ICD-10 Codes Future

An ICD-10 Coordination and Maintenance Committee virtual meeting is scheduled for March 9–10, from 9 a.m. to 5 p.m. The Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention National Center for Health Statistics (CDC NCHS) have posted tentative agendas on their websites.

Stakeholders will present on a variety of procedures or diseases they feel are either mis- or under-represented in the procedural (ICD-10-PCS) or diagnosis (ICD-10-CM) code set. No decisions are made at these meetings, which occur every spring and fall, but presentations and subsequent public comment periods weigh in on future code set updates, sometimes as soon as the next quarterly update.

These meetings are extremely informative for medical coders because they provide insight as to why codes change every year. Presentations also provide coders with a deeper understanding of the medical intervention or disease process, which can help them in proper code selection.

ICD-10-PCS Code Changes for Consideration

The first day of the meeting is dedicated to procedure code issues and is led by CMS.

The six new technology add-on payment (NTAP) related ICD-10-PCS procedure code requests that involve the administration of a therapeutic agent are:

  • Administration of Trilaciclib
  • Administration of ZEPZELCA™ (lurbinectedin)
  • Administration of ENSPRYNG™ satralizumab-mwge
  • Administration of Ciltacabtagene Autoleucel (cilta-cel)
  • Administration of Amivantamab
  • Transfusion of Pathogen Reduced Cryoprecipitated Fibrinogen Complex (PRCFC)

Other topics on the agenda include regional anticoagulation for renal replacement therapy, gene expression assay, total artificial heart systems, and others. The tentative agenda and other meeting materials are available on the CMS website.

ICD-10-CM Code Changes for Consideration

The second day of the meeting is dedicated to diagnosis code discussions and is led by CDC NCHS.

There are currently 25 items on the list of topics to be covered. They are:

  • Acute and chronic metabolic acidosis
  • ANCA vasculitis
  • Apnea related conditions of newborn
  • Dementia: Stages of severity, behavioral and psychological symptoms
  • Encounter for pain management
  • Encounter for pediatric to adult counseling
  • Encounter for PPD test reading and medication review
  • Endometriosis
  • Fetal anomalies
  • Flank anatomical specificity
  • Immunoglobulin A Nephropathy (IgAN)
  • Limb girdle muscular dystrophies expansion
  • Lumbar disc degeneration, with pain
  • Mild cognitive disorder due to physiological conditions
  • Parkinson’s disease with OFF episodes
  • Post traumatic visual disturbance
  • Prolonged grief disorder
  • Refractory angina pectoris
  • Rheumatic mitral valve leaflet calcification
  • Slipped upper femoral epiphysis
  • Short stature due to endocrine disorder
  • Substance use unspecified in remission
  • Torsade de pointes expansion
  • Von Willebrand disease
  • Addenda

If your providers see patients with any of the disorders listed, you may want to attend the meeting. Alternatively, you can watch a recording of the meeting once it is posted on the CDC NCHS website.

Here’s What You Missed Last Year

You can also go back and watch past ICD-10 Coordination and Maintenance Committee meetings. The most recent was held Sept. 8–9, 2020. On day two, when ICD-10-CM was discussed, stakeholders presented on 36 topics — from abnormal findings of blood amino-acid level to vulvovaginal candidiasis recurrent. From these discussions, you can learn a lot about a code. For example:

Allergy to mammalian meats – According to the presenter, “Alpha-gal syndrome of late has been associated with allergic reactions to red meat and other products made from mammals. In the United States, the condition most often occurs from Lone Star or Deer Tick bites. The bite transmits a sugar molecule called alpha-gal into the person’s body. Alpha-gal is a carbohydrate found in all mammals but not in humans. In some people, this triggers an immune system reaction that later produces mild to severe allergic reactions to red meat. Examples of meats that have alpha-gal are beef, pork, lamb, venison, rabbit, goat, buffalo, bison, etc. Alpha-gal is also present in the milk from these animal sources as well as their organ meats. Chicken, turkey, fish, and shellfish do not have alpha-gal and are safe for patients with Alpha-gal Syndrome (AGS) allergy to consume.”

The presenter continued to describe this subject in detail and proposed new code Z91.014 Allergy to mammalian meats. (This code has not been approved.)

Cough – You would think something as basic as a cough would already be well represented in ICD-10-CM. The American Thoracic Society and the American College of Chest Physicians Clinical Practice Committee beg to differ. They recommended “consideration of paroxysmal cough as a potential inclusion term under both Whooping cough due to Bordetella pertussis, without pneumonia, A37.00, and Whooping cough due to Bordetella pertussis, with pneumonia, A37.01.” Additionally, they proposed the addition of several new codes under subcategory R05 Cough to differentiate various types of coughs further. (These codes have not been approved.)

COVID-19 issues – A few additional codes for reporting COVID-19 were proposed and later finalized for a January 2021 implementation:

Z20.822 Contact with and (suspected) exposure to COVID-19
Z11.52 Encounter for screening for COVID-19
Z86.16 Personal history of COVID-19

Multisystem inflammatory syndrome (MIS) – There has been a recent increase in MIS cases, believed to be related to COVID-19 and possibly misdiagnosed or misclassified as other syndromes. As such, the following new codes for reporting MIS or similar conditions were proposed and later implemented for use in January 2021:

M35.81 Multisystem inflammatory syndrome
M35.89 Other specified systemic involvement of connective tissue

Although no decisions are made at these meetings, it’s exciting to know ahead of time what code changes are coming, and to have a better understanding of code changes as you implement them into your billing system.

For More Information: https://www.aapc.com/blog/63344-get-a-peek-at-future-icd-10-codes/

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