As you know, CMS and the CDC release the majority of code changes for the fiscal year on October 1 each year. However, they are now making a second release of updates, as well as an update to the grouper, that become effective on April 1 of each year. This Coding Tip presents the ICD-10-CM code changes that will go into effect on April 1, 2024.
To ensure you are current on all ICD-10 code updates, read ICD-10-PCS CODE CHANGES EFFECTIVE APRIL 1, 2024.
To download the updated files, use this link to the CMS website: https://www.cms.gov/medicare/coding-billing/icd-10-codes/2024-icd-10-cm. The files include an updated version of the guidelines, the index and the tabular as well as an addendum with files that include only the specific changes being made to the classification. Reviewing the addendum makes it easy to see exactly what is being changed/updated.
There are no new diagnosis codes being implemented in the April 1, 2024, release of ICD-10-CM updates, but there are additions, deletions, and revisions to some index entries, tabular entries and instructional notes that have implications for the coding process. In addition to the updates to the Index to Diseases and Injuries and the Tabular List, there were updates made to the Official Guidelines for Coding and Reporting.
ICD-10-CM April 1, 2024, Code Updates - Summary | |
Section of ICD-10-CM | Updates |
Index to Diseases and Injuries |
1 nonessential modifier removed 2 code entries changed 7 subterms added 1 spelling correction 1 main term added |
Tabular List of Diseases and Injuries |
6 Excludes1 notes changed to Excludes2 notes 1 change in instructional note direction 1 addition of an inclusion term 2 additions to excluded codes lists 3 punctuation changes to excluded codes 2 changes to excluded codes |
Table of Neoplasms |
No Changes |
Table of Drugs and Chemical |
No Changes |
External Cause of Injuries Index |
No Changes |
Official Guidelines for Coding and Reporting |
Change to guideline I.C.4.a.6.b.i Change to guideline I.C.21.c.7 |
Index to Diseases and Injuries
The are 5 alphabetic sections of the ICD-10-CM Index to Diseases and Injuries that have updates for April 1, 2024.
B
C
D
Note: This is a significant update as code R09.2 is an MCC. The change to G98.8 for reporting depression of central nervous system rather than R09.2 will result in the loss of an MCC.
F
This change in the index is based on the expansion of category R09 to include codes that are specific for reporting Foreign body sensation of the circulatory and respiratory system in the October release of the ICD-10-CM 2024 updates.
M
Tabular List of Diseases and Injuries
The are 11 chapters in the ICD-10-CM Tabular List that have updates for April 1, 2024.
Chapter 1 Certain infectious and parasitic diseases (A00-B99)
Chapter 4 Endocrine, nutritional and metabolic diseases (E00-E89)
Note that this change effects sequencing and the decision of whether a code from category E13 Other specified diabetes mellitus, which reports post pancreatectomy and postprocedural diabetes, should be assigned. Refer to the updated guideline I.C.4.a.6.b.i for official sequencing direction.
Chapter 6 Diseases of the nervous system (G00-G99)
Chapter 9 Diseases of the circulatory system (I00-I99)
Chapter 10 Diseases of the respiratory system (J00-J99)
Additionally, Other specified chronic obstructive pulmonary disease (J44.89) was added to the list of diagnoses in the Excludes2 note for category J45.
Chapter 11 Diseases of the digestive system (K00-K95)
Chapter 15 Pregnancy, childbirth and the puerperium (O00-O9A)
Chapter 16 Certain conditions originating in the perinatal period (P00-P96)
Chapter 17 Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
Chapter 18 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
Chapter 21 Factors influencing health status and contact with health services (Z00-Z99)
In the cases where an Excludes1 note was changed to an Excludes2 note, if the patient has both the condition listed in the code with the note and the excluded code, it is now appropriate to report codes for both conditions if they are not integral to one another and meet the criteria for reporting.
For example, to report both K11.7 Salivary gland hyposecretion and R68.2 Dry mouth, unspecified the documentation should support the symptom of dry mouth as secondary to something other than salivary gland hyposecretion, such medication use, for both conditions to be reportable.
Official Guidelines for Coding and Reporting
The are 2 ICD-10-CM coding guidelines that have updates for April 1, 2024.
I.C.4.a.6.b.i Secondary diabetes mellitus due to pancreatectomy
This is the guideline as it stood in the October 2024 release of ICD-10-CM.
FY2024 October
This is the guideline as it has been updated for April 1, 2024, by adding the content in bold text.
The update to this guideline changes the direction for sequencing of diagnosis codes when a patient has diabetes secondary to surgical removal of the pancreas. Previously this guideline directed the assignment of code E89.1 Postprocedural hypoinsulinemia as the principal or first-listed diagnosis with the appropriate code from category E13 Other specified diabetes mellitus and code Z90.41 Acquired absence of pancreas assigned as additional codes. The April 1, 2024, update reverses the sequencing of the principal/first-listed diagnosis making a code from category E13 the principal/first-listed diagnosis and code E89.1 a secondary diagnosis. Code Z90.41 is still assigned as an additional code. The corresponding instructional notes in the Tabular List have been updated as well as discussed above.
This is a significant update because the change in principal diagnosis sequencing changes the MS-DRG the case is assigned to from 641 Miscellaneous disorder of nutrition, metabolism, fluid and electrolytes to 639 Diabetes without CC/MCC, which has a lower relative weight.
I.C.21.c.7 Categories of Z codes, Aftercare
This guideline has been updated to replace the specification of “solely” with the specification of “chiefly” in the following sentence: “These codes are to be first listed, followed by the diagnosis code when a patient’s encounter is chiefly solely to receive radiation therapy, chemotherapy, or immunotherapy for the treatment of a neoplasm.”
This change has implications for correct selection of the first-listed diagnosis for encounters when patients are admitted for radiation therapy, chemotherapy, or immunotherapy as well as treatment of another condition.
To review the impact of this change in more depth, read the Coding Tip Admission Solely vs Chiefly for Chemotherapy, Immunotherapy and Radiation Therapy FY2024.
Note that coders should download all the files from the CMS.gov website listed below to have a complete copy of the changes/updates going into effect on April 1, 2024, to use as a reference when coding.
References
https://www.cms.gov/medicare/coding-billing/icd-10-codes/2024-icd-10-cm
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