Updates to ICD-10 and Official Coding Guidelines

Updates to ICD-10 and Official Coding Guidelines

  • 11 Oct Off
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by Dr. George W. Brett

The multi-year freeze on changes to ICD codes ended with the launch of ICD-10 last October. We are all up to speed with ICD-10, right? Good, because on October 1, 2016, the 2017 edition became effective. Providers, coders and billers need to be knowledgeable with these changes as there is no grace period. Using codes that are deleted or changed will impact claims and risk adjustment.

George W. Brett, MD Chief Medical Officer

George W. Brett, MD
Chief Medical Officer

Over 1900 codes are new, 422 are revised and 305 will be deleted. Included in the changes are 264 new codes for diabetes mellitus, 81 codes that relate to the circulatory system, 152 musculoskeletal system and connective tissue codes, 79 new symptoms, signs and laboratory findings, 62 codes in the genitourinary chapter and a whopping 885 new codes related to injuries, poisoning, and certain other consequences of external causes.

The changes in Chapter 5 (Mental, Behavioral, and Neurodevelopmental Disorders) include additions to bring ICD-10 into better alignment with DSM5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Ed). PACE providers will notice especially the language for classifying dementia (major or minor neurocognitive impairment) and in drug or alcohol abuse and dependence, which is now referred to as a Substance Use Disorder in DSM5. The criteria for diagnosis of Substance Use Disorder are different than for abuse and dependence.

If that isn’t enough, CMS has provided a revised version of the Official Coding Guidelines on their website. The changes are mostly relevant to coders, but since many providers essentially function as coders when their EMR forces them to choose a diagnosis code, providers should become familiar with the new CMS Guidelines

Capstone consultants, auditors and coders are staying up-to-date on these changes and will continue expert education for our clients’ providers and provide real-time feedback through our auditors and coders. If your program needs any help with coding compliance or optimization, please contact us.