ICD-10-CM Update for FY2017

Transcription

1 ICD-10-CM Update for FY2017 Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA President, Kuehn Consulting, LLC Waukesha, WI

2 Update Documents Where to find the files: 10-CM-and-GEMs.html Fastest way to find what you need: Download Addendum folder Find the file: icd10cm_tabular_addenda_ pdf Details every addition, deletion and change

3 Changes Across Many Chapters Individual codes for hemorrhage, hematoma and seroma

4 What s the Difference? Hemorrhage Seroma Hematoma

5 Chapter-by-Chapter Review of Additions and Changes

6 Zika Virus Disease A92.5 Zika virus disease Code only confirmed cases

7 Kidney Neoplasms of Uncertain Behavior Subcategory D49.5 has been expanded to include specific codes for neoplasms of unspecified behavior of the kidney. The new codes provide laterality for the kidneys, as well as unspecified kidney and a new code for unspecified behavior of other genitourinary organs than the kidneys.

8 Mast Cell Activation Syndrome Hyper-responsive mast cells

9 Insulin and Oral Hypoglycemic Drug Use for Control In 2016, we had a Use Additional Code note at the beginning of the E08, D09, E11 and E13 Diabetes categories providing instructions to code also any insulin use (Z79.4). In 2017, the Use Additional Code note has been changed to code the methods of control, including insulin (Z79.4), oral antidiabetic drugs (Z79.84) and oral hypoglycemia drugs (Z79.84). NOTE: This Use Additional Code note does not appear at E10 because patients with Type 1 Diabetes must always use insulin.

10 Laterality for Detailed Diabetic Eye Conditions This includes diabetes codes ending in:.32 Mild nonproliferative diabetic retinopathy.33 Moderate nonproliferative diabetic retinopathy.34 Severe nonproliferative diabetic retinopathy.35 Proliferative diabetic retinopathy.37 Diabetic macular edema, resolved following treatment This allows a specific diagnosis to be coded for each individual eye.

11 Proliferative Diabetic Retinopathy In addition, subcategory E11.35 has been expanded to identify macular involvement, retinal detachment and stable proliferative diabetic retinopathy.

12 Pure Hypercholesterolemia Subcategory E78.0, Pure Hypercholesterolemia has been expanded to identify whether the cause is familial or unspecified.

13 Obsessive-Compulsive Disorder

14 Eating Disorders

15 Gender Identity Disorders

16 Social Pragmatic Communication Disorder Subcategory F80.8, Other developmental disorders of speech and language has been expanded to include a new code for social pragmatic communication disorder (SCD). SCD includes verbal and nonverbal communication problems for social purposes which can impact the patient s ability to participate socially, maintain relationships and perform in an academic or occupational setting.

17 Multifocal Motor Neuropathy Subcategory G61.8, Other inflammatory polyneuropathies has been expanded to include a new code for multifocal motor neuropathy (MMN). MMN is a progressive condition of weakening of the muscles of primarily the lower extremities, including muscle cramps, spasms and twitching but without consistent pain.

18 Retinal Vein Occlusion Subcategories H34.81, Central retinal vein occlusion and H34.83, Tributary (branch) retinal vein occlusion both now have the addition of a 7 th character to identify the severity of the occlusion.

19 Age-Related Macular Degeneration When age-related macular degeneration is identified as nonexudative or exudative, subcategory H35.31 or H35.32 is assigned and the code requires a 7 th character to identify the stage of the disease. The 7 th character options are different for each code.

20 Amblyopia Subcategory H53.0, Amblyopia ex anopsia has been further expanded to include a code for Amblyopia suspect, and includes laterality.

21 Hearing Loss H90.A Conductive and sensorineural hearing loss with restricted hearing on the contralateral side

22 Hypertensive Crisis Hypertensive crisis is either hypertensive urgency or hypertensive emergency. Urgency = 180 systolic (top) OR 110 diastolic (bottom) Emergency = 180 systolic (top) OR 120 diastolic (bottom) Provider must document the words but we can ask if the blood pressure readings are this high and no diagnosis is documented.

23 Hypertensive Crisis, Continued

24 Sequelae Category I69, Sequelae of cerebrovascular disease has additional 6 th character subdivisions that describe detail about cognitive sequelae. These are the 6 th character subdivisions of I69.01, Cognitive deficits following nontraumatic subarachnoid hemorrhage, but each 5 th character subcategory has the same subdivisions.

25 Arterial Dissection

26 Arterial Dissection, Continued Subcategory I77.7, Other Arterial Dissection has ben further expanded to include codes for: I77.70, Dissection of unspecified Artery I77.75, Dissection of precerebral arteries I77.76, Dissection of artery of upper extremity I77.77, Dissection of artery of lower extremity

27 Mediastinitis Subcategory J98.5, Diseases of mediastinum, not elsewhere classified has been expanded to identify Mediastinitis individually as code J98.51.

28 Allergic and Dietetic GE and Colitis Subcategory K52.2, Allergic and dietetic gastroenteritis and colitis has been expanded to include food protein-induced enterocolitis syndrome and food proteininduced enteropathy. Subcategory K52.3, Indeterminate colitis has been added.

29 Allergic and Dietetic GE and Colitis Subcategory K52.8, Other specified noninfective gastroenteritis and colitis has been expanded to include K52.83 for Microscopic colitis. This new 5 character subdivision also contains new 6 character codes for various types of microscopic colitis.

30 Acute Vascular Intestinal Disorders Subcategory K55.0, Acute vascular disorders of intestine was significantly expanded to identify the small vs. large intestine and the types of vascular disease. Example:

31 Other Intestinal Disorders Subcategory K55.3, Necrotizing enterocolitis was added and expanded to include the stages of the disease.

32 Constipation Subcategory K59.0, Constipation was further expanded to include drug induced constipation and chronic idiopathic constipation.

33 Pancreatitis Category K85, Acute Pancreatitis has all of its subcategories expanded to include: Without necrosis or infection With uninfected necrosis With infected necrosis

34 Periorbital Cellulitis Subcategory L03.2, Cellulitis and acute lymphangitis of face has been expanded to include a specific code for periorbital cellulitis:

35 Excessive and Redundant Skin Category K98, Other disorders of skin and subcutaneous tissue, not elsewhere classified has been expanded to include excessive and redundant skin and subcutaneous tissue.

36 Sarcopenia Code M62.84, Sarcopenia has been added for Sarcopenia is the loss of muscle mass, strength and function related to aging. This disease is different from muscle wasting and muscle weakness. Normal Muscle Sarcopenia

37 Atypical Femoral Fracture This new code is used to describe atypical femoral fracture, which is a specific fracture thought to be associated with the use of bisphosphonates in treating osteoporosis. Common medications in this class are Fosamax, Boniva and Actonel. While these medications are successful in reducing the number of vertebral and other fractures, atypical femoral fracture may be an unintentional side affect of using these medications. The new 6 th character subdivisions identify laterality and whether the fracture is complete and incomplete, with complete fractures identified as transverse or oblique. Notice that 7 th characters are applied for these fractures, similar to pathological fractures in this chapter.

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39 Periprosthetic Fracture Category M97, Periprosthetic fracture around internal prosthetic joint has been created to identify these fractures. These codes are not new but were moved to the musculoskeletal chapter from Chapter 19 on Injuries. In 2016, they were classified to the codes of the T84.04 subcategory in Complications of Internal Orthopedic Prosthetic Devices, Implants and Grafts. Category M97 was created to replicate the T84.04 code series but has been expanded to include fractures of the elbow, shoulder, ankle and includes laterality. Category M97 will retain the 7 th character requirement of A, D or S to identify the episode of care, similar to the pathological fracture categories found in the musculoskeletal system.

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41 Code Title Changes N10 is being renamed to Acute Pyelonephritis and will no longer be called Acute tubulo-interstitial nephritis. N40 is being renamed to Benign Prostatic Hypertrophy and will no longer be Enlarged Prostate. The inclusion term enlarged prostate has been added to category N40.

42 Subcategory Expansions in GU N13.0 Obstructive and reflux uropathy N13.0 added for hydronephrosis with Ureteropelvic junction obstruction N39.49 Other specified urinary incontinence Codes added for coital and postural incontinence N42.3 Dysplasia of prostate Codes added for type of dysplasia N50.8 Other specified disorders of male genital organs Codes added for testicular pain on right, left or unspecified Code added for scrotal pain N52 Male erectile dysfunction Codes added for following radiation, interstitial seed therapy and prostate ablation

43 Subcategory Expansions in GU, Continued N61 N83 Inflammatory disorders of breast Codes added for mastitis without abscess and for abscess of breast and nipple Noninflammatory disorders of ovary, fallopian tubes and broad ligament Codes added for torsion of ovaries and fallopian tubes, including laterality of right, left and unspecified added to all codes N90.6 Hypertrophy of vulva Codes added for specific types N99.1 Postprocedural urethral stricture Code added for Postprocedural fossa navicularis urethral stricture

44 Z3A, Weeks of Gestation Guidelines tell us that abortive outcomes should not be assigned a Z3A code.

45 Placenta Previa Category O44, Placenta Previa has been changed and expanded to identify the three conditions pictured at the right: Complete placenta previa Partial placenta previa Low lying placenta Each of the subcategories is now specific to: with hemorrhage or without hemorrhage and the trimester of gestation.

46 Maternal Conditions Affecting Newborn Categories P00-P04 had a title change to remove (suspected to be) from the title. There is a new category added to Chapter 21 for coding the ruled out conditions: Z05 Encounter for observation and evaluation of newborn for suspected diseases and conditions ruled out

47 Light and Small for Dates Subcategory P05.0 has been expanded to allow identification of a newborn who is over 2500 grams but yet light for gestational age. Subcategory P05.1 has been expanded to allow identification of a newborn who is over 2500 grams but yet small in size for gestational age or BOTH light and small for gestational age.

48 Atresia of Aorta Subcategory Q25.2, Atresia of Aorta has been expanded to include a specific code for interrupted aortic arch.

49 Other Congenital Malformations of Aorta Category Q25.4, Other congenital malformations of aorta was expanded to include absence of aorta, hypoplasia, aneurysm, dilation, double arch, tortuous arch, right arch, and anomalous origin of subclavian artery.

50 Other Anomalies Category Q82, Other congenital malformations of skin now includes a specific code for sacral dimple.

51 NIHSS Stroke Scale A new category R29.7, NIHSS Stroke Scale has been added. The stroke scale is used to objectively quantify the impairment caused by a stroke. It is a structured assessment questionnaire the higher the number, the higher the impairment, with a scale from 0 to 42. The score matches the 5 th and 6 th characters for ease in assignment.

52 Glasgow Coma Scale Subcategory N40.24, Glasgow coma scale, total score now has a required 7 th character to describe when and where the scale was determined. This is the same scale previously used only for R R40.23.

53 Concussion vs. Intracranial Injury Subcategory S06.0, Concussion has been streamlined to show without loss of consciousness, with loss of 30 minutes or less and with loss of unspecified duration. 6 th characters 2 though 8 have been deleted and the Excludes1 note directs the coder to other subcategories to identify the most specific injury or injuries. Concussion without these more extensive injuries is coded to S06.0.

54 Growth Plate Fractures Physeal fractures are fractures of the growth plate, the cartilaginous ends of long bones that generates new bone growth. The injury chapter contains many code changes and additions for Salter-Harris fractures types 1 through 5 in the growth plate of bones. Subcategories S99.0, Physeal fracture of calcaneus and S99.1, Physeal fracture of metatarsal are new for 2017 with other code title changes for Salter-Harris fractures.

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56 Code Changes and Additions T82.855, Stenosis of coronary artery stent and T82.856, Stenosis of peripheral stent were added. A standard grouping of breakdown, displacement, leakage, other mechanical complications, infection and inflammation were added for new devices types of: Indwelling urethral catheter Nephrostomy catheter Urinary stents Implanted testicular prosthesis Implanted penile prosthesis Implanted urinary neurostimulation device Neurostimulator and electrode (lead) Cranial or spinal infusion catheter Ventricular intracranial shunt

57 Code Changes and Additions, Continued New codes were added for erosion or exposure of graft of urinary organs, vaginal mesh, urethral mesh, ureteral bulking agent and other implanted mesh. The standard grouping of embolism, fibrosis, hemorrhage, pain, stenosis, thrombosis or other complication was added for the genitourinary system, the nervous system and other internal prosthetic device, implants or grafts. Code T88.53, Unintended awareness under general anesthesia during procedure was added for this unusual event under anesthesia.

58 Overexertion

59 New Activity

60 Newborn Conditions Ruled Out Category Z05 has been added for observation and evaluation of newborn for suspected diseases and conditions that were ruled out (found not to exist). These codes became necessary because of the change in wording in the P00-P04 categories. Example: This category continues through the major body systems and contains codes for other specified and unspecified.

61 Reproductive Health These subcategories include additional codes: Z30.0 Encounter for initial prescription of contraceptives Z30.4 Encounter for surveillance of contraceptives Both initial and surveillance of contraceptive by vaginal ring, transdermal patch and implantable subdermal route have been added Z31.7 Encounter for procreative management and counseling for gestational carrier Z33.3 Pregnant state, gestational carrier (surrogate) Gestational carrier is the medical term for surrogacy, or carrying of a pregnancy for intended parents by an arrangement or agreement

62 Returning Codes Z45.01 Encounter for adjustment and management of cardiac pacemaker (includes resynchronizer) Z Presence of automatic implantable cardiac defibrillator (AICD) Z45.02 Encounter for adjustment and management of AICD

63 Returning Codes Z51.6 Encounter for desensitization to allergens

64 Major Guideline Change Page 42 of 114 in 2017 ICD-10-CM Guidelines

65 With = Automatic Linkage