Cracking the Code

Significant Changes Coming to ICD-10-CM for FY 2023

Dementia-related diagnoses, as well as brain illness and injury, take over a substantial portion of the 1,100+ new ICD-10-CM codes for FY 2023.  Other changes include additional codes relating to the nervous system chapter, external causes for morbidity, cardiovascular chapter, and musculoskeletal/connective tissue chapter. We also see coding changes for factors influencing health status among many others. In total, 17/22 ICD-10-CM chapters will see coding changes beginning October 1, 2022.

We will also see ICD-10-CM Guideline changes for FY 2023. Some of the highlights include an update to Guideline 1.A.19 (Code assignment and Clinical Criteria) adding “If there is conflicting medical record documentation, query the provider.”  Another change is to Guideline 1.C.2.t to add, “Secondary malignant neoplasm of lymphoid tissue: When a malignant neoplasm of lymphoid tissue metastasizes beyond the lymph nodes, a code from categories C81-C85 with a final character “9” should be assigned identifying “extranodal and solid organ sites” rather than a code for the secondary neoplasm of the affected solid organ. For example, for metastasis of B-cell lymphoma to the lung, brain, and left adrenal gland, assign code C83.39, Diffuse large B-cell lymphoma, extranodal and solid organ sites.”

All diabetes sections see revisions for FY 2023 which encompasses both general and gestational. We are introduced to a new code, Z79.85, which will be defined as, “Long-term (current) use of injectable non-insulin antidiabetic drugs” to replace the generic ‘other long-term drug therapy’ when the documentation supports it.

Dementia is receiving a significant expansion indicating severity. Guideline I.C.5.d. will reveal if a patient is admitted at one severity and progresses, only the higher level is reported. “If a patient is admitted to an inpatient acute care hospital or other inpatient facility setting with dementia at one severity level and it progresses to a higher severity level, assign one code for the highest severity level reported during the stay.”

Another FY 2023 Guideline change is to 1.C.19.e.5(c). We see additional verbiage when coding underdosing which now includes the directive “Documentation of a change in the patient’s condition is not required in order to assign an underdosing code. Documentation that the patient is taking less of a medication than is prescribed or discontinued the prescribed medication is sufficient for code assignment.”

This week’s Crack the Code only touches on a few of the more highlighted changes. The FY 2023 ICD-10-CM Guidelines have been provided in the link below for a deeper dive into the upcoming revisions.

Reference: ICD-10-CM Official Guidelines for Coding and Reporting
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