The Centers for Medicare & Medicaid Services (CMS) released on June 20 the ICD-10-CM code descriptions, tables and index, and addendum for fiscal year 2020. There are 273 additions, 21 deletions, and 30 revisions, effective Oct. 1, 2019, which will increase the code set from 71,932 to 72,184 diagnoses.
Chapter Review
The majority of changes to ICD-10-CM for 2020 are seen in Chapters 9, 12, 17, 19, and 20 — adding a considerable number of new codes, mainly to improve data specificity.
Chapter 9: Diseases of the Circulatory System (I00-I99)
This chapter is getting many new codes to improve reporting specificity of phlebitis and thrombophlebitis, acute embolism and thrombosis, and chronic embolism and thrombosis. A few added, deleted, and revised codes elsewhere in this chapter serve to improve specificity of existing diagnoses, as well.
Chapter 12: Diseases of the Skin and Subcutaneous Tissue (L00-L99)
In this chapter, there are 25 codes being added to report pressure-induced deep tissue damage with more anatomical specificity.
Chapter 17: Congenital Malformations, Deformations, and Chromosomal Abnormalities (Q00-Q99)
There are 30 codes being added to this chapter for increased specificity of anatomical location. For example, Q66.0 Congenital talipes equinovarus will become:
Q66.00 Congenital talipes equinovarus, unspecified foot
Q66.01 Congenital talipes equinovarus, right foot,
Q66.02 Congenital talipes equinovarus, left foot
Chapter 19: Injury, Poisoning, and Certain other Consequences of External Causes (S00-T88)
Under S02 Fracture of skull and facial bones, there are 60 new fracture codes being added to describe with more specificity injuries to the orbital roof, medial or lateral orbital wall, or orbit.
Under Injury, poisoning and certain other consequences of external causes (T07-T88), you’ll find revisions to underdosing codes T40.9- to include [hallucinogens]; and 27 new codes for poisoning, adverse effects, underdosing of multiple unspecified drugs, and heatstroke. Three less-specific heatstroke codes are being deleted.
Chapter 20: External Causes of Morbidity (V00-Y99)
In this chapter, we’re getting minor revisions to three V codes describing auto accidents, and many new Y codes for describing injuries resulting from legal intervention. For example, Y35831A describes a physician’s initial encounter of a police suspect injured during legal intervention using a “conducted energy device.”
Other chapters that are getting minor changes include:
Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99): Just three codes (B96.21-B96.23) are being revised to change (STEC) to [STEC].
Chapter 3: Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism (D50-D89) is getting five new codes and losing one to improve reporting for adenosine deaminase deficiency.
Chapter 6: Diseases of the Nervous System (G00-G99) is getting just two revisions for codes G43.A0 and G43.A1 to add “in migraine.”
Chapter 7: Diseases of the Eye and Adnexa (H00-H59) has four code deletions: H81.41-H81.43 and H81.49.
Chapter 10: Diseases of the Respiratory System (J00-J99) has just one code revision: The descriptor for J44.0 is being revised to put “acute” in parentheses.
Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) includes a handful of minor code revisions.
Chapter 14: Diseases of the Genitourinary System (N00-N99) is getting three new codes and one code revision.
Chapter 18: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99) will see three new codes, one deletion, and one revision in October.
Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00-Z99): The new Z codes proposed by the American Medical Association and UnitedHealthcare to expand the codes we have know to describe social determinants of health (SDOH) were not approved for Oct. 1, 2019.
There are, however, several new codes to report personal history of in-situ neoplasm in various locations, and two code revisions in other areas of this chapter.
Status Quo
There are no changes to Chapter 2: Neoplasms (C00-D49), Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E00-E89), Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01-F99), Chapter 8: Diseases of the Ear and Mastoid Process (J00-H95), Chapter 11: Diseases of the Digestive System (K00-K95), Chapter 15: Pregnancy, Childbirth and the Puerperium (O00-O9A), and Chapter 16: Certain Conditions Originating in the Perinatal Period (P00-P96).
Look for a more detailed review of the changes for 2020 diagnosis coding coming in Healthcare Business Monthly.