Second Quarter 2023 Updates are Different This Year

April 6th, 2023 - Wyn Staheli

The second quarter of 2023 is NOT business as usual so it is important to pay attention to ensure that organizational processes and training take place to avoid mistakes. Not only have ICD-10-CM coding updates been added to the usual code set updates (e.g., CPT, HCPCS, ICD-10-PCS), but the end of the COVID-19 Public Health Emergency will bring about changes that will also take place during the quarter (but not on April 1, 2023).

ICD-10-CM Changes for April 1, 2023

For us coding old-timers, ICD-10-CM changes only took place on October 1st of each year. Then, COVID hit and the CDC announced that effective March 18, 2020, an “emergency use” category (U07) was created which included codes U07.0 “Vaping-related disorder” and U07.1 “COVID-19”. This was soon followed with special mid-year COVID coding guidance. Although the new Post-COVID sequela (PASC or long-COVID) code U09.9 was added in October 2021, it was later revised as of April 2022 along with 

Yes, it’s been a bit of a roller coaster ride and it is still going on. CMS stated the following (emphasis added):

In an effort to better enable the collection of health-related social needs (HRSNs), defined as individual-level, adverse social conditions that negatively impact a person’s health or healthcare, are significant risk factors associated with worse health outcomes as well as increased healthcare utilization, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is implementing 42 new diagnosis codes into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), for reporting effective April 1, 2023.

This April, the following changes took place for ICD-10-CM coding:

  • Subcategory Y07.0- “Spouse or partner, perpetrator of maltreatment and neglect” has been expanded to differentiate between current and former spouse/partner and added “Non-binary” partner.
  • New subcategories were added for Financial abuse (T74.1- for confirmed and T76.A- for suspected)
  • Social Determinants of Health (SDoH) codes were significantly revised and expanded along with changes to the Official Guidelines for Coding and Reportingabout their use.

Tip:  Click hereto see the official April 2023 update document.

Not all payers require the use of SDoH codes, but it appears that CMS is getting serious about collecting this information. Watch for further announcements about the required use of these codes.

COVID Coding Changes

When the COVID-19 PHE officially ends on May 11, 2023, there are many changes that will take place. Two things or particular to note are:

  1. Specimen collection codes G2023 and G2024 will be deleted.
  2. The laboratory high throughput technology surcharge codes U0003, U0004, U0005 will be deleted.

Click here to read more about changes to laboratory reporting at the end of the PHE including changes to Stark Law flexibilities.

Click here to read more about other changes (e.g., test coverage, end of 1135 waiver, telehealth flexibilities) taking place when the COVID-19 PHE ends.

In case you missed it, on March 17, 2023, it was announced that there were some changes to the CPT codes for reporting Pfizer bivalent vaccines which became retroactively effective on March 14, 2023. Code 0173A for the 3rd dose was revised and code 0174A for a booster was added.

Note: subscribers have access to our Coronavirus page which is updated frequently.

Alert: The Official Guidelines for Coding and Reporting will be changing effective October 1, 2023 in regards to the reporting of encounters for COVID screening (Z11.52). Even though the PHE ends on May 11, officially the guideline will not change until October so watch for further information.

Other Coding Changes

As a reminder, there are changes in other coding sets for April 1st which include:

  • CPT® Proprietary Laboratory Analyses (PLA) Codes: 23 new (0364U0386U), 2 changed (0022U, 0095U), 2 deleted (0324U, 0325U)
  • HCPCS: 43 new, 8 changed, 5 deleted
  • HCPCS modifiers: 2 new (JK, JL), 1 changed (LU)
  • ICD-10-PCS: 34 new, no changed or deleted

Reminder: Payer policies can also change because of quarterly updates to code sets. Be sure to recheck policies of payers that are frequently billed by your organization to see if anything has changed which may require you to update your internal policies.


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.

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