C&M Update: Enhancements to ICD-10 Continue

The ICD-10-CM/PCS Coordination and Maintenance (C&M) Committee met this past week, and there were lots of proposed enhancements to the code set presented and discussed. According to the Oxford dictionary, “enhancement” means an increase or improvement in quality, value, or extent. This definition truly describes the efforts of the C&M Committee and those who participate in the biannual process.

Per the Centers for Medicare & Medicaid Services (CMS) website, the Committee is a federal interdepartmental entity comprised of representatives from CMS and the Centers for Disease Control and Prevention’s (CDC’s) National Center for Health Statistics (NCHS). The Committee is responsible for approving coding changes and developing errata, addenda, and other modifications. Requests for coding changes are submitted to the Committee for open discussion at either the spring or fall C&M meeting. Attendees can include clinicians, clinical societies and associations, suppliers, researchers, and health information management (HIM) coding professionals.

Among proposed changes to the ICD-10-CM (diagnosis) code set, the following topics were on the March 2017 agenda for discussion (note that these have not been approved yet):
o Acute Appendicitis
o Antenatal Screening
o Blepharitis
o Breakthrough Pain
o Brow ptosis
o Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL)
o Classification of Types of Myocardial Infarction
o Disorders of the Gallbladder and Biliary Tract
o Disorders of Metabolism of Gamma Aminobutyric Acid (GABA)
o Diverticular Disease of Intestine
o Electronic Nicotine Delivery Systems
o Encounter for Screening for Certain Developmental Disorders in Childhood
o Encounter for Rehabilitation Services
o Epiphora
o Eyelid Cancer
o Factitious Disorder
o Fetal Inflammatory Response Syndrome (FIRS)
o Heart Failure Classification
o Hemifacial spasm (HFS)
o Immunization Not Carried Out
o Immunocompromised Status
o Infection Following a Procedure
o Infection of Obstetric Surgical Wound
o Lacunar Infarction
o Lagophthalmos
o Meibomian Gland Dysfunction
o Multiple Sulfatase Deficiency (MSD)
o Non-Healing Traumatic Wounds and Surgical Wounds
o Nonprocreative Genetic Counseling
o Nonruptured Cerebral Aneurysm
o Orbital Roof and Wall Fracture
o Osteoporosis-Related Pathological Fracture of Jaw
o Osteoporosis-Related Pathological Fracture of Rib and Pelvis
o Paralytic Ectropion
o Pediatric Glasgow Coma Scale
o Rosacea Conjunctivitis
o Secondary Mesothelioma and Mesothelioma in Remission
o Substance Use Disorders, in Remission
o Temporomandibular Joint Disorders
o Thyroid Eye Disease
o Urethral Stricture

As you can see, there are many extremely interesting and relevant topics associated with the diagnosis code set. Recommendation details, which can be found on the ICD-10-CM agenda materials, include the rationale for the change and revisions and modifications (enhancements) to the index and the tabular by way of adding, revising, or deleting a term, code, or instructional note (and/or adding laterality).

For ICD-10-PCS (procedure coding system) the following proposed procedure changes were on the March 2017 agenda for discussion (note these also have not been approved yet):

• Cerebral Embolic Protection during Transcatheter Aortic Valve Replacement
• Oxidized Zirconium Polyethylene Implant for Hip and Knee Replacement
• Administration of ZINPLAVA (Bezlotoxumab)
• Endovascular Cardiac Implant
• Combined Thoracic Arch Replacement and Thoracic Aorta Restriction
• Renal Replacement Therapy
• Radiotherapeutic Brain Implant
• Occlusion of Left Atrial Appendage
• Spinal Fusion with Radiolucent Interbody Fusion Device
• Administration of VYXEOS
• Administration of KTE-C19 (axicabtagene ciloleucel)
• Congenital Anomaly Procedures
• Magnetically Controlled Growth Rods
• Endovascular Intracranial Thrombectomy Procedures/Techniques
• Addenda and Key Updates

Certainly, the list of topics above demonstrates the great enrichment that this code set brings to many aspects of surgical treatment, clinical practice, and data quality. The ICD-10-PCS revisions often include proposals to add unique values to describe procedures, which otherwise would be omitted.

It should be noted that there were no requests for ICD-10 codes to capture new diagnoses or new technology for implementation on April 1, 2017.

Submit written comments by April 7, 2017 for codes discussed at the March 7-8, 2017 C&M meeting:

• Procedure comments to CMS (new address): ICDProcedureCodeRequest@cms.hhs.gov
• Diagnosis comments should be sent to Donna Pickett at the CDC: nchs@cdc.gov

We can anticipate that the final addendum’s will be posted around late July or early August on Web pages as follows:

• Diagnosis addendum – http://www.cdc.gov/nchs/icd/icd10cm.htm
• Procedure addendum – http://cms.hhs.gov/Medicare/Coding/ICD10/index.html

Besides attending in person to these valuable public forums, you may also attend via free live stream webcast or via listening to the proceedings through a free live conference line. Be sure to watch for details on the September 2017 meeting so you can attend and learn more about enhancements to the code sets.


Photo courtesy of: ICD10 Monitor

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