Coders should be aware of new codes for diabetics, heart failure patients, and new medical technologies.
Question: What are the big coding changes for the FY18 inpatient prospective payment system (IPPS)?
Answer: Although ICD-10-CM is still in its early years, there are a lot of changes this year. Below are the highlights. As an overview, there are approximately 363 new codes and 250 code revisions to ICD-10-CM. ICD-10-PCS jumps from an overall 75,789 codes in 2017 to 78,705 for FY18.
Diabetes. There has never been a code for type 2 diabetic ketoacidosis because historically this condition was only found in type 1 diabetics. With the numbers of type 2 diabetics on the rise, ketoacidosis is now a reality for these patients. As a result, ICD-10-CM has added new codes to account for this: E11.10 Type 2 diabetes mellitus with ketoacidosis without coma and E11.11 Type 2 diabetes mellitus with ketoacidosis with coma.
Myocardial infarction (MI): MIs are now being broken down by type. There are five types of acute MIs:
- Type 1 – a primary coronary event. I21.0-I21.4 are used to identify these types of MIs, which we are familiar with already in ICD-10-CM and are further specified by what wall was affected, such as an anterior wall or inferior wall.
- Type 2 – MI due to demand ischemia is assigned code I21.A1, and a code for the underlying cause should be assigned, if known.
- Type 3 – sudden cardiac death.
- Type 4 – associated with a percutaneous transluminal coronary angioplasty (PTCA) or in-stent thrombosis.
- Type 5 – associated with coronary artery bypass grafting, and MI types 3-5 are reported using code I21.A9.
Congestive heart failure (CHF). New codes for CHF have been added for right heart failure (category I50.81-), biventricular heart failure (I50.82), high output heart failure (I50.83) and end-stage heart failure (I50.84). The codes for biventricular heart failure and end-stage heart failure can also be accompanied by a code for systolic, diastolic, or combined if it is supported by the documentation. These additional codes will add to the query decision-making for clinical documentation specialists.
ICD-10-PCS. Less specificity is required in some ICD-10-PCS codes. Yes, you read that correctly. ICD-10-PCS has pulled back on some specificity and that is a relief for coders who struggled to find specificity in the documentation.
For example, no longer will you have to differentiate if the saphenous vein that is being excised is “greater” or “lesser.” Those terms have been removed from the body part, under “Body System: Lower Veins” and is now replaced with simply “saphenous vein, right” and “saphenous vein, left.”
Another place where specificity was lessened was for diaphragm in the respiratory system. Previously it had to be determined if the procedure was being performed on the left or right diaphragm in order to report an ICD-10-PCS code. This has been revised to be diaphragm only, laterality is no longer needed. Laterality has also been removed for omentum in the gastrointestinal system and for several facial bones under the head and facial bones body system including frontal, occipital, sphenoid, and maxillary bones. This is a big relief for coders who struggled with getting this level of specificity in operative reports.
New medical technology. A final note on new technology codes. Watch for new medical technologies that include magnetically controlled growth rods being used for vertebral fracture reductions. Fusion procedures are now using interbody fusion devices that are radiolucent porous and vein grafts are being infused with endothelial damage inhibitors. These new technology codes can mean potential increased payment for hospitals. During FY16, the additional payment ranged from $1,000 to $72,000 per case. So be sure to pay close attention to those each year, as they are revised.
