2023 ICD-10-CM Guideline Changes

October 13th, 2022 - Chris Woolstenhulme
Categories:   Diagnosis Coding  

View the ICD-10-CM Guideline Changes for 2023
  
Chapter 19 (Injury, poisoning, and certain other consequences of external causes [S00-T88])

The guidelines clarify that coders do not need to see a change in the patient’s condition to assign an underdosing code. According to the updated guidelines, “Documentation that the patient is taking less of a medication than is prescribed or discontinued the prescribed medication is sufficient for code assignment.”

15 new codes were added to ICD-10-CM category Z79 (long-term [current] drug therapy), including Z79.85 (long-term [current] use of injectable non-insulin antidiabetic drugs). A new guideline was added to Chapter 4 (Endocrine, Nutritional, and Metabolic Diseases) advising that if the patient is treated with both insulin and an injectable non-insulin antidiabetic drug, assign codes Z79.4 (long-term [current] use of insulin) and Z79.85 (long-term [current] use of injectable non-insulin antidiabetic drugs). If the patient is treated with both oral hypoglycemic drugs and an injectable non-insulin antidiabetic drug, assign codes Z79.84 (long-term [current] use of oral hypoglycemic drugs) and Z79.85.

Changes in the guidelines are in Bold
B. General Coding Guidelines

B, 14. Documentation by Clinicians Other than the Patient's Provider
There are a few exceptions when code assignment may be based on medical record documentation from clinicians who are not the patient’s provider (i.e., physician or other qualified healthcare practitioner legally accountable for establishing the patient’s diagnosis). In this context, “clinicians” other than the patient’s provider refer to healthcare professionals permitted, based on regulatory or accreditation requirements or internal hospital policies, to document in a patient’s official medical record.
Added: Underimmunization status

The BMI, coma scale, NIHSS, blood alcohol level codes, codes for social determinants
of health and underimmunization status should only be reported as secondary
diagnoses.

16. Documentation of Complications of Care:  There must be a cause-and-effect relationship between the care provided and the condition, and the documentation must support that the condition is clinically significant. It is not necessary for the provider to explicitly document the term  complication.”

For example, if the condition alters the course of the surgery as documented in the operative report, then it would be appropriate to report a complication code. 

Query the provider for clarification if the documentation is not clear as to the relationship between the condition and the care or procedure.


C. Chapter-Specific Coding Guidelines,

C,1,2), (a) Patient admitted for HIV-related condition
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. 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.

(b) Patient with HIV disease admitted for unrelated condition
(i) HIV managed by antiretroviral medication
If a patient with documented HIV disease, HIV-related illness or AIDS is currently managed on antiretroviral medications, assign code B20, Human immunodeficiency virus [HIV] disease. 

d. Sepsis, Severe Sepsis, and Septic Shock Infections resistant to antibiotics
9) Hemolytic-uremic syndrome associated with sepsis If the reason for admission is hemolytic-uremic syndrome that is associated with sepsis, assign code D59.31, Infection-associated

hemolytic-uremic syndrome, as the principal diagnosis. Codes for the underlying systemic infection and any other conditions (such as severe sepsis) should be assigned as secondary diagnoses.

Chapter 2: Neoplasms (C00-D49) 
a. Admission/Encounter for treatment of primary site If the malignancy is chiefly responsible for occasioning the patient admission/encounter and treatment is directed at the primary site, designate the primary malignancy as the principal/first-listed diagnosis. The only exception to this guideline is if the administration of chemotherapy, immunotherapy or external beam radiation therapy is chiefly responsible for occasioning the admission/encounter. In that case, assign the appropriate Z51.-- code as the first-listed or principal diagnosis and the underlying diagnosis or problem for which the service is being performed as a secondary diagnosis. 

t. Secondary malignant neoplasm of lymphoid tissue 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. For example, for metastasis of B-cell lymphoma to the lung, brain and left adrenal gland, assign code C83.39, Diffuse large B-cell lymphoma, extranodal and solid organ sites.

4. Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00-E89)
3) Diabetes mellitus and the use of insulin, oral hypoglycemic, and injectable non-insulin drugs

If the patient is treated with both oral hypoglycemic drugs 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. 

If the patient is treated with both insulin and an injectable non-insulin antidiabetic drug, assign codes Z79.4, Long term (current) use of insulin, and Z79.85, Long-term (current) use of injectable non-insulin antidiabetic drugs.

If the patient is treated with both oral hypoglycemic drugs and an injectable non-insulin antidiabetic drug, assign codes Z79.84, Long term (current) use of oral hypoglycemic drugs, and Z79.85, Long-term (current) use of injectable non-insulin antidiabetic drugs.

(a) Secondary diabetes mellitus and the use of insulin, oral hypoglycemic drugs, or injectable non-insulin drugs.

If the patient is treated with both oral hypoglycemic drugs 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.

If the patient is treated with both insulin and an injectable non- insulin antidiabetic drug, assign codes Z79.4, Longterm (current) use of insulin, and Z79.85, Long-term (current) use of injectable non-insulin antidiabetic drugs.

If the patient is treated with both oral hypoglycemic drugs and an injectable non-insulin antidiabetic drug, assign codes Z79.84, Long-term (current) use of oral hypoglycemic drugs, and Z79.85, Long-term (current) use of injectable noninsulin antidiabetic drugs.

5. Chapter 5: Mental, Behavioral and Neurodevelopmental disorders
(F01 – F99)
b.,d. Dementia
The ICD-10-CM classifies dementia (categories F01, F02, and F03) on the basis of the etiology and severity (unspecified, mild, moderate or severe). Selection of the appropriate severity level requires the provider’s clinical judgment and codes should be assigned only on the basis of provider documentation (as defined in the Official Guidelines for Coding and Reporting), unless otherwise instructed by the classification. If the documentation does not provide information about the severity of the dementia, assign the appropriate code for unspecified severity.

If a patient is admitted to an inpatient acute care hospital or other inpatient facility setting with dementia at one severity level and it progresses to a higher severity level, assign one code for the highest severity level reported during the stay.

15. Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A)
a., 7) Completed weeks of gestation
In ICD-10-CM, “completed” weeks of gestation refers to full weeks. For example, if the provider documents gestation at 39 weeks and 6 days, the code for 39 weeks of gestation should be assigned, as the patient has not yet reached 40 completed weeks.

i. Gestational (pregnancy induced) diabetes
Long-term (current) use of insulin, Z79.84, Long-term (current) use of oral hypoglycemic drugs, and Z79.85, Long-term (current) use of injectable non-insulin antidiabetic drugs, should not be
assigned with codes from subcategory O24.4.

4) Hemorrhage following elective abortion
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. 

c. Categories of Z Codes

14) Miscellaneous Z Codes
Z73 Problems related to life management difficulty Note: These codes should be assigned only when the documentation specifies that the patient has an associated problem.

10) 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.

q. Termination of Pregnancy and Spontaneous abortions

4) Hemorrhage following elective abortion
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. 

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Compliance Billing: Power Mobility Devices
December 27th, 2022 - Chris Woolstenhulme
In May of 2022, the OIG conducted a nationwide audit of Power Mobility Device (PMD) repairs for Medicare beneficiaries. The findings were not favorable; the audit revealed CMS paid 20% of durable medical suppliers incorrectly during the audit period of October 01, 2018- September 30, 2019. This was a total of $8 million in device repairs out of $40 million paid by CMS. We gathered information in this article to assist providers and suppliers in keeping the payments received, protecting beneficiaries, and assisting you in ensuring compliance.
Leveraging Hierarchical Condition Category (HCC) Coding to Improve Overall Healthcare
December 27th, 2022 - Kem Tolliver
Diagnosis code usage is a major component of optimizing HCCs to improve overall healthcare. Readers will gain insight into how accurate diagnosis code usage and selection impacts reimbursement and overall healthcare.
Accurately Reporting Diabetic Medication Use in 2023
December 20th, 2022 - Aimee Wilcox
Along with the ICD-10-CM coding updates, effective as of October 1st, the guidelines were also updated to provide additional information on reporting diabetic medications in both the general diabetic population and pregnant diabetics. Accurate reporting is vital to ensure not only maximum funding for risk adjusted health plans, but also to ensure medical necessity for the services provided to this patient population.
REMINDER: CMS Discontinuing the use of CMNs and DIFs- Eff Jan 2023 Claims will be DENIED!
December 19th, 2022 - Chris Woolstenhulme
Updated Article - REMINDER! This is important news for durable medical suppliers! Effective January 1, 2023, CMS is discontinuing the use of Certificates of Medical Necessity (CMNs) and DME information forms (DIFs). We knew this was coming as the MLN sent out an article on May 23, 2022, but it is time to make sure your staff knows about these changes.
How Automation Could Impact the Future of Medical Coding
December 15th, 2022 - Find-A-Code
Automation is a fact of life in the modern world. As digital systems expand and mature, the creators of those systems are bringing more automation to more industries. Medical coding isn't the exception.
CPT Codes and Medicare's Relative Value Unit
December 13th, 2022 - Find-A-Code
A recently published study looking to explain income differences between male and female plastic surgeons suggests that billing and coding practices may be part of the equation. The study focused primarily on Medicare's relative value units (RVU) as applied to surgeon pay. But what exactly is an RVU?
Identifying the MEAT to Support Reporting Chronic Conditions in the Computer-Assisted-Coding (CAC) World
December 13th, 2022 - Aimee Wilcox
The benefits of computer-assisted-coding (CAC) are great and understanding how to engage with the engine to ensure maximum coding efficiency is vital to the program's success for your organization. But how do you know when to accept an autosuggested code and when to ignore it, especially when it has to do with historical patient data?



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2023 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association