Uncovering Coding Changes in ICD-10-CM/PCS

Continuing with our discussion of the ICD-10-CM and PCS code updates issued earlier this month, today we will examine an update potpourri of some relevant topics.

We can now assign for severity on some eating disorder diagnoses. For anorexia nervosa, both restricting type and binge eating/purging type, as well as bulimia nervosa and binge eating disorder, we can now assign for the following levels of severity:

• Mild;
• Moderate;
• Severe;
• Extreme; and
• In remission.

There is also an “unspecified” option. If you routinely assign these diagnoses, are you seeing this level of severity documented? If not, this is a great opportunity for some provider education if they aren’t aware of these new codes and the level of specificity we can assign for, if documented.

We are all aware of the importance of assigning for the social determinants of health (SDoH) conditions. These non-medical factors can have such a profound effect on a patient’s health, sense of well-being, and follow-up or aftercare. There are two new Z codes of which to be aware:

• Z59.71 Insufficient health insurance coverage. This includes inadequate or insufficient social insurance, as well as no health insurance coverage; and 
• Z59.72 Insufficient welfare support. 

These codes could be valuable indicators representing your particular patient population and tracking the needs they may have.

Another new Z code I want to note was already referenced by our own Dr. Erica Remer in August, in an ICD10monitor Special Bulletin. It is Z51.A, Encounter for Sepsis Aftercare. This code category, Z51 (Encounter for other aftercare and medical care) has a Code Also instructional note instructing the coder to code also the condition requiring care.

This could be the residual causative infection or weakness, debility, or whatever the condition may be. Dr. Remer noted that there is some vagueness around this code, and I agree. It will still be a good addition for providers providing follow-up care, and for those post-acute care settings, including home health agencies.

I also agree with Dr. Remer’s thought that a code for personal history of sepsis would be a welcome addition. There is always next year!

There is also an instructional note change on I08, Multiple valve disease. What was an Excludes 1 note has now changed to an Excludes 2 note. The new Excludes 2 note includes multiple valve disease specified as nonrheumatic, and includes codes I34-, I35-, I36-, I37-, I38-, Q22-, Q23-, and Q24.8-.

 As coders, we know per the Official Guidelines that the Excludes 1 note is that pure excludes note meaning “not coded here.” The Excludes 2 note is the guidance that the excluded condition is not part of the condition represented by the code. It is essentially that “not included here” meaning. So, with this change to an Excludes 2 note, the valve diseases represented here may now be coded together.

We also have a new code note on J69, Pneumonitis due to solids and liquids. This covers our aspiration pneumonias. The note instructs coders to code also, if applicable, other types of pneumonias. While I think most coders are already assigning codes for multiple types of pneumonia when present and documented, this change gives the coder additional guidance and support. 

While we obviously weren’t able to cover each and every change in this year’s ICD-10-CM update, hopefully we touched on some areas of interest. Some of the other changes include topics of lymphomas, KCNQ 2-related epilepsy, anal, anorectal, and rectal fistulas, as well as hypoglycemia. If you routinely see these diagnoses documented, I encourage you to review the related updates in detail.