Final ICD-10-CM Codes for 2018 Contain Some Surprises

Revisions include 322 more changes than CMS proposed in April

The final updated ICD-10-CM codes for 2018, posted on the Centers for Medicare and Medicaid Services’ (CMS) website, contain 360 new, 142 deleted, and 226 revised diagnosis codes, according to a report from HealthLeaders Media. The revisions include 322 more changes than what was proposed by the CMS in April’s Inpatient Prospective Payments System (IPPS) rule. The new codes take effect on October 1.

Key changes include:

Substance abuse remission codes revised.

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).

Myocardial infarction codes added.

New codes for myocardial infarction (MI) type-2 (I21.A1) and other MI type (I21.A9) mean that caregivers need to take into consideration the type of MI the patient is having. A type-2 MI describes an MI 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 updated code set includes 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 advanced disease who no longer respond to medications.

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 also includes more than 100 deletions that were not in the proposed code set, including a reversal on new codes, such as:

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.

In addition, 36 thumb subluxation and dislocation codes have been deleted.

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