Ready, Set Go: A Deluge of New Codes from FY 2018 IPPS

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!


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.

Register to attend.


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