Comments Due Friday on Proposed New ICD-10 Codes

By
Original story posted on: April 3, 2017
The Coordination and Maintenance Committee Meeting was held March 7-8 at the Centers for Medicare & Medicaid Services (CMS) headquarters for the purposes of reviewing proposals for new ICD-10-CM (diagnosis) and ICD-10-PCS (procedures) codes for the 2018 and 2019 fiscal years.

Comments on the proposals for 2018 are due April 7, 2017. This article provides more detail on two subjects – types of myocardial infarctions (MI) and heart failure classifications.

The types of myocardial infarctions are based on the American College of Cardiology (ACC) categorization.

  • Type 1 indicates that the patient has evidence of spontaneous plaque rupture or erosion in an epicardial coronary vessel.
  • Type 2 indicates that the MI is due to either increased oxygen demand or decreased supply (e.g. coronary artery spasm, coronary embolism, anemia, arrhythmia, hypertension, hypotension, etc.).
  • Type 3 indicates that the MI resulted in sudden death.
  • Type 4a indicates that the MI is associated with percutaneous coronary intervention (PCI) within 48 hours of the procedure.
  • Type 4b indicates that the MI is associated with in-stent thrombosis.
  • Type 4c indicates that the MI is associated with restenosis of a PCI.
  • Type 5 is an MI associated with a coronary artery bypass graft (CABG) within 48 hours of the procedure.
In the code proposals, type 1 would be included in I21.0-I21.4, which are the ST elevation myocardial infarctions (STEMI) with the specificity of the involved wall and non-ST elevation myocardial infarction (NSTEMI). A new code would be added for MI NOS (I21.9). Type 2 would be assigned a new code of I21.A1. MI types 3-5 would be assigned to the proposed new code of I21.A9. Please note that demand ischemia will remain at I24.8 unless specified as “with myocardial infarction.” If that documentation is provided, the new code of I21.A1 would be assigned, as it is now a type 2 MI.

The proposal for heart failure classifications is based on those used by the ACC as well as the American Heart Association. The entities use stages of A, B, C, and D. The New York Hospital Association classifications have not been included in this proposal.

The heart failure stages are defined as:

  • Stage A – the patient has a presence of risk factors, but is asymptomatic. The code assigned should be Z91.89, other specified personal risk factors, not elsewhere classified.
  • Stage B – heart disease is present, but there are no symptoms. There are structural changes to the heart present.
  • Stage C – structural heart disease is present with symptoms.
  • Stage D – the patient is in end-stage heart failure with advanced structural heart disease and pronounced symptoms of heart failure at rest or upon minimal exertion.
A new subcategory is proposed for right heart failure (I50.84). New codes have been proposed for biventricular failure (I50.82), high-output heart failure (I50.83), end-stage heart failure (I50.84), and other heart failure (I50.89). These new codes will provide more information regarding the patient’s severity of illness.

Comments regarding the proposed diagnosis and procedure codes are due on April 7 for the codes for which expedited action has been requested. Comments regarding ICD-10-CM can be emailed to the Centers for Disease Control and Prevention (CDC) at . The comments for ICD-10-PCS can be emailed to CMS at . Here is your opportunity to participate in the code development process! I look forward to seeing the results in June 2017.
Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Laurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS Trainer

Laurie M. Johnson, MS, RHIA, FAHIMA, AHIMA Approved ICD-10-CM/PCS Trainer is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an American Health Information Management Association (AHIMA) approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and makes frequent appearances on Talk Ten Tuesdays.

Related Stories

  • National Coding Contest Indicates Outpatient Coding is Getting Worse, not Better
    More than 4,000 cases were coded in the 2019 contest focused on outpatient coding. ICD-10 is well-established, and we are already discussing and planning for ICD-11. However, where are the long-anticipated and promised increased accuracy and most definitive diagnoses? At…
  • Be a Success in Your Coding Career
    Success can cost you more than you thought it would. You might have heard the phrase, “everyone wants to be successful until they see what it actually takes.”  While I’m not sure where the quote originates, I’ve seen it attached…
  • Why this Holiday Could be Perilous for Some
    New Year’s thoughts and reflections. The holidays are times for people to connect with loved ones, including family and friends. I would ask that during this holiday season, please look out for our adolescents.    In October 2019, the Public Broadcasting…