The Centers for Medicare & Medicaid Services has released its latest updates to the Clinical Modification (ICD-10-CM) system and the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS). Effective April 2023, healthcare leaders will have 42 ICD-10-CM and 34 ICD-10-PCS additions to navigate.
Previously, more extensive code set updates have occurred once per year. However, CMS announced last year that from this point forward, two significant updates to code sets will happen every year—one in April and one in October.
The April 2023 updates include 42 ICD-10-CM additions, seven deletions, and one revision. For ICD-10-PCS, there are 34 additions, no deletions, and no revisions. The updates are effective beginning April 1, 2023.
New ICD-10 Codes for Diagnosis
The following new codes are categorized by ICD-10-CM chapter:
Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88): 12 new codes regard confirmed or suspected financial abuse. These new codes specify whether the financial abuse concerns an adult or child and whether it’s an initial or subsequent encounter or a sequela.
Chapter 20: External Causes of Morbidity (V00-Y99): 15 new codes regard maltreatment and neglect. These new codes specify the perpetrator as one of the following: husband, wife, male partner, female partner, non-binary partner, child, grandchild, grandparent, parental sibling, or acquaintance or friend.
Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00-Z99). New codes regard the following:
One new code covers problems related to health literacy. This code applies when patients cannot find, understand, and use information and services to make health-related decisions.
Two new codes cover problems associated with the physical environment. They include essential services unavailable in the patient’s physical environment and other issues with the environment. For example, these codes apply to a lack of sanitation in the patient’s home.
Four new codes cover inadequate housing, including issues involving the environmental temperature within the housing, inadequate housing utilities, unspecified inadequate housing, and other inadequate housing.
Four new codes cover a history of various types of abuse. These personal history codes apply to child financial abuse, intimate partner abuse in childhood, adult financial abuse, and intimate partner abuse in adulthood.
Four new codes cover patients’ noncompliance with medication or renal dialysis due to financial hardship or any reason other than financial hardship.
Deleted Diagnosis Codes
CMS will delete four codes regarding maltreatment or neglect perpetrated by a husband, wife, male partner, or female partner. New codes in Chapter 20 (External Causes of Morbidity) replace these codes. The new codes specify if the perpetrator is a current or former spouse or partner.
Also deleted is the code for inadequate housing. CMS will replace this with the expanded codes in Chapter 21 (Factors Influencing Health Status and Contact with Health Services) regarding inadequate housing to further specify the issues with the housing (such as environmental temperature or inadequate housing utilities).
The final two deleted codes apply to a patient’s noncompliance with a medication regimen or renal dialysis. Expanded codes in Chapter 21 will also replace these noncompliance codes. The new codes further specify why the patient is noncompliant (e.g., due to financial hardship).
Revised Diagnosis Code
CMS is revising the code for material hardship to include “due to limited financial resources, not elsewhere classified.” This code describes when a patient cannot obtain adequate childcare, clothing, utilities, or other basic needs due to financial hardship.
New ICD-10 Codes for Procedures
The following newcodes have been categorized by ICD-10-PCS section and body system:
The Medical and Surgical Section:
Heart and Great Vessels: One new code covers the occlusion of the thoracic aorta using a temporary intraluminal device. The new code captures an open approach to the surgery. Previous codes only captured percutaneous or percutaneous endoscopic approaches.
Lower Arteries: One new code covers the occlusion of the abdominal aorta using a temporary intraluminal device. Like above, this new code captures an open approach to this procedure.
Upper Bones: Six new codes cover the destruction of the cervical and thoracic vertebra with laser interstitial thermal therapy (LITT) using an open, percutaneous, or percutaneous endoscopic approach. CMS added LITT to the Upper Bones Destruction table as a qualifier to capture cases that specifically use this technology. LITT uses thermal therapy rather than ionizing radiation and destroys the vertebra using heat generated by a laser probe.
Lower Bones: Six new codes cover the destruction of the lumbar vertebra and sacrum using LITT with an open, percutaneous, or percutaneous endoscopic approach. LITT was added to the Lower Bones Destruction table as a qualifier to capture cases that specifically use this technology.
The Administration Section:
Circulatory: 14 new codes cover the transfusion of whole blood, serum albumin, frozen or fresh plasma, frozen or fresh red blood cells, and platelets into the bone marrow. CMS added the body region “bone marrow” to the Administration table to capture procedures such as the intraosseous administration of blood products.
The New Technology Section:
One new code covers the introduction of regn-cov2, a monoclonal antibody used in post-exposure prophylaxis for COVID-19 in patients at high risk for progression to severe COVID-19. This addition will enable the efficient tracking of this therapeutic when used in the treatment of COVID-19.
Three new codes cover the introduction of sabizabulin, an orally administered ani-viral/anti-inflammatory therapeutic used to treat hospitalized patients with severe COVID-19. These additions will enable the efficient tracking of this therapeutic when used in the treatment of COVID-19.
Two new codes cover the introduction of exagamglogene autotemcel, a genetically modified cell therapy used to treat sickle cell disease and beta-thalassemia. thalassemia. Exa-cel, also known as CTX001™, is an investigational therapy administered via a stem cell transplant procedure as a single dose through a central venous catheter.
Preparing for the ICD-10-CM Updates
CMS will publish these codes in the 2024 ICD-10-CM codebook. However, healthcare leaders can review the new codes now within Vitalware® by Health Catalyst products.
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