In just about two months, we will be dealing with our second ICD-10 code deluge from the Centers for Medicare & Medicaid Services (CMS). Our first deluge came last year, when over 5,500 new codes were added to the ICD-10 code set.
Somewhat surprisingly, with about 4,000 new codes being introduced this time around, we now find ourselves in the same boat as last year. The ICD-10-CM and ICD-10-PCS code sets are remarkably susceptible to exponential growth, and there are reasons to believe that this is our new normal. That fact, combined with the fact that the reach of codes and code-derived data is ever-expanding, gives us good reason to take these annual changes seriously.
The 2018 fiscal-year ICD-10-CM changes include 360 new diagnosis codes. While this amounts to about 20 percent of last year’s additions, one should not assume that these new codes should be taken lightly. For example, new codes have been added for heart failure and myocardial infarctions.
The new additions to the heart failure category, I50, allow for the capture of commonly encountered heart failure variants that to this point were not able to be captured. Examples of heart failure variants include biventricular heart failure, high-output heart failure, and end-stage heart failure. The new additions to acute myocardial infarction (MI), category I21, allow us to code supply-demand mismatch MIs, otherwise known as Type 2 MIs. In fact, there is even a new code allocated to coding Type 3, Type 4a/4b, and Type 5 MIs. Moreover, these new code additions are accompanied by a multitude of critical instructional notes that need to be taken into consideration during code assignment.
These changes also include almost 3,600 new procedure codes. Examples include new codes due to the addition of new body part values such as the common hepatic duct, diaphragm, and omentum. And new codes also appear due to the addition of new qualifier values for flaps used during transfer procedures and supracervical hysterectomies. There are even new qualifier values that will allow us to code the removal and revision of external heart assist systems. Lastly, there are an incredible amount of new codes across a larger portion of the code set due to the expansion of approach value 8, via natural or artificial opening, endoscopic.
These are just some examples and not the totality of additions. There is much, much, more.
At the very least, changes of this magnitude can be intimidating. At worst, not having a plan to successfully integrate new codes into your coding process can adversely affect reimbursement and publicly reported quality rankings.
It’s critical to understand the impact of the new codes and to develop a strategy. Get ready to hit the ground running with these new codes!
PROGRAM NOTE:
Scot Nemchik, CCS, AHIMA-Certified ICD-10 Trainer and Janice Tarlecki, MBA, RHIA, CCS, director of advance education at Ciox Health, will be conducting a three-part webcast on the new ICD-10 code changes Aug. 16, Aug. 23 and Aug. 30. The three-part series is being produced by ICD10monitor.
The Centers for Medicare & Medicaid Services’ (CMS’s) $50 billion Rural Health Transformation Program was designed by the Trump Administration to reshape healthcare delivery in
At times, it can seem as though the chips are stacked against hospitals. There are a multitude of organizations collecting hospital claim data and monetizing
Please log in to your account to comment on this article.
Sepsis sequencing continues to challenge even experienced coding and CDI professionals, with evolving guidelines, documentation gaps, and payer scrutiny driving denials and data inconsistencies. In this webcast, Payal Sinha, MBA, RHIA, CCDS, CDIP, CCS, CCS-P, CCDS-O, CRC, CRCR, provides clear guideline-based strategies to accurately code sepsis, severe sepsis, and septic shock, assign POA indicators, clarify the relationship between infection and organ dysfunction, and align documentation across teams. Attendees will gain practical tools to strengthen audit defensibility, improve first-pass accuracy, support appeal success, reduce denials, and ensure accurate quality reporting, empowering organizations to achieve consistent, compliant sepsis coding outcomes.
Expert presenters Kathy Pride, RHIT, CPC, CCS-P, CPMA, and Brandi Russell, RHIA, CCS, COC, CPMA, break down complex fracture care coding rules, walk through correct modifier application (-25, -57, 54, 55), and clarify sequencing for initial and subsequent encounters. Attendees will gain the practical knowledge needed to submit clean claims, ensure compliance, and stay one step ahead of payer audits in 2026.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
