Leah Savage MSN, RN, CCDS Norton Children’s Hospital 2018 UPDATES Leah Savage MSN, RN, CCDS Norton Children’s Hospital

Objectives Verbalize three coding updates for ICD-CM 2018. Acknowledge three query opportunities from ICD-10 CM 2018. Identify two changes to ICD-10 PCS that affect assigned DRG.

UPDATES There are new ICD-10-PCS codes effective October 1, 2017. There are revised and 646 codes deleted, mostly to simplify certain body part values or to correct clinical discrepancies. 3,562 1,821

Code updates

Clostridium difficile enterocolitis Code A04.7, Enterocolitis due to Clostridium difficile recurrent (A04.71) not specified as recurrent (A04.72). ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD-10 2017 Page: 4 Effective with discharges: October 1, 2017

Diabetic ketoacidosis E11.10, Type 2 diabetes mellitus with ketoacidosis without coma E11.11, Type 2 diabetes mellitus with ketoacidosis with coma ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD-10 2017 Page: 6 Effective with discharges: October 1, 2017

Substance related disorders, in remission Alcohol (F10.11) Opioid (F11.11) Cannabis (F12.11) Sedative, hypnotic or anxiolytic (F13.11) Cocaine (F14.11) Other stimulant (F15.11) Hallucinogen (F16.11) Inhalant (F18.11) Other psychoactive substance (F19.11) ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD-10 2017 Page: 8 Effective with discharges: October 1, 2017 Prior to this change, ICD-10-CM included codes for "in remission" for substance dependence, but not for substance abuse. The new codes for substance abuse in remission have inclusion terms for substance use disorder specified as "mild in early remission" and "mild, in sustained remission."

Types of acute myocardial infarction I21 Acute myocardial infarction Addresses “Type” of MI I21.0-I21.4 designated as Type 1 I21.9 Acute myocardial infarction, unspecified I21.A1 Myocardial infarction Type 2 MI due to demand ischemia I21.A9 Other myocardial infarction type Types 3, 4a, 4b, 4c, 5 ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD-10 2017 Pages: 12-14 Effective with discharges: October 1, 2017

Types of acute myocardial infarction Type 1: Spontaneous myocardial infarction due to a primary coronary event like plaque rupture. Type 2: Myocardial infarction secondary to an ischemic imbalance as in coronary vasospasm, anemia or hypotension. Type 3: Myocardial infarction resulting in death when biomarker values are unavailable Type 4a: Myocardial infarction related to percutaneous coronary intervention (PCI) Type 4b: Myocardial infarction related to stent thrombosis Type 4c: Myocardial infarction due to restenosis greater than or equal to;50% after an initially successful PCI Type 5: Myocardial infarction related to coronary artery bypass grafting (CABG) "Third Universal Definition of Myocardial Infarction“ (consensus clinical classification of myocardial infarctions) developed by A global task force, which included the European Society of Cardiology, the American College of Cardiology, the American Heart Association and the World Heart Federation (WHF)

Pulmonary hypertension Expanded I27.2 Other secondary pulmonary hypertension I27.20 Pulm htn, unspecified I27.21 Secondary pulmonary arterial hypertension I27.22 Pulm htn d/t left heart disease I27.23 Pulm htn d/t lung disease and hypoxia I27.24 Chronic thromboembolitic pulm htn I27.29 Other secondary pulm htn ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD-10 2017 Pages: 12-14 Effective with discharges: October 1, 2017

Other heart failure Expanded I50.8 I50.810 Right heart failure, unspecified I50.811 Acute right heart failure I50.812 Chronic right heart failure I50.813 Acute on chronic right heart failure I50.814 Right heart failure due to left heart failure I50.82 Biventricular heart failure I50.83 High output heart failure I50.84 End stage heart failure ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD-10 2017 Pages: 15-16 Effective with discharges: October 1, 2017

COPD J44.0 COPD with acute lower respiratory infection “use additional code” to identify infection mandated that J44.0 be sequenced first regardless of reason for admission October 1, 2017 changed to “code also” to identify infection Sequencing is no longer mandated COPD or respiratory infection can be sequences ad principle diagnosis ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD-10 2017 Page: 96 Effective with discharges: October 1, 2017

ICD-10-CM Official Guidelines for Coding and Reporting FY 2018 Page 49 of 117

ICD-10-CM Official Guidelines for Coding and Reporting FY 2018 Page 50 of 117

Spinal stenosis Expanded M48.06 spinal stenosis, lumbar region M48.061 Spinal stenosis, lumbar region without neurogenic claudication M48.062 Spinal stenosis, lumbar region with neurogenic claudication ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD-10 2017 Pages: 18-19 Effective with discharges: October 1, 2017

Acute respiratory distress R06.03- Finally has a code!!! Acute respiratory distress, was created to separate acute respiratory distress from the life-threatening condition, acute respiratory distress syndrome (ARDS) ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD-10 2017 Page: 23 Effective with discharges: October 1, 2017

Neonatal codes Several new codes added to allow for greater specificity when coding newborn diagnoses P29.30 Pulmonary hypertension of newborn P29.38 Other persistent fetal circulation P83.81 Umbilical granuloma P91.811 Neonatal encephalopathy in diseases classified elsewhere P91.819 Neonatal encephalopathy, unspecified P91.88 Other specified disturbances of cerebral status of newborn

Pediatric codes R40.22 Coma scale, best verbal response has new descriptions to more appropriately assess the patient based on their age

Pediatric codes R40.23 Coma scale, best motor response has new descriptions to more appropriately assess the patient based on their age

Non-pressure chronic ulcer 63 new codes have been created for category L97 to provide additional information regarding severity of the ulcer

Non-pressure chronic ulcer

DRG updates

DRG 23 Previously craniotomy with major device implant or acute complex central nervous system (CNS) principle diagnosis with MCC or chemotherapy implant Now includes or Epilepsy with neurostimulator

DRG 61/62/63 Previously for CVA’s with use of thrombolytic agent Now includes Precerebral occlusion or transient ischemia with thrombolytic agent

DRG 246 and 248 Title has changed- Previously used the term vessels, now states arteries Percutaneous cardiovascular procedures with non-drug eluting stent with MCC or 4+ Arteries

Mitral Valve Replacements Previously grouped to 216-221 Now group to 266 & 267, along with percutaneous aortic valve replacements

DRG 469 Previously stated Major hip and knee replacement or reattachment of lower extremity with MCC Now states or Total ankle replacement Total ankle replacement revisions are included in this DRG.

Complications of internal prosthetic devices, implants, and grafts Previously in DRG 949 & 950 Now in DRG’s 919-921

Reserved for future guideline expansion kind of scares me……

Just in case you need to know…. Swallowing eye drops now goes to poisoning DRG (917-918) instead of eye DRG’s (124-125)

Questions