Complete Guide On Annual ICD-10 Coding Update

When the healthcare industry adopted a new E&M coding structure, ICD-10, in October 2015, the majority of healthcare professionals dreaded the change as it was introduced to change several factors of billing and coding in the healthcare industry. However, every year, ICD-10 coding updates have been launched to improve medical services.

However, the new and improved ICD-11 was set to be released worldwide in 2022. This means that in just a few years, the US will switch to using this new system for labeling medical conditions. Before 2015, the US used ICD-9, a system for categorizing medical conditions that had been around since 1979. But as healthcare evolved over the years, the old system wasn't keeping up with the changes. The way we take care of people's health now is very different from how it was 40 years ago.

ICD-9 had some problems. Some of its codes used outdated terms and didn't match the modern medical practices we use today. This made it hard to get accurate information about a patient's medical condition. Also, the way ICD-9 was organized limited the number of new codes that could be added. This became a problem because there were already a lot of categories in ICD-9 that were completely filled up with codes.

So, because of these issues, a new and better coding system was created. This new system, called ICD-10, aimed to fix the problems of ICD-9 and bring medical coding up to date. And now, in a few more years, we’re witnessing annual ICD 10 updates, which should make things even better for keeping track of medical conditions and treatments.

What is ICD-10?

ICD-10 is the tenth edition of the  International Classification of Diseases that doctors and hospitals use to organize and label different health problems. It was created by the World Health Organization (WHO) with worldwide health standards. They put similar diseases in groups and then list more specific problems under those groups. This way, it's easier for doctors to keep track of all the different health issues. In different countries they have their own set of codes, and in the United States, the ICD-10 has two parts: ICD-10-CM and ICD-10-PCS. These are created by the Centers for Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS).

ICD-10-PCS, or International Classification of Diseases, Tenth Revision, and Procedure Coding System, helps hospitals keep track of the treatments and surgeries they do on patients while they're staying in the hospital. ICD-10-CM, or International Classification of Diseases, Tenth Revision, and Clinical Modification are used all over the healthcare system to report problems that people have, like diseases or injuries. It's like a dictionary that helps doctors and insurance companies understand what's going on with a person's health. This part covers everything from illnesses to injuries to reasons why someone got sick or hurt.

ICD-10 Codes Structure

The way ICD-10-CM codes are structured is pretty interesting. Each code is made up of three to seven characters, including letters or numbers. Let's break down how these codes work.

• First Character: Every code starts with a letter. This letter gives a hint about the chapter where the code belongs.
• Second and Third Characters: The next two characters are numbers. These numbers help narrow down the category within the chapter. They provide more information about the type of problem.
• Fourth, Fifth, Sixth, and Seventh Characters: These characters can be numbers or letters that go into even more detail about the specific condition. As you add more of these characters, the code gets more specific and detailed.

Here are some examples of the ICD-10 code structure to help you understand better:

• G10: This code is about Huntington's disease. The "G" points to the chapter about diseases of the nervous system, and the "10" further specifies the type of nervous system issue.
• K26.1: This code stands for an acute duodenal ulcer with perforation. The "K" tells us it's related to the digestive system. The "26" narrows it down to a specific area, and the ".1" adds more detail about the problem.
• A37.81: This code represents whooping cough due to other Bordetella species with pneumonia. The "A" is for diseases related to the respiratory system. The "37" helps identify the particular disease, and the ".81" gives extra information about the situation.
• I25.111: This code talks about atherosclerotic heart disease of a certain artery with angina pectoris and documented spasms. The "I" indicates diseases of the circulatory system. The "25" points to atherosclerotic heart disease, and the ".111" makes it even more specific.
• M80.021G: This code is quite detailed. It's about age-related osteoporosis with a specific kind of fracture. The "M" relates to diseases of the musculoskeletal system. The "80" shows it's about osteoporosis, and the ".021G" goes into even more detail.

Use of ICD-10 Codes

ICD-10 codes, an essential part of healthcare, serve diverse purposes within the industry. These alphanumeric codes, which succinctly represent medical conditions, diagnoses, and procedures, play a pivotal role in several aspects of healthcare management and administration.

ICD-10 codes are fundamental for accurate billing and reimbursement processes. Health insurance claims, medical bills, and reimbursement requests all require these codes to ensure proper categorization of services rendered. These codes enable efficient communication between healthcare providers, insurance companies, and regulatory bodies, facilitating transparent and accurate financial transactions.

ICD-10 codes are integral to clinical documentation and patient care. Physicians, nurses, and other healthcare professionals utilize these codes to record diagnoses and procedures in electronic health records (EHRs). This enhances the continuity of care as medical history, treatment plans, and outcomes are consistently documented and shared among care teams, optimizing patient management and minimizing errors.

Moreover, ICD-10 codes are crucial for epidemiological studies, health research, and public health surveillance. By aggregating and analyzing data based on these codes, researchers can identify trends, patterns, and emerging health threats, facilitating evidence-based interventions and policy decisions.

ICD-10 codes also contribute to quality improvement initiatives. Healthcare organizations can use these codes to track outcomes, identify areas for enhancement, and implement targeted interventions to enhance patient care and safety.

ICD-10 CM Code Changes 2023

In 2021, the Centers for Medicare & Medicaid Services (CMS) issued guidance emphasizing the importance of social determinants of health (SDOH) - factors like social, economic, and environmental conditions that impact health outcomes. SDOH encompasses aspects like food and transportation accessibility, housing stability, education, exposure to violence, social networks, health-related behaviors, and employment status.

CMS introduced three new codes within category Z55-Z65 in Chapter 21, which pertain to factors influencing health status and interactions with health services (Z00-Z99):

• Z59.8 - Other issues related to housing and economic circumstances
• Z59.82 - Uncertainty in transportation (encompassing excessive transportation time, unattainable transportation, insufficient transportation, lack of transportation, unaffordable transportation, undependable transportation, and unsafe transportation)
• Z59.86 - Financial instability (encompassing bankruptcy, overwhelming debt, economic stress, financial strain, monetary challenges, financial depletion, and inability to meet financial needs)
• Z59.87 - Material deprivation (including lack of adequate childcare, insufficient clothing, inadequate utilities, failure to meet basic necessities)

The collection of SDOH can be carried out by various members of the patient's healthcare team, such as clinicians, social workers, community health workers, case managers, patient navigators, and nurses. Data on SDOH can be collected during intake through screening tools, interactions between individuals and providers, and individual self-reporting. CMS instructs coders to assign all pertinent SDOH Z codes to support quality enhancement initiatives.

New Codes for Dementia: The range of dementia codes has been expanded. A total of eighty-three new ICD-10 codes have been introduced in Chapter 5 (Mental, Behavioral, and Neurodevelopmental Disorders [F01-F99]), which includes sixty-nine fresh codes for dementia accompanied by or lacking psychological symptoms. Here are three examples of the newly introduced dementia codes:

• F02.811 - Dementia in other diseases classified elsewhere, unspecified severity, with agitation
• F02.A11 - Dementia in other diseases classified elsewhere, mild, with agitation
• F02.B11 - Dementia in other diseases classified elsewhere, moderate, with agitation

For patients admitted to inpatient acute care hospitals or other inpatient facilities with dementia at a certain severity level that subsequently progresses to a higher level, a single code representing the highest reported severity level during the stay should be assigned.

Clarifications have been provided by the ICD-10 Coordination and Maintenance Committee regarding dementia stages:

Mild dementia: Clearly observable functional impact on daily life, predominantly affecting instrumental activities. Partial independence necessitates occasional assistance.

Moderate dementia: Extensive functional impact on daily life, involving basic activities. Full independence is lost, necessitating frequent assistance.

Severe dementia: Clinical assessment might not be feasible. Complete dependence arises due to a severe functional impact on daily life, encompassing basic self-care.

Fresh Head Injury Codes (S00-S09): The introduction of eighty-six new codes pertaining to head injuries, including novel concussion codes, has occurred. Here are three examples of these concussion codes:

• S06.0XAA - Concussion with uncertain loss of consciousness status, initial encounter
• S06.0XAD - Concussion with uncertain loss of consciousness status, subsequent encounter
• S06.0XAS - Concussion with uncertain loss of consciousness status, sequela

Additional Endometriosis Codes: The ICD-10-CM code set's endometriosis section has seen the addition of nearly 400 new codes encompassing ob-gyn conditions. N80 endometriosis codes have been expanded to specify whether the condition is superficial or deep, along with indicating laterality in sites. Novel sites like sigmoid, rectum, and pleura have been included. The following definitions play a crucial role in selecting the appropriate code:

Superficial endometriosis: Abnormal growth of endometrial-like tissue that extends 5mm or less beneath the peritoneal surface. Lesions can occur singularly or in multiple locations.

Deeply infiltrating endometriosis: Ectopic growth of endometrial-like tissue that extends over 5mm beneath the peritoneal surface. Lesions can occur singularly or in multiple locations and are frequently associated with profound fibrosis and adhesions.

If the physician hasn't explicitly mentioned "deep" or "superficial" in the documentation, the coder should seek indications regarding the extent of tissue extension below the peritoneal surface to determine the appropriate ICD-10 code.

Other Modifications: The ICD-10 category Z79, signifying long-term (current) drug therapy, encompasses fifteen new codes, including Z79.85 (long-term [current] use of injectable non-insulin antidiabetic drugs). A fresh guideline in Chapter 4 (Endocrine, Nutritional, and Metabolic Diseases) states:

If a patient is on both insulin and an injectable non-insulin antidiabetic drug, assign codes Z79.4 (long-term [current] use of insulin) and Z79.85. For a patient receiving both oral hypoglycemic drugs and injectable non-insulin antidiabetic drugs, assign codes Z79.84 (long-term [current] use of oral hypoglycemic drugs) and Z79.85.

Importance of ICD-10 Codes in the Healthcare

ICD-10 codes play a vital role in the world of healthcare for various reasons. One of the key benefits lies in the enhancement of clinical documentation and the subsequent improvement in the quality of patient care. These codes offer a precise and standardized way to label and describe medical conditions, procedures, and treatments. This clarity in documentation facilitates effective communication among healthcare providers, ensuring that everyone involved in a patient's care has a consistent understanding of their condition. As a result, medical decisions can be better informed, leading to improved patient outcomes and safety.

Furthermore, ICD-10 code updates serve as a powerful tool for tracking public health conditions and establishing health policies. By categorizing diseases, injuries, and other health issues, public health officials can identify patterns and trends in different populations. This enables the swift identification and response to potential outbreaks or health concerns. The data gathered from these codes also contributes to the formulation of health policies, enabling governments and organizations to allocate resources effectively and tailor interventions to specific health needs.

Final Thoughts

ICD-10 codes are a cornerstone of the healthcare industry, serving purposes ranging from accurate billing and reimbursement to enhancing patient care, supporting research, and driving quality improvements. Their standardized and systematic approach to categorizing medical information ensures efficient communication, informed decision-making, and optimal healthcare management across various facets of the industry. It’s important for healthcare professionals to stay up-to-date on the annual ICD-10 coding updates.