POA is MIA from the FY 2024 ICD-10-CM Guidelines

The Centers for Disease Control and Prevention (CDC) released the ICD-10-CM guidelines for the 2024 fiscal year (FY) on July 5. The guidelines are approved by the Cooperating Parties, which include the American Hospital Association (AHA), American Health Information Management Association (AHIMA), Centers for Medicare & Medicaid Services (CMS), and National Center of Health Statistics (NCHS).

The guidelines are 120 pages long, and there are updates to the ICD-10-CM codes throughout, to take effect for the coming fiscal year.

The narrative updates include the following:

1. Section I.A.13 (Etiology/manifestation convention) has an update to the example in that code, which was updated to Category G20 (Parkinson’s Disease), first followed by F02.80 or F02.81;
2. Section I.B.14 (Documentation by clinicians other than the patient’s provider) has the point of Social Determinants of Health (SDoH) to expand to classified to Chapter 21;
3. Section I.C.1.d.5.b (Sepsis due to postprocedural infection) has some rewording, specifically “(for) sepsis following a post-procedural wound (surgical site), a code from T81.41 to T81.43 (Infection following a procedure) or O86.00 to O86.03 (Infection of obstetrical surgical wound) should be sequenced first. Assign an additional code for sepsis;”
4. Section I.C.1.g.1.f (Screening for COVID-19) has been updated for the end of the pandemic. It now states that for screening for COVID-19, including pre-operative testing, assign Z11.52 (Encounter for screening for COVID-19);
5. Section I.C.2.t (Secondary malignant neoplasm of lymphoid tissue) had the example updated to include metastasis of diffuse large B-cell lymphoma;
6. Section I.C.9.e.6 (Myocardial infarction with coronary microvascular dysfunction) is a new guideline. It states “coronary microvascular dysfunction (CMD) is a condition that impacts the microvasculature by restricting microvascular flow and increasing microvascular resistance.” Code I21.B is assigned for myocardial infarction with coronary microvascular disease, myocardial infarction with coronary microvascular dysfunction, and myocardial infarction with non-obstructive coronary arteries (MINOCA) with microvascular disease;
7. Section I.C.18.e (Coma) has been updated to note that R40.20 (Unspecified coma) should be assigned when the underlying cause of coma is not known, or the cause is traumatic brain injury, when the coma scale is not documented in the medical record;
8. Section I.C.18.e.1 (Coma scale) had code updates to include R40.21- to R40.24-. It also states that these codes can be used in conjunction with traumatic brain injury codes. The coma codes cannot be used with code R40.2A (non-traumatic coma due to underlying condition);
9. Section I.C.21.B had the title updated to read, “Z codes Indicate a Reason for an Encounter or Provide Additional Information About a Patient Encounter;” and
10. Section III (Reporting additional diagnoses) had the definition of “other diagnoses” updated to note that “other diagnoses” is interpreted as additional clinically significant conditions.

There were no updates to the present-on-admission (POA) reporting. The last pieces for FY 2024 will be included in Final Rule for the MS DRG changes, New Technology Add-On Payment applications, and updates to the Medicare Code Editor. The Final Rule should be published in early August.