June 27, 2016

DEVELOPING: CDC Releases 2017 ICD-10-CM Codes

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EDITOR'S NOTE: The Centers for Disease Control and Prevention (CDC) which administers the diagnosis codes released the 2017 ICD-10-CM codes on June 24, 2016. This information can be found at https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-CM-and-GEMs.html 

Since the release of the 2017 ICD-10-PCS codes, the healthcare vendor community has been waiting with bated breath for the 2017 ICD-10-CM codes. Now they’re here. 

Those codes were just released on June 24, 2016 with the Index and Tabular files. There are 1,974 additions, 311 deletions, and 425 revisions. The resulting total for diagnosis codes is 71,486.

The addenda for the Index (90 pages), Table of Drugs and Chemicals (2 pages), Neoplasm Table (11 pages), External Cause Index (9 pages), and Tabular (160 pages) are included in this release. Two additional files include the Code Descriptor in Tabular Order file and Duplicate Code file.   

The addenda provide information regarding the changes for the code set. The Code Descriptor in Tabular Order provides the code descriptor at each level of the code set. One important file that is missing from the update is the 2017 ICD-10-CM Official Coding and Reporting Guidelines. That information is still pending as well as the General Equivalence Mappings (GEMs).

Here is a brief synopsis of additions and changes throughout the code set.  Conditions that were added throughout the code set is postoperative seroma which had been discussed at Coordination and Maintenance Meeting in March 2016. 

There is only one addition to Chapter 1 (Infectious and Parasitic Diseases) which is A92.5.    This code has been assigned by the World Health Organization (WHO) for the Zika Virus.   

There are numerous code title revisions throughout Chapter 2 (Neoplasms) with five new codes.    

There are five new codes in Chapter 3 (Diseases of Blood and Blood Forming Organs and Certain Disorders Involving the Immune Mechanism).   

The revisions to Chapter 4 (Endocrine, Metabolic, and Nutritional Diseases) include further specificity of diabetic retinopathy (proliferative vs. non-proliferative and severity of mild, moderate, or severe) and the ability to capture that macular edema has resolved after treatment with laterality.   

The changes in Chapter 5 (Mental, Behavioral, and Neurodevelopmental Disorders) include additions to capture hoarding, various obsessive-compulsive disorders, and social pragmatic communication disorder.    

Chapter 6 (Diseases of the Nervous System) include carpal tunnel disorder, tarsal tunnel disorder, and various lesions of specific nerves.   

Chapter 7 (Diseases of the Eye and Adnexa) added central occlusion of the retinal vein, nonexudative and exudative age related macular degeneration, expansion of stages of primary open angle glaucoma, and amblyopia suspect.   

Chapter 8 (Diseases of the Ear and Mastoid Process) added hearing loss with additional information in relationship to the contralateral ear and pulsatile tinnitus.    

Chapter 9 (Diseases of the Circulatory System) updates include the addition of hypertensive urgency, emergency, or crisis; reducing specificity of nontraumatic subarachnoid hemorrhage and the communicating artery; expansion of the cerebral infarction and sequela of stroke codes; addition of aneurysm of precerebral and vertebral arteries; and addition of dissection of unspecified arteries.    

Chapter 10 (Diseases of the Respiratory System) added a minimal number of codes which included the mediastinitis and other diseases of the mediastinum.    

Chapter 11 (Diseases of the Digestive System) add numerous dental conditions, ischemia or acute infarction of the intestines, megacolon types, and more specific pancreatitis codes.    

Chapter 12 (Diseases of the Skin and Subcutaneous Tissue) updates include the addition of preorbital cellulitis and excessive and redundant skin and subcutaneous tissue.   

Chapter 13 (Diseases of the Musculoskeletal System and Connective Tissue) added bunion, bunionette, pain in joints of the hand, more specificity to temporomandibular joints, cervical disc disorders at specific levels, atypical femoral fractures, and periprosthetic fractures.   

Chapter 14 (Diseases of the Genitourinary System) have a few title changes as well as the code additions for specific urinary incontinence conditions, various prostatic dysplasia, testicular and scrotal pain, erectile dysfunction, ovarian cysts, conditions of the fallopian tubes, and complications of the urinary tract including fistulas, hemorrhage, infection, malfunction, etc.   

Chapter 15 (Pregnancy, Childbirth, and Puerperium) have added various conditions involving ectopic pregnancy; pre-eclampsia, severe pre-eclampsia, and eclampsia complicating childbirth and puerperium; gestational edema; gestational diabetes controlled by oral medications; partial or low lying placenta previa; and expansion of third degree perineal laceration.   

Chapter 16 (Certain Conditions Originating in the Perinatal Period) changes include a significant amount of updates to the code titles and the addition of two codes. The two new codes are newborn light for gestational age greater than 2500 grams and newborn light for gestational age other.   

Chapter 17 (Congenital Malformations, Deformations, Chromosomal Abnormalities) additions include new congenital cardiac conditions and various longitudinal vaginal septum conditions.  

Chapter 18 (Symptoms, Signs, and Abnormal Clinical and Laboratory Findings) have added the National Institute of Health Stroke Scale (NIHSS) scores, microscopic hematuria, expansion of total Glasgow Coma Score, bacteriuria, abnormal radiologic findings on diagnostic imaging, and expansion of abnormal Prostate Specific Antigen (PSA).   

Chapter 19 (Injuries, Poisoning, and Certain Other Consequences of External Causes) changes include significant number of additions regarding the specific fractures to bones of skull, various fracture types of the foot; title revisions to complications involving prosthetic devices; new stenosis of cardiac stent codes, and additions to complication types including breakdown, displacement, infection, erosion, exposure, pain, fibrosis, thrombosis, and leakage.   

Chapter 20 (External Causes of Morbidity) has updated some of the vehicular accident codes, added contact with paper or sharp objects, overexertion, and an activity of the choking game. The addition of the overexertion codes will be a welcome addition for many Emergency Department coders.    

Chapter 21 (Factors Influencing Health Status and Contact with Health Services) has added a variety of observation of newborn for various conditions, hormone malignancy status, encounter for prophylactic medications, encounter for contraceptives, gestational carrier status, conversion of endoscopic procedures to open, and long term use of oral hypoglycemic drugs. 

There are many long-awaited updates in this release of ICD-10-CM. There are still many that have been discussed during the Coordination and Maintenance Committee meetings that have not been addressed such as the myocardial infarction, type II. It is important to continue to monitor these meetings for future updates.    

The last important piece to the updates will be the Inpatient Prospective Payment System (IPPS) Final Rule FY2017 to see what is new in the MS-DRGs as well as value based purchasing.   

Stay tuned!
Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer

Laurie M. Johnson, MS, RHIA, FAHIMA 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.

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