by Wyn Staheli, Director of Research
October 1st, 2019
It’s that time of year for offices to get ready for the ICD-10-CM code revisions. As part of that process, it’s also good to know what is going on with the ICD-10-CM Official Guidelines for Coding and Reporting. In the examples listed below, strikeout text is deleted and highlighted text is new.
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Some of the changes were wording changes or corrections which clarify the guideline, but they might not be significant depending on your organizations internal processes. For example:
Z68 Body mass index (BMI) BMI codes should only be assigned when the there is an associated, reportable diagnosis (such as overweight or obesity). Do not assign BMI codes during pregnancy.
See Section I.B.14 for BMI documentation by clinicians other than the patient’s provider.
There are several places where the phrases "compatible with" and "consistent with” were added to guidelines referencing documentation stating "probable," "suspected," "likely," "questionable," "possible," or "still to be ruled out,"
Another revision to note is the change from “physician” to “provider” in a few places. For example:
G. ICD-10-CM code for the diagnosis, condition, problem, or other reason for encounter/visit List first the ICD-10-CM code for the diagnosis, condition, problem, or other reason for encounter/visit shown in the medical record to be chiefly responsible for the services provided. List additional codes that describe any coexisting conditions. In some cases the first-listed diagnosis may be a symptom when a diagnosis has not been established (confirmed) by the physician provider.
The following are some of the new guidelines that were added. These guidelines are not found in the 2019 guidelines. The page numbers shown below are the page numbers for the 2020 guidelines (see References below).
Section I.12.a has been revised to reflect the addition of a new category (deep tissue pressure injury) for pressure ulcers.
1) Pressure ulcer stages
Codes from in category L89, Pressure ulcer, identify the site and stage of the pressure ulcer as well as the stage of the ulcer. The ICD-10-CM classifies pressure ulcer stages based on severity, which is designated by stages 1-4, deep tissue pressure injury, unspecified stage, and unstageable.
Assign as many codes from category L89 as needed to identify all the pressure ulcers the patient has, if applicable.
See Section I.B.14 for pressure ulcer stage documentation by clinicians other than patient's provider.
Section 19.b added a new guideline for injuries due to a medical condition:
3) Iatrogenic injuries
Injury codes from Chapter 19 should not be assigned for injuries that occur during, or as a result of, a medical intervention. Assign the appropriate complication code(s).
It should be noted that at the beginning of chapter 19, it does state that birth trauma (P10-P15), and obstetric trauma (O70-O71) are Excludes1 which means that the two codes cannot be used together. However, when new guidelines are added, it is often done to address some sort of problem or new code(s) that are being added.
- Iatrogenic simply means relating to illness caused by medical examination or treatment.
- While the instructions say to use a complication code, many complication codes (e.g., T81.9XXA) are listed in Chapter 19. Pay close attention to all coding guidelines to ensure compliance.
Section 19.c added a new guideline for growth plate fractures:
3) Physeal fractures
For physeal fractures, assign only the code identifying the type of physeal fracture. Do not assign a separate code to identify the specific bone that is fractured.
4. If two or more drugs, medicinal or biological substances are taken reported, code each individually unless a combination code is listed in the Table of Drugs and Chemicals.
If multiple unspecified drugs, medicinal or biological substances were taken, assign the appropriate code from subcategory T50.91, Poisoning by, adverse effect of and underdosing of multiple unspecified drugs, medicaments and biological substances.
5. Intraoperative and postprocedural complication codes are found within the body system chapters with codes specific to the organs and structures of that body system. These codes should be sequenced first, followed by ac code(s) for the specific complication, if applicable.
Complication codes from the body system chapters should be assigned for intraoperative and postprocedural complications (e.g., the appropriate complication code from chapter 9 would be assigned for a vascular intraoperative or postprocedural complication) unless the complication is specifically indexed to a T code in chapter 19.