: cardiac pacemaker status (Z95.0) was removed from Z99 Dependence on enabling machines and devices, NEC. This had been causing problems previously.
Chapter 22: Codes for Special Purposes (U00-U49) START
So WOW this is a great new code we have received this year:
U09.9 Post COVID-19 condition, unspecified
Note: This code enables establishment of a link with COVID-19.
This code is not to be used in cases that are still presenting with active COVID-19.
However, an exception is made in cases of re-infection with COVID-19, occurring with a condition related to prior COVID-19.
Post-acute sequela of COVID-19
Code first the specific condition related to COVID-19 if known, such as:
chronic respiratory failure (J96.1-)
loss of smell (R43.8)
loss of taste (R43.8)
multisystem inflammatory syndrome (M35.81)
pulmonary embolism (I26.-)
pulmonary fibrosis (J84.10)
In essence, U09.9 is replacing code B94.8 for sequela or post COVID-19 conditions. So coders will NOT be using B94.8 any longer for post-COVID conditions. And, Z86.16 excludes U09.9, Post COVID-19 condition so you can’t code both. It is a bit confusing that they have “unspecified” at the end of the code description, because usually the sequela condition is going to be specified. Nevertheless I would follow the OCG for U09.9. Here are a few examples to help understand the new code use:
Example A:
Patient is seen in hospital with COVID-19 related multisystem inflammatory syndrome. Patient has a history of COVID-19 infection 2 months ago but is not now infected.
Assign: M35.81, Multisystem inflammatory syndrome
U09.9, Post COVID-19 condition, unspecified
Example B:
Patient is seen in hospital with re-infection with COVID-19 and COVID pneumonia. Patient also has COVID-19 related multisystem inflammatory syndrome from previous infection.
Assign: U07.1, COVID-19
J12.82, pneumonia due to COVID-19
M35.81, Multisystem inflammatory syndrome
U09.9, Post COVID-19 condition, unspecified
Official Guidelines for Coding and Reporting
I will briefly summarize the major changes not already mentioned above that were made in the guidelines. Coders must review all the changes before October 1, 2021. Our New ICD-10-CM Diagnosis Codes and Changes FY2022 module discusses all the changes however.
For General Coding Guidelines, 13. Laterality was updated to allow laterality to be coded from clinicians other than the patient’s provider. If there are any conflicts, or unspecified, a query is recommended. “Unspecified” side should rarely be used.
Also, for 14. Documentation by Clinicians Other than Patient’s Provider the information for laterality an blood alcohol level as well as social determinants of health can be taken from a clinician’s documentation. Of course, the main diagnosis must still be documented by a licensed provider for establishing the patient’s diagnosis.
- Use of sign/Symptom Unspecified codes, a notation was added that complete documentation is needed for accurate coding and that the entire record should be reviewed to determine the reason for encounter and conditions treated. Here, they are just really stating that unspecified codes are not as helpful as specified codes.
For Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99), U07.1, U09.9, the term “HIV Disease” is synonymous with AIDS and coded to B20. Also If a patient with documented history of HIV disease is currently managed on antiretroviral medications, assign code B20, Human immunodeficiency virus [HIV] disease. Code Z79.899, Other long term (current) drug therapy, may be assigned as an additional code to identify the long-term (current) use of antiretroviral medications.
And as stated patients with a history of COVID-19 without residual symptoms(s) or condition(s) are coded to Z09 if follow up exam and Z86.16 for Personal history of COVID-19. Other COVID-19 OCG updates state what we have previously stated above for U09.9.
For Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E00-E89), If the patient is
treated with both oral medications and insulin, both code Z79.4, Long term (current) use of insulin, and
code Z79.84, Long term (current) use of oral hypoglycemic drugs, should be assigned.
For Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01-F99), the medical condition due to substance abuse/dependence/use has been further clarified. Medical conditions due to substance use, abuse, and dependence are not classified as substance-induced disorders. Assign the diagnosis code for the medical condition as directed by the Alphabetical Index along with the appropriate psychoactive substance use, abuse or dependence code. For example, for alcoholic pancreatitis due to alcohol dependence, assign the appropriate code from subcategory K85.2, Alcohol induced acute pancreatitis, and the appropriate code from subcategory F10.2, such as code F10.20, Alcohol dependence, uncomplicated. It would not be appropriate to assign code F10.288, Alcohol dependence with other alcohol-induced disorder.
For Chapter 12: Diseases of the Skin and Subcutaneous Tissue (L00-L99), if during an encounter, the stage of an unstageable pressure ulcer is revealed after debridement, assign only the code for the stage revealed following debridement.
For Chapter 15: Pregnancy, Childbirth and the puerperium (O00-O9A), whenever delivery occurs during the current admission, and there is an “in childbirth” option for the obstetric complication being coded, the “in childbirth” code should be assigned. When the classification does not provide an obstetric code with an “in childbirth” option, it is appropriate to assign a code describing the current trimester. Also all terms “women, woman or mother” were changed to “patient.”
Finally, for Chapter 18: Symptoms, signs an abnormal findings (R00-R99), 1) Coma Scale, Code R40.20, Unspecified coma, may be assigned in conjunction with codes for any medical condition.
Do not report codes for unspecified coma, individual or total Glasgow coma scale scores for a patient with a medically induced coma or a sedated patient. If multiple coma scores are captured within the first 24 hours after hospital admission, assign only the code for the score at the time of admission. ICD-10-CM does not classify coma scores that are reported after admission but less than 24 hours later. In essence, there is only one score captured in the first 24 hours after admission.
In Part 2 of this series, we will look at some highlights of the new ICD-10-PCS codes and changes.
References
https://www.cdc.gov/nchs/icd/icd10cm.htm
https://www.cms.gov/medicare/acute-inpatient-pps/fy-2022-ipps-proposed-rule-home-page
The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.