Final ICD-10-CM Codes for 2018 Contain a Few Surprises

The final codes include 322 more changes than what was proposed by CMS in April’s hospital IPPS rule.

Starting Oct. 1, it will be possible to select a specific ICD-10-CM code when a patient is in remission from abuse of each of a variety of substances, including alcohol, opioids, cannabis and nicotine.

Those nine new codes are among 360 new, 142 deleted, and 226 revised diagnosis codes in the final 2018 update posted by the Centers for Medicare & Medicaid Services to its website on June 13.

The final 2018 ICD-10-CM codes include 322 more change hospital IPPS rule in April.

Explanatory information included with the substance abuse remission codes will classify the severity of the use as mild, moderate, or severe to better coordinate ICD-10-CM coding with the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Further changes in the final code set include:

Myocardial infarction (MI) codes added. New codes for myocardial infarction type 2 (I21.A1) and other myocardial infarction type (I21.A9) mean you will need to take into consideration the type of MI the patient is having. A type 2 MI describes a myocardial infarction due to demand ischemia. In addition, notes added under ST-elevation MI codes (I21.0-I21.4) clarify that the condition is a type 1 MI.
Heart failure gets new codes. The code set has new codes for various types of right heart failure, including acute (I50.811), chronic (I50.812), acute on chronic (I50.813) and unspecified (I50.810). There are also new codes for right heart failure due to left heart failure (I50.814), biventricular heart failure (I50.82), high output heart failure (I50.83) and end-stage heart failure (I50.84) for patients with an advanced form of the disease who no longer respond to medication.
Antenatal screening codes expand reporting options. Medical practices will be able to report specific screening tests administered to pregnant patients, such as fetal growth retardation and chromosomal abnormalities with 17 new Z codes.

The final code set includes more than 100 deletions that were not in the proposed code set, including a reversal on new codes. Here are the highlights of those changes:

Three anorectal abscess codes for horseshoe, ischiorectal, and supralevator abscesses were issued in the proposed code set but were not included with the final codes.
The head injury section of Chapter 19 will lose 68 subsequent encounter and sequela codes.

Thirty-six thumb subluxation and dislocation codes have been deleted. The codes represent initial and subsequent encounters, as well as sequela.

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