New ICD-10 codes to know before October

Changes for ICD-10 documentation codes that will come into effect in October 2022.

Question: What are the new documentation codes for 2023?

Answer: The Centers for Disease Control and Prevention (CDC) has published the code ICD-10-CM 2023 updates on June 9, 2022, which include 1,176 new, 28 revised, and 287 removed codes to be used for patient encounters and discharges from October 1, 2022 through September 30, 2023. They apply to all insurers, whether you bill Medicare , Medicaid, Tricare, or a commercial payer. So let’s break down the revisions, deletions, and additions to help you prepare.

New dementia codes

An extension of dementia codes came from a request at the Centers for Disease Control (CDC) in September 2021 ICD-10-CM Coordination and Maintenance Committee Meetingthe National Minority Quality Forum (NMQF) has called for an expansion of dementia codes to include stage and severity and identification of behavioral and psychological symptoms of dementia. According to the NMQF, “These two clinical elements are major factors in patient management strategies. . “As a result, the 2023 ICD-10 code set now includes nearly 100 new dementia-related codes. You can now report conditions such as vascular dementia (F01.5-F01.C4), dementia in other diseases .8-F02.C4) and unspecified dementia (F03.9-F03.C4).

The new guidelines for reporting dementia emphasize that providers must clearly document the severity of the patient’s condition. If the documentation is incomplete, the coder should query the vendor or default to the appropriate unspecified code. The updated guidelines also state that if a patient with dementia is admitted to a hospital setting and worsens during their stay, the coder should assign the highest level of severity reported during the stay.

In the CDC meetingthe Committee provided the following clarifications to help determine the stage of dementia.

mild dementia: “Obvious functional impact on daily life, mainly affecting instrumental activities. No longer fully independent/requires occasional assistance with activities of daily living. »

Moderate dementia: “Significant functional impact on daily life with alteration of basic activities. No longer independent and requires frequent assistance with activities of daily living.

Severe dementia: “Clinical maintenance may not be possible. Complete dependency due to severe functional impact on daily living with impairment of basic activities including basic self-care.

Here are some of the new dementia-specific codes:

  • F02.811, dementia in other diseases classified elsewhere, not serious, with agitation
  • F02.A11, dementia in other diseases classified elsewhere, mild, with agitation
  • F02.B11, dementia in other diseases classified elsewhere, moderate, with agitation

Endometriosis Code Extensions

For providers seeing patients for endometriosis or maternal care, there are now nearly 400 new codes representing gynecological conditions. The American College of Obstetricians and Gynecologists (ACOG) has proposed an expansion of the endometriosis section of the ICD-10-CM code set, and you will now see many of the new endometriosis codes with added precision for specify whether the condition is superficial or deep. The definitions below will be essential to choose the right code:

Superficial endometriosis: Ectopic growth of endometrial-like tissue that extends 5 mm or less below the peritoneal surface. The lesions can vary in number (single or in several places).

Deeply infiltrating endometriosis: Ectopic growth of endometrial-like tissue that extends more than 5 mm below the peritoneal surface. The lesions can vary in number (single or in several places). These lesions are often associated with deep fibrosis and adhesions.

If you don’t see the terms “deep” or “superficial” in the doctor’s notes, look for an indication of the distance below the peritoneal surface of the extended tissue. This will be essential to select the correct code under the new 2023 ICD-10-CM codes. For example, you would report superficial endometriosis of the right ovary with N80.111, and deep endometriosis of the right ovary would be coded N80.121.

Fetal abnormalities

ACOG and the Society for Maternal Fetal Medicine (SMFM) have also requested new codes for fetal abnormalities (eg, central nervous system (CNS) abnormalities, chromosomal abnormalities, and fetal abnormalities and lesions). According to these groups, “This proposal will allow for better tracking, measurement and ultimately improved treatment modalities for identified fetal abnormalities.”

Clarification of loss of consciousness

For concussion and brain injury codes (e.g., concussion, contusion, traumatic brain injury, blast injury, and hemorrhage), more than 100 new codes from ICD-10-CM 2023 were added in S06 (Intracranial injuryAccording to the American Academy of Pediatrics (AAP), patients often present with injuries that code in the S06 category without a clear history of loss of consciousness (LOC), so they requested new codes to include identification of the LOC and, if present, how long did it last.

With the LOC addition, you will need to know if a patient has passed out in order to select the correct diagnostic code. For example, if a patient lost consciousness with a concussion, you would report a code from the S06.0XA series, whereas a primary blast injury to the brain with loss of consciousness lasting 30 minutes or less would be coded to the code range S06.8A1. Here are some specific examples:

  1. S06.0XAA, concussion with loss of consciousness unknown, initial encounter
  2. S06.0XAD, concussion with loss of consciousness status unknown, subsequent encounter
  3. S06.0XAS, concussion with loss of consciousness status unknown, sequelae

New Meth Overdose Codes

You will find a new category of codes describing methamphetamine poisoning, as well as codes for adverse effects related to methamphetamine use. In the past, coders reporting methamphetamine overdoses had to report these services under the general category of “amphetamines,” but using this code made it difficult for public health authorities to track methamphetamine overdoses.

You will find new codes in this category under the new T43.65 (Methamphetamine intoxication, adverse reaction, and underdose due to self-harm or assault) interval. To report them accurately, you need to find on file whether the overdose was accidental, was, or the status is undetermined. These factors will be essential for you to select the right code.

Additional New Codes

In addition to the new ICD-10-CM 2023 codes described above, there are numerous code changes impacting almost every specialty. Take the time to consider the following points:

Full CDC ICD-10-CM list available here.

Renee Dowling is a compliance auditor for Sansum Clinic, LLC, in Santa Barbara, California.

Lance B. Holton