The ever-changing healthcare industry scenario has released important updates and revisions in coding guidelines and codes, many of these changes were prompted by the shift from a fee-for-service to a value-based care healthcare model. As a result, the new reimbursement model is based on the quality level of care provided, requiring a more thorough documentation process with a way by adding on making sure code precision that accurately captures the acuity of the patient and the treatment given.

Let’s have a look at the latest changes in the code system and guidelines.

A quick glance at the highlights and new edit groups:

Hemolytic-uremic syndrome, Dementia, Neurocognitive disorder, Postural orthostatic tachycardia syndrome [POTS], Post-viral fatigue syndrome, Refractory angina pectoris, Ventricular tachycardia, Dissection and aneurysm of the aorta, Endometriosis, Atrial septal defect, PTEN tumor syndrome, Poisoning by, adverse effect of and under dosing of methamphetamines, New Z codes, and External cause of morbidity and mortality codes are the groups majorly where codes have been modified and added. There are 1176 additons, 28 revisions, and 287 deletions from the existing ones with highest edits in social determinants of health.

ICD-10 CM Changes FY 2023

Documentation by Clinicians Other than the Patient’s Provider

Code assignment is based on the documentation by the patient’s provider but there are a few exceptions when code assignment may be based on medical record documentation from clinicians who are not the patient’s provider. Apart from the other exceptions it will also include “Under-immunization status”.

Patient admitted for HIV-related condition

When a patient is admitted for an HIV-related condition, the principal diagnosis should be B20, Human immunodeficiency virus [HIV] 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.

Hemolytic-uremic syndrome associated with sepsis

If the reason for admission is hemolytic-uremic syndrome that is associated with sepsis, assign code D59.31

Mental, Behavioral and Neuro-developmental disorders

The ICD-10-CM classifies Dementia (categories F01, F02, and F03) on the basis of the etiology and 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.

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.

Hemorrhage following elective abortion

For hemorrhage post elective abortion, assign code O04.6, Delayed or excessive hemorrhage following (induced) termination of pregnancy.

Counseling

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.

Social Determinants of Health

Assign as many SDOH codes as are necessary to describe all of the problems or risk factors. These codes should be assigned only when the documentation specifies that the patient has an associated problem or risk factor. For example, not every individual living alone would be assigned code Z60.2, Problems related to living alone.

Sources:

FY 2023 ICD 10 CM Coding Guidelines

2023 ICD 10 CM

ICD-10-PCS Procedure Changes FY 2023

There are 331 new procedure codes, 64 deleted procedure codes, and no revised titles. Changes to the guidelines include the addition of B3.19 for detachment, and revisions to B4.1c for tubular body part, and B6.1a for general coding of device.

Below are the areas where additions have been made:

The Central Nervous System and Cranial Nerves section has a new qualifier 3 under root operation of Destruction to reflect use of using Laser Interstitial Thermal Therapy. Cerebrum now has its own body part under the root operation of extraction.

In the Heart and Great Vessels section under root operation Replacement, qualifier N, Rapid Deployment Technique, was added to body part F, Aortic Valve, when zooplastic tissue is the qualifier.

In the Lower Arteries, the root operation Occlusion in the Lower Arteries section has been updated to reflect right and left prostatic arteries as qualifiers V and W.

The Respiratory, Gastrointestinal, Hepatobiliary, Endocrine, Skin and Breast, and the Male Reproduction systems have a major addition. The root operation Destruction using Laser Interstitial Thermal Therapy (LITT) is now represented by qualifier 3. LITT was relocated from the Radiation Therapy section.

In the Gastrointestinal System section, root operation Transfer, bladder, left and right ureters, and bilateral ureters were added as qualifiers to Body Part small intestine.

In the Head and Facial Bones section, infusion device was added to the sixth character under root operations Removal and Revision of the skull body part.

The Anatomical Regions, General section, neck is now located above pelvic cavity.

For 2023, we now have one new and two revised ICD-10-PCS guidelines:

B3.19 – Detachment of extremities guideline
B4.1c – Body part general guideline
B6.1a – Device general guideline

Sources:
FY 2023 Updates ICD 10 PCS
2023 Official ICD 10 PCS Coding guidelines
2023 ICS 10 PCS

These are the highlights of some of the changes by ICD and the full information can be accessed from the given sources.