2018 ICD-10-CM UPDATES JULIE BOS, CPC, CPB, CPPM

AGENDA OFFICIAL GUIDELINES CHAPTER SPECIFIC CHAPTERS 1-7

Section I Guideline Changes Information has been added to clarify the meaning of ‘with (new text is bold) The word ‘with’ or ‘in’ should be interpreted to mean ‘associated with’ or ‘due to’ when it appears in a code title, the Alphabeti Index, or an instructional note in the Tabular List The 2018 Official Guidelines for Coding and Reporting includes a dozen substantive changes in Section I and one important change in Section II Those changes are: *presumes a casual relationship between the two conditions linked by these terms in Alpha/Tabular *these conditions should be coded as related even in the absence of provider documentation explicitly linking them, UNLESS the documentation clearly states the conditions are unrelated, *…OR, when another guideline exists that specifically requires a documented linkage between two conditions (e.g. sepsis guideline for acute organ dysfunction that is not clearly associated with the sepsis) * For conditions not specifically linked by these relational terms in the classification or when a guideline requires that a linkage between two conditions be explicitly documented

Section I Guideline Changes “CODE ALSO” guidelines are clarified. When two codes may be required to fully describe a condition, a ‘code also’ note is indicated. The note does not provide sequencing direction. The new guidelines explain, “THE SEQUENCING DEPENDS ON THE CIRCUMSTANCES OF THE ENCOUNTER”

Section I Guideline Changes Information is added for brachytherapy, within admissions/encounters involving chemotherapy, immunotherapy and radiation therapy Admission solely for administration of the above: Assign code Z51.0, Z51.11, or Z51.12 as the first listed or principal diagnosis code If more than one of these therapies are done within the same encounter, more than one may be assigned in any sequence The malignancy should be assigned as a secondary diagnosis Z51.0 = Encounter for antineoplastic Radiation Therapy Z51.11 – Encounter for antineoplastic Chemotherapy Z51.12 – Encounter for antineoplastic Immunotherapy However…IF the patient is being seen for the insertion or implantation of radioactive elements (brachytherapy), the appropriate malignancy code is sequenced first

Section I Guideline Changes COMPLICATIONS OF RADIATION, CHEMO OR IMMUNOTHERAPY: SEQUENCE Z51.0, Z51.11, OR Z51.12 FIRST FOLLOWED BY COMPLICATION CODES COMPLICATIONS FOR BRACHYTHERAPY SEQUENCE THE MALIGNANCY FIRST FOLLOWED BY THE COMPLICATION

Section I Guideline Changes DIABETES Diabetes Mellitus and the use of insulin and oral hypoglycemics E11-Type 2 diabetes Z79 – long-term use of insulin or oral hypoglycemic drugs Secondary diabetes mellitus E08 – DM due to underlying conditon E09 – Drug or chemical induced DM E13 – Other specified DM Underlying Condition must be sequenced first Coding for diabetes with the use of insulin or oral diabetic medication is clarified: *If the documentation in a medical record does not indicate the type of diabetes, but does indicate that the patient uses insulin, code E11-Type 2 Diabetes An additional code from category Z79 should be assigned to indicate the long-term use of Insulin Secondary DM: - ALWAYS caused by another condition or event (cystic fibrosis, malignant neoplasm of pancreas, pancreatectomy, adverse effect of drug, poisoning, etc.) and must have the underlying condition sequenced FIRST If insulin used in treating Secondary DM – An additional code from category Z79 should be assigned to indicate the long-term use of Insulin – not to be assigned if insulin given temporarily

Section I Guideline Changes MENTAL AND BEHAVIORAL DISORDERS “In Remission” Abuse vs Dependence Mental and behavioral disorders due to psychoactive substance use (F10-F19) requires the provider’s clinical judgement. The appropriate codes for ‘in remission’ are assigned only on the basis of provider documentation, unless otherwise instructed by the classification Abuse = mild substance use disorders Dependence = moderate to severe use disorders

Section I Guideline Changes ‘BLINDNESS’ OR ‘LOW VISION’ Documented in both eyes, but visual impairment category not docmented H54.3 – Unqualified visual loss, both eyes H54.6 – Unqualified visual loss, one eye H54.7 – Unspecified visual loss (no specification of one or both eyes) New Guidelines for Blindness or low vision in both eyes documented when visual impairment category is not documented

Section I Guideline Changes PULMONARY HYPERTENSION I27 – OTHER PULMONARY HEART DISEASES I27.1 – SECONDARY PULMONARY HYPERTENSION (KYPHOSCOLIOTIC H.D.) I27.2 – OTHER SECONDARY PULMONARY HYPERTENSION *BASE SEQUENCING ON THE REASON FOR THE ENCOUNTER*

Section I Guideline Changes ACUTE MYOARDIAL INFARCTION (AMI) REVISED GUIDELINES: SPECIFY TYPE I AMI WHERE REQUIRED OTHER GUIDELINES ADDED FOR OTHER TYPES OF MI TYPE 1 ST elevation MI (STEMI) CODES IDENTIFY THE SITE, SUCH AS ANTEROLATERAL WALL OR TRUE POSTERIOR WALL SUBCATEGORIES I21.0-I21.2 = TYPE 1 ST elevation MI NON-ST ELEVATION = I21.4 (NSTEMI) OTHER UPDATED GUIDELINES FOR MI ICLUDE: AMI documented as nontransmural or subendocardial but site provided Subsequent acute myocardial infarction See ‘Code also’ and ‘Code first’ notes related to complications and post-procedural MI’s following Cardiac Surgery

Section I Guideline Changes NON-PRESSURE CHRONIC ULCERS For admitted patients with non-pressure ulcers, do not assign a code if the documentation says the non-pressure ulcer is completely ‘healed’. For admitted patients with non-pressure ulcers documented as ‘healing’, the new guidelines state: Code based on documentation in record If severity not provided, assign ‘unspecified’ severity Unclear if ‘new’ or ‘healing’, query the provider Present on admission, but healed at the time of discharge, code to documentation at time of admission

Section I Guideline Changes RETAINED PRODUCTS OF CONCEPTION FOLLOWING A SPONTANEOUSW OR ELECTIVE TERMINATION OF PREGNANCY SUBSEQUENT ENCOUNTERS WITHOUT COMPLICATIONS = O03.4 INCOMPLETE SPONTANEOUS W/O COMPLICATONS = O07.4 SPECIFIC COMPLICATION: - ASSIGN O03 OR O07 APPROPRIATE COMPLICATION INSTEAD OF O03.4, OR O07.4

Section I Guideline Changes CODING OF PATHOLOGIC FRACTURES LANGUAGE ADDE TO CLARIFY ‘ACTIVE TREATMENT’ NEW LANGUAGE = 7TH CHARACTER ‘D’ IS REPORTED FOR ENCOUNTERS AFTER THE PATIENT HAS COMPLETED ACTIVE TREATMENT (Routine care for the fracture during the healing and recovery phase) USE OTHER 7TH CHARACTERS AS APPROPRIATE FOR HEALING PROBLEMS SUCH AS MALUNIONS, NONUNIONS, SEQUELAE GUIDELINES FOR FUNCTIONAL QUADRIPLEGIS ARE DELETED, EFFECTIVE 10/1/2017

Section II Guideline Changes ADMISSIONS/ENCOUNTERS FOR REHABILITATION SEQUENCE FIRST THE CONDITION FOR THE SERVICE PERFORMED IF THE CONDITION IS NO LONGER PRESENT: REPORT THE APPROPRIATE AFTERCARE CODE AS THE FIRST LISTED/PRINCIPAL DIAGNOSES AFTER CARE FOLLOWING AN INJURY ASSIGN THE INJURY CODE WITH THE APPROPRIATE 7TH CHARATER FOR SUBSEQUENT ENCONTER

2018 CODE CHANGES CHAPTERS 1-7 BRIEF OVERVIEW – REVIEW NOTATIONS IN CURRENT ICD-10-CM CODING BOOKS

CHAPTERS 1-3 CHAPTER ONE: CERTAIN INFECTIOUS AND PARASITIC DISEASES (A00-A09) TWO CODES ADDED UNDRE A04.7 CHAPTER TWO: NEOPLASMS (C00-D49) NOTE REVISIONS; INCLUSION AND EXCLUSION REVISIONS NEW CODES UNDER SUBCATEGORY C96.2 C96.20; C96.21, C96.22, C96.29 CHAPTER THREE: DISEASES OF THE BLOOD AND BLOOD-FORMING ORGANS AND CERTAIN DISORDERS INVOLVING THE IMMUNE MECHANISM (D50-D89) ADDED AND DELETED LANGUAGE IN D63.0 & D64.81 ADDED, DELETED AND REVISED EXCLUDES NOTES UNDER D89.4

CHAPTERS 4-5 CHAPTER FOUR: ENDOCRINE NUTRITIONAL AND METABOLIC DISEASES (E00-E89 NEW DM CODES: E11.1,, E11.10, E11.11 NEW METABOLIC DISORDER CODES: E85.81, E85.82, E85.89 WATCH FOR REVISIONS, ADDITIONS AND DELETIONS IN INCLUDES/EXCLUES NOTES CHAPTER FIVE: MENTAL BEHAVIORAL AND NEURODEVELOPMENTAL DISORDERS (F01-F99 ADDED NEW INCLUSION TERMS UNDER SEVERAL CODES NEW CODES: F10.11; F11.11; F12.11; F13.11; F14.11; F15.11; F16.11; F18.11; F19.11; F50.82

CHAPTERS 6-7 CHAPTER SIX: DISEASES OF THE NERVOUS SYSTEM (G00-G99) WATCH EXLUDES1 NOTES AND ADDITIONAL LANGUAGE NEW CODES: G12.23; G12.24; G12.25 DISEASES OF THE EYE AND ADNEXA (H00-H59) MANY NEW CODES TO INCREASE SPECIFICITY WATCH NEW ‘CODE FIRST’ GUIDELINES NEW CODES FOR H44.2 H44.2A; H44.2B, H44.2C; H44.2D; H44.2E