Important ICD-10 Specialty Changes Coming as Code Freeze Ends

October 1, 2016 was an important date in the world of coding, and ICD-10 in particular. And because of that, this date was also important in terms of physician reimbursement. That’s because it’s date on which the first official ICD-10-CM/PCS code update took effect. Up until now, the industry has been under a partial code freeze that allowed only limited changes to accommodate certain new technologies and diagnoses. With this latest update, there are 1,974 code additions, 311 deletions, and 425 revisions, and physicians must ensure that their practices are ready.

“We’re used to code changes every year, and the volume always varies,” says Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, CRC, vice president of strategic development at AAPC. “We expected this one to be pretty large just based on the proposals.”

Buckholtz says many of the changes—which are spread out across all specialties—not only add laterality, but they also expand clinical and anatomical specificity. In this article, she provides several important specialty-specific changes of which physicians must be aware. 

Primary care
Many of the new codes for 2017 affect primary care. Most notably, there is a new code for the Zika virus (A92.5). Also review these changes:

Unspecified sensorineural hearing loss (H90.5) has been replaced by the following more specific codes:

• H90.A21 (Sensorineural hearing loss, unilateral, right ear, with restricted hearing on the contralateral side)
• H90.A22 (Sensorineural hearing loss, unilateral, left ear, with restricted hearing on the contralateral side)

Conductive hearing loss, unspecified (H90.2) now includes more specificity related to laterality and the contralateral side as follows:

• H90.A11 (Conductive hearing loss, unilateral, right ear with restricted hearing on the contralateral side)
• H90.A12 (Conductive hearing loss, unilateral, left ear with restricted hearing on the contralateral side)
• H90.A21 (Sensorineural hearing loss, unilateral, right ear, with restricted hearing on the contralateral side)
• H90.A22 (Sensorineural hearing loss, unilateral, left ear, with restricted hearing on the contralateral side)

Codes for tinnitus (H93.11-H93.19) now specify pulsatile tinnitus.

Mental health
Other eating disorders (F50.8) now includes the more specific binge eating disorder (F50.81). In addition, there are new codes for hoarding disorder (F42.3), various obsessive-compulsive disorders, and social pragmatic communication disorder (F80.82). 

OB/GYN
This is another specialty that saw many changes. For example, other ovarian cysts (N83.29) has been expanded to include laterality as follows:

• N83.291 (Other ovarian cyst, right side)
• N83.292 (Other ovarian cyst, left side)
• N83.299 (Other ovarian cyst, unspecified side)

Abdominal pregnancy (O00.0) now includes a more specific code to denote withintrauterine pregnancy (O00.01).

Newborn light for gestational age (P05.0x) now includes a 10^th sub-classification to denote 2,500 grams and over (P05.09).

In addition, there are new codes to denote ectopic pregnancy, pre-eclampsia, severe pre-eclampsia, eclampsia complicating childbirth and puerperium, gestational edema, gestational diabetes controlled by oral medications, and partial or low-lying placenta previa.

Endocrinology
Type 1 diabetes mellitus with ophthalmic complications (E10.3xx) now includes many revised codes that indicate laterality (i.e., left, right, or bilateral). For example, E10.3493 denotes type 1 diabetes mellitus with severe non-proliferative diabetic retinopathy without macular edema, bilateral. Review these codes carefully to ensure compliance. And don’t forget to document laterality at all times.

Oncology
Many of these codes are expanded to include greater anatomical specificity. Consider the following:

Malignant neoplasm of connective and soft tissue of abdomen (C49.4) has been expanded into the following:

• C49.A3 (gastrointestinal stromal tumor of small intestine)
• C49.A4 (gastrointestinal stromal tumor of large intestine)
• C49.A5 (gastrointestinal stromal tumor of rectum)

Neoplasm of unspecified behavior or other genitourinary organs (D49.5) has been expanded to include the following:

• D49.511 (Neoplasm of unspecified behavior of right kidney)
• D49.512 (Neoplasm of unspecified behavior of left kidney)
• D49.519 (Neoplasm of unspecified behavior of unspecified kidney)

Cardiology
Laterality is now included in various codes. Consider the following:

• Cerebral infarction due to embolism of right or left carotid arteries (I63.131 and I63.132 respectively) now includes a third option for bilateral (I63.133).
• Cerebral infarction due to unspecified occlusion or stenosis of right or left vertebral arteries (I63.211 and I63.212 respectively) now includes a third option for bilateral(I63.213).
• Cerebral infarction due to unspecified occlusion or stenosis of right or left carotid arteries (I63.231 and I63.232 respectively) now includes a third option for bilateral(I63.233).

Urology
There are many new codes in this specialty. For example, displacement of other urinary devices and implants (T83.12xx) now includes a code for displacement of other urinary stents (T83.123). Physicians must specify whether this is an initial, subsequent, or sequela encounter.

In addition, there are new codes 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.

Gastrointestinal
Greater specificity is now included in other vascular disorders of the intestine (K55.8). This code has been expanded into the following:

• K55.31 (Stage 1 necrotizing enterocolitis)
• K55.32 (Stage 2 necrotizing enterocolitis)
• K55.33 (Stage 3 necrotizing enterocolitis)

Neurology
Carpal tunnel syndrome of the upper limb (G56.01 and G56.02) now includes a code that denotes bilateral (G56.03). Other code changes pertain to tarsal tunnel disorder and various lesions of specific nerves.

Orthopedics
Be on the lookout for added laterality. In addition, there are expanded codes for a foot bunion (M21.611-M21.619), bunionette of the foot (M21.621-M21.629), joint pain in the hand (M25.541-M25.549), temporomandibular joint disorder (M26.601-M26.609), cervical disc disorder at specific levels of the spine (M50.020-M50.123), peri-prosthetic fractures (M97.01XA-M97.21XA), and complete transverse atypical femoral fracture (M84.754x-M84.756x). There are also a significant number of additions regarding specific fractures to the bones of the skull and foot.

Tips to Ensure ICD-10 Compliance
The codes listed above are by no means a comprehensive list. To prepare most fully, consider these tips:

1. Review all of the new, revised, and deleted codes that potentially affect specialty, noting any important changes—especially laterality.
2. Ensure that your documentation reflects the added specificity required for compliant code assignment.
3. Work with your EMR vendor to ensure that all code updates will be completed by October 1, 2016.
4. Review the FY 2017 ICD-10-CM Official Coding Guidelines, and be sure that coders review them as well.
5. Encourage coders to attend training on the new code sets so they can assist with documentation improvement and coding compliance.

Check out the Kareo ICD-10 Resource Center for more information on how to be successful with ICD-10.