Look Ahead at ICD-10-CM Coding in 2018

The ICD-10-CM Tabular List of Diseases and Injuries 2018 Addenda provides insight to future diagnosis coding. Let’s review what is new, deleted, and revised in chapters 1-7. In future months, we will cover additional chapters.

Chapter 1: Certain Infectious and Parasitic Diseases (A00-A09)

Two codes are added under A04.7:
A04.71 Enterocolitis due to Clostridium difficile, recurrent
A04.72 Enterocolitis due to Clostridium difficile, not specified as recurrent

The Excludes1 note under A05 is revised to “Clostridium difficile foodborne intoxication and infection (A04.7-),” to require a fifth character.
The Excludes1 note under B81 is revised to “antiostrongyliasis due to: Angiostrongylus cantonensis (B83.2) and Parastrongylus cantonensis (B83.2).” The Excludes1 note under B81.3 is similarly revised.

Chapter 2: Neoplasms (C00-D49)

The Excludes2 note, “lymph node metastases (C77.0),” is deleted under C79 and added under C79.11.
C86.4 has a new inclusion term: “Blastic plasmacytoid dedritic cell neoplasm (BPDCN).”
C96.2 is revised to Malignant mast cell neoplasm, and is no longer applicable to “Aggressive systemic mastocytosis” or “Mast cell sarcoma.”
An Excludes1 note under C96.2 is revised to “indolent mastocytosis (D47.02).”

New codes in this subcategory include:
C96.20 Malignant mast cell neoplasm, unspecified
C96.21 Aggressive systemic mastocytosis
C96.22 Mast cell sarcoma
C96.29 Other malignant mast cell neoplasm
Code D47.0 is revised to Mast cell neoplasms of uncertain behavior, removing the reference to histiocytic tumors, and deleting the inclusion of indolent systemic mastocytosis, mast cell tumor not otherwise specified (NOS), and mastocytoma NOS.

Excludes1 notes “malignant mast cell tumor (C96.2)” and “mastocytosis (congenital) (cutaneous)(Q82.2)” are deleted under D47.0 and “congenital cutaneous mastocytosis (Q82.2-),” “histiocytic neoplasms of uncertain behavior (D47.Z9),” and “malignant mast cell neoplasm C96.2-” are added.
Subcategory code D47.01 Cutaneous mastocytosis is added with five inclusion terms for the conditions for which this code is to be used.
An Excludes1 note added under D47.01 lists: “congenital (diffuse) (maculopapular) cutaneous mastocytosis (Q82.2),” “congenital urticaria pigmentosa (Q82.2),” and “extracutaneous mastocytoma (D47.09).”
Subcategory code D47.02 Systemic mastocytosis is added with four inclusion terms.
A new note under D47.02 says to “Code also, if applicable, any associated hematological non-mast cell lineage disease, and lists several examples.”
Also under D47.02 is a new Excludes1 note for “aggressive systemic mastocytosis (C96.21) and mast cell leukemia (C94.3-).”
Subcategory code D47.09 Other mast cell neoplasms of uncertain behavior is added with four inclusion terms.

Chapter 3: Diseases of the Blood and Blood- forming Organs and Certain Disorders Involving the Immune Mechanism (D50-D89)

Under D63.0, Excludes1 note “anemia due to antineoplastic chemotherapy (D64.81)” is deleted and Excludes2 note “anemia due to antineoplastic chemotherapy (D64.81)” is added.

The Excludes1 note under D89.4 is revised, as follows:
Added: (con-congenital) cutaneous mastocytosis (D47.01), (indolent) systemic mastocytosis (D47.02), malignant mast cell neoplasm (C96.2-), malignant mastocytoma (C96.29), mast cell sarcoma (C96.22), mastocytoma NOS (D47.09), other mast cell neoplasms of uncertain behavior (D47.09), and systemic mastocytosis associated with hematologic non-mast cell lineage disease (SM-AHNMD) (D47.02)

Deleted: indolent systemic mastocytosis (D47.0), malignant mastocytoma (C96.2), mastocytoma (D47.0), systemic mastocytosis associated with a clonal hematological non-mast cell lineage disease (SM=AHNMD) (D47.0).

Revised: Aggressive systemic mastocytosis (C96.21), congenital cutaneous mastocytosis (Q82.2)

Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00-E89)

New codes under Diabetes mellitus (E08-E13) include:

E11.1 Type 2 diabetes mellitus with ketoacidosis
E11.10 Type 2 diabetes mellitus with ketoacidosis without coma
E11.11 Type 2 diabetes mellitus with ketoacidosis with coma

New codes under Metabolic disorders (E70-E88) include:
E85.81 Light chain (AL) amyloidosis
E85.82 Wild-type transthyretin-related (ATTR) amyloidosis
E85.89 Other amyloidosis

The Excludes1 note under E13 is deleted, and under E13.00 is new Excludes2 note “type 2 diabetes mellitus (E11.-).” The Excludes1 note under E16.0 is revised to “diabetes with hypoglycemia without coma (E09.649).” Under E83.11, see newly added Excludes1 note: GALD (P78.84), Gestational alloimmune liver disease (P78.84), and Neonatal hemochromatosis (P78.84). And under E85, Excludes1 note “Alzheimer’s disease (G30.0-) is deleted; but is added as an Excludes2 note.

Also in chapter 4, under E85.0, you’ll find new Excludes2 note “Transthyretin-related (ATTR) familial amyloid cardiomyopathy (E85.4),” and a note that tells you to “Code also associated disorders, such as: autoinflammatory syndromes (M04.-).”

Lastly, “(Pure) hypercholesterolemia NOS” is added under E78.00; “Transthyretin-related (ATTR) familial amyloid polyneuropathy” is added under E85.1 and E85.4; and “Senile system amyloidosis (SSA)” is added under new code E85.82.

Chapter 5: Mental, Behavioral, and Neurodevelopmental Disorders (F01-F99)

Scientists learn more about mental illness every year, and coding must reflect this progress. As such, a new inclusion term is added under F06.31 and F06.32: “Depressive disorder due to known physiological condition, with major depressive-like episode;” and two new inclusion terms are added under F06.33:
Bipolar and related disorder due to a known physiological condition, with manic features
Bipolar and related disorder due to known physiological condition, with manic- or hypomanic-like episodes

F06.34 adds two new inclusion terms:
Bipolar and related disorder due to known physiological condition, with mixed features
Depressive disorder due to known physiological condition, with mixed features

A new inclusion term is also added under F06.8:
Obsessive-compulsive and related disorder due to a known physiological condition

Under category F10 is new code:
F10.11 Alcohol use disorder, mild

With two new inclusion terms:
Alcohol use disorder, mild, in early remission
Alcohol use disorder, mild, in sustained remission

Four similar inclusion terms are added under existing code F10.21.
The opioid crisis also demands more coding specificity to differentiate the various types and stages of drug abuse. A new code is added under F11: F11.11 Opioid abuse, in remission

This code has two inclusion terms:
Opioid use disorder, mild, in early remission
Opioid use disorder, mild, in sustained remission

Four new inclusion terms are added to F11.21 to identify the various stages of the disease.
Under category F12, there is new code: F12.11 Cannabis dependence, in remission
With two inclusion terms:
Cannabis use disorder, mild, in early remission
Cannabis use disorder, mild, in sustained remission

Existing code F12.21 also adds four similar inclusion terms.
Under F13, there is a new code: F13.11 Sedative, hypnotic or anxiolytic abuse, in remission

With two inclusion terms:
Sedative, hypnotic or anxiolytic use disorder, mild, in early remission
Sedative, hypnotic or anxiolytic use disorder, mild, in sustained remission

Under existing code F13.21, four similar inclusion terms are added.
Under F14, 2018 ICD-10-CM adds:

F14.11 Cocaine abuse, in remission
With two inclusion terms:
Cocaine abuse, mild in early remission
Cocaine abuse, mild, in sustained remission

F14.21 adds four similar inclusion terms.

Under category F15, you’ll find more new codes:
F15.11 Other stimulant abuse, in remission
This code has four inclusion terms:
Amphetamine type substance abuse disorder, mild, in early remission
Amphetamine type substance abuse disorder, mild, in sustained remission
Other specified stimulant disorder, mild, in early remission
Other specified stimulant disorder, mild, in sustained remission
For existing code F15.21, eight inclusion terms are added to describe various stages of amphetamine or other substance abuse.

Under F16, there is one new code:
F16.11 Hallucinogen abuse, in remission
With four inclusion terms:
Other hallucinogen use disorder, mild, in early remission
Other hallucinogen use disorder, mild, in sustained remission
Phencyclidine use disorder, mild, in early remission
Phencyclidine use disorder, mild, in sustained remission
Existing code F16.21 adds eight similar inclusion terms.

Existing codes F17.201-F17.291 each add six inclusion terms to better capture the various stages of nicotine dependence to tobacco, cigarettes, chewing tobacco, and other tobacco products.

There is a new code under F18 Inhalant related disorders:
F18.11 Inhalant abuse, in remission
Which has two inclusion terms:
Inhalant use disorder, mild, in early remission
Inhalant use disorder, mild, in sustained remission
For code F18.21 you’ll find four similar inclusion terms added.

Under F19, there is a new code:
F19.11 Other psychoactive substance abuse, in remission
With two inclusion terms:
Other (or unknown) substance use disorder, mild, in early remission
Other (or unknown) substance use disorder, mild, in sustained remission
Existing code F19.21 adds four similar inclusion terms.

“Schizophreniform psychosis, manic type” and “Schizophreniform psychosis, depressive type” are deleted from the inclusion terms for codes under category F25. And inclusion term “Other specified schizophrenia spectrum and other psychotic disorder” is added to category F28 and F29 codes.

Category F31 Bipolar disorder adds an Includes note for bipolar I disorder and bipolar type I disorder; and adds the inclusion term “Bipolar I disorder, current or most recent episode manic with psychotic features” under codes F31.2 and F31.5. Also for 2018, F31.81 includes “Bipolar disorder, type 2” and F31.9 includes “Manic depression.”

F33.3 also adds “Major depressive disorder, recurrent, with psychotic features” to its list of inclusion terms.
F40.1 adds inclusion term “Social anxiety disorder;” and F41.0 is revised to remove “without agoraphobia.”
F44.4 adds four inclusion terms that describe the various motor symptoms or deficits. Codes F44.5 and F44.6 add similar inclusion terms.

F50 Eating disorders includes a new Excludes1 note, several new inclusion terms, and a new code:
F50.82 Avoidant/restrictive food intake disorder

Codes in category F60-F69 include a few new inclusion terms such as “Gambling disorder” for F63.0.
New inclusion terms are also added to some codes in category F90 Attention-deficit hyperactivity disorders.

Chapter 6: Diseases of the Nervous System (G00-G99)

The Excludes1 note under G00 now specifies bacterial meningoencephalitis and meningomyelitis (G04.2).

G10 Huntington’s disease adds a directive to “Code also dementia in other diseases classified elsewhere without behavioral disturbance (F02.80).”

The G12.2 subcategory has several additions:

G12.23 Primary lateral sclerosis

G12.24 Familial motor neuron disease

G12.25 Progressive spinal muscle atrophy

“Familial motor neuron disease” and “Primary lateral sclerosis” are deleted under G12.29 and added to their own subcategory. Several other codes under G20-G47 also have inclusion terms added or deleted.

G92 Toxic encephalopathy adds, “Code first, if applicable, drug induced (T36-T50).” And under G93.7 Reye’s syndrome a Code first note is revised to read, “Code first (T39.0-), if salicylates-induced poisoning due to salicylates, if applicable (T39.0-, with sixth character 1-4).” Also added under G93.7, “Use Additional code for adverse effect due to salicylates, if applicable (T39.0-, with sixth character 5).”

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