Every year, we’re curious to learn about the changes to ICD-10-CM codes that become effective on October 1st, and this year, there are many interesting additions. Of course, our company looks at codes primarily through the risk adjusted payment lens, so for a more complete summary of the changes in all code categories, we suggest you consult the CMS website directly.

As an overview, 1,790 code changes were announced, which includes 1,468 new ICD-10-CM codes, 251 deleted codes, 35 revisions and 36 codes that were converted to parent codes; this last one means they were tapped to head up a new series of codes, which entails the availability of greater coding specificity.

  • Von Willebrand disease is an inherited bleeding disorder that, currently, has one ICD-10-CM code (D68.0). The Washington Manual of Medical Therapeutics calls it the most common inherited bleeding disorder. There are several types of the disease and each of them will have its own code, spawning D68.00 through D68.09.
  • D75.82 Heparin induced thrombocytopenia (HIT) is also expanding to allow for distinction among immune-mediated, non-immune and other HIT. See codes D75.821 through D75.829.
  • Considerable changes are affecting the dementia category of codes (F01.- vascular dementia, F02.-dementia in diseases classified elsewhere, and F03.- unspecified dementia). These diagnoses currently have two codes available: with or without behavioral disturbance. Shortly, however, providers will be able to better specify any disturbance (e.g., with agitation, with psychotic disturbance, with mood disturbance, with anxiety, with other behavioral disturbance) and also assign a severity (e.g., mild, moderate or severe) to the condition. In short, 29 ICD-10-CM codes will exist for each of the three dementia categories. In a subsequent blog, we’ll explain the criteria for categorizing a dementia as mild, moderate or severe.
  • Right now, substance disorders have codes for use with intoxication, withdrawal and induced disorders. The updated ICD-10-CM adds unspecified use, uncomplicated for alcohol (F10.90), and unspecified use in remission (F1-.91) for alcohol, cannabis, sedatives, cocaine, other stimulants, hallucinogens, inhalants and other psychoactive substances.
  • To all the atherosclerotic heart disease types in I25, a code for with refractory angina pectoris (I25.7–) will be added.
  • ICD-10 is expanding the lonely ventricular tachycardia (I47.2) to include a little more specificity, and the world of aneurysms is being shaken up to provide specificity about their location. While current ICD-10 codes allow for general aneurysm locations (I71.-), with/without rupture (e.g., thoracic aorta, abdominal aorta, etc), these codes will expand to include a more specific site, such as the ascending aorta, descending aorta and aortic arch.
  • The last section for discussion is additions to Z-codes, which are used to report statuses, histories and other factors influencing health. Of note are Z79.63 Long term (current) use of chemotherapeutic agent (along with codes for more specific agents) and Z79.85 Long-term (current) use of injectable non-insulin antidiabetic drugs. Z91.1- Patient’s noncompliance is expanding to identify factors relevant to social determinants of health, such as due to financial hardship, other reason and unspecified reason. And a whole new code series (Z91.A) allows providers to detail reasons for a caregiver’s noncompliance with the patient’s medical treatment and regimen.

As a reminder, ICD-10-CM code changes become mandatory for use on October 1, 2022 through September 30, 2023. Make sure that your EMR or billing system will automatically update the code-set and make it available on October 1st. Old codes should be flagged so your billers can distinguish the correct code based on the date of service being billed. Check with your EMR and billing company so your practice doesn’t experience payment interruptions due to incorrect ICD-10-CM codes. There is no grace period for implementing the ICD-10 changes.