Dig a Little Deeper Into the 2020 ICD-10-CM Revisions (Part 1)

By: Bruce Pegg

If circulatory diseases, skin diseases, and congenital malformations take up a lot, or even a little, of your coding time, there are many substantive changes heading your way that you will need to understand prior to ICD-10-CM 2020 taking effect on Oct. 1, 2019. The good news is that you should be able to focus … Continue reading Dig a Little Deeper Into the 2020 ICD-10-CM Revisions (Part 1)

If circulatory diseases, skin diseases, and congenital malformations take up a lot, or even a little, of your coding time, there are many substantive changes heading your way that you will need to understand prior to ICD-10-CM 2020 taking effect on Oct. 1, 2019.

The good news is that you should be able to focus on these changes because, as we noted in a recent blog post, the 2020 revisions to ICD-10-CM are relatively small compared to previous years. In fact, many of them are cleanup changes, including corrections to parentheses, supplementary words, and square brackets.

New MI Instructions, AFib and Embolism Codes Help You Get More Specific …

First up are some big changes in the Diseases of the circulatory system (I00-I99) chapter. Beginning Oct.1, the Code Also instruction that accompanies myocardial infarction (MI) type 2 (I21.A1) will read that you must Code First, and not Code Also, any underlying causes for the MI. Note that CMS has not included heart failure (I50.-) and renal failure (N17.0-N19) in the Code First list even though they are in the ICD-10-CM 2019 Code Also note for I21.A1.

In addition, you will have two new pulmonary embolism codes – I26.93 (Single subsegmental pulmonary embolism without acute cor pulmonale) and I26.94 (Multiple subsegmental pulmonary emboli without acute cor pulmonale) – and four new atrial fibrillation (AFib) codes:

  • I48.11 (Longstanding persistent atrial fibrillation)
  • I48.19 (Other persistent atrial fibrillation)
  • I48.20 (Chronic atrial fibrillation, unspecified)
  • I48.21 (Permanent atrial fibrillation).

But perhaps the biggest change to this section is the addition of a huge number of new phlebitis and thrombophlebitis (I80.-) and other venous embolism and thrombosis (I82.-) codes. The additions will allow you to pinpoint conditions in the peroneal and calf muscle veins by using these options:

  • I80.24- (Phlebitis and thrombophlebitis of peroneal vein)
  • I80.25- (Phlebitis and thrombophlebitis of calf muscular vein)
  • I82.45- (Acute embolism and thrombosis of peroneal vein)
  • I82.46- (Acute embolism and thrombosis of calf muscular vein)
  • I82.55- (Chronic embolism and thrombosis of peroneal vein)
  • I82.56- (Chronic embolism and thrombosis of calf muscular vein).

As with many other codes in the Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified (I80-I89) group, you will be able to add a sixth digit to specify right (1), left (2), bilateral (3), and unspecified (9).

… While ICD-10 Introduces a New Pressure Ulcer Category …

ICD-10-CM has also made some changes to the L89.- (Pressure ulcer) codes, adding a new classification of pressure injuries: deep tissue damage.

If you’re familiar with reporting ICD-10-CM codes for pressure ulcers, then you’ll be able to adapt to these new codes quickly. As with the current codes, you’ll use the appropriate code for the anatomical site. Then, rather than using one of the existing final characters to document an unstageable (0), stage 1 (1), stage 2 (2), stage 3 (3), stage 4 (4), or unspecified (5) pressure ulcer, ICD-10-CM 2020 will give you the option to use 6 as the sixth (or sometimes fifth) character to indicate pressure-induced deep tissue damage.

For instance, the new code set will include L89.016 (Pressure-induced deep tissue damage of right elbow) and L89.46 (Pressure-induced deep tissue damage of contiguous site of back, buttock and hip).

… and Adds Numerous Congenital Malformation Codes

There are also some big changes coming to Chapter 17: Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99).

Beginning Oct. 1, you will be able to add a fifth (or, in the case of Q66.2- [Congenital metatarsus (primus) varus], sixth) digit to a number of the Q66.- (Congenital deformities of feet) codes, which will enable you to indicate right, left, or unspecified. This will bring them in line with Q66.5- and Q66.8-, which already have that capability.

Additionally, ICD-10-CM 2020 has also pluralized the code for Ehlers-Danlos syndrome. This will soon be subcategory Q79.6.- (Ehlers-Danlos syndromes) to reflect variants of this connective tissue disorder for which ICD-10 has also assigned the following new codes:

  • Q79.60 (Ehlers-Danlos syndrome, unspecified)
  • Q79.61 (Classical Ehlers-Danlos syndrome)
  • Q79.62 (Hypermobile Ehlers-Danlos syndrome)
  • Q79.63 (Vascular Ehlers-Danlos syndrome)
  • Q79.69 (Other Ehlers-Danlos syndromes).

You will also be able to use two more new codes – Q87.11 (Prader-Willi syndrome) and Q87.19 (Other congenital malformation syndromes predominantly associated with short stature). The list of synonyms that was previously under Q87.1 (Congenital malformation syndromes predominantly associated with short stature) has also been modified, with Prader-Willi syndrome no longer a part of the list now that the condition has its own code. The list has also been relocated under Q87.19.

Next time: We’ll take a closer look at the changes to the external cause and encounter codes that you need to know about before they are implemented on Oct. 1, 2019.

Learn More

Put an end to avoidable denials, needless audit risks, and debilitating payback demands with your monthly subscription to ICD-10 Coding Alert. Every issue of this indispensable resource delivers high-impact tips and how-to reporting tutorials to guide you over your reimbursement hurdles and help you conquer the revenue-risking challenges that threaten your claims and compliance success.

Nail down correct diagnosis coding with the 2020 ICD‑10‑CM for Physicians & Hospitals, packed with highlighted alerts, detailed anatomical illustrations, a new/revised/deleted codes list as a separate file, and Guideline Tips that walk you through the 2019 Official Guidelines changes in language that is easy to read and understand. Among the many bonus features, you’ll find coding tips and definitions of medical terms throughout the Tabular List.

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