2019 ICD-10 updates…A sign of the times

Oct. 8, 2018 / By Allison Morgan, MS, CPC

I always look forward to the release of the new ICD-10 codes for the upcoming year, and the 2019 updates did not disappoint. At first glance, there are a sea of codes flagged as added, deleted or revised. Overwhelming…yes…but at the same time it’s interesting how these changes reflect a sign of the times and what’s on the radar of healthcare payer and provider communities when it comes to reporting patient conditions.

So, let’s do a quick rundown of some of the top changes we will see with the 2019 codes:

Specificity continues to be the key!

We remember the flexibility we encountered with several unspecified codes in the initial rollout of ICD-10, but over the years ICD-10 codes have been added to reflect more specificity, whether related to anatomical location or additional conditions. This year came the deletion of several codes from the C4XXX, D0XXX, and D2XXX series related to melanoma, carcinomas and neoplasm of the eye related to the location of the condition on the eyelid. The codes were expanded out to include the location of upper or lower on the eyelid itself and they continue to include anatomical location.

Three other codes that saw a huge change were R938, H578 and M791. R938 (Abnormal findings on diagnostic imaging of other specified body structures) was deleted and replaced with the range of R93811-R9389 to include options associated with the anatomical location of testes. H578 also got the axe and was replaced with specific laterality options with the new range of H57811-H57819. M791 (Myalgia) was deleted and expanded out to M7910-M7918 which now includes specific muscle locations in the description. All three codes illustrate the continued direction of accurate reporting related to specific anatomical locations.

The Continuing Expansion

Conditions with associated complications, signs or symptoms also saw an expansion of code options, as clearer cut and more definitive diagnosis are encouraged to be reported and captured. It’s important when using the following codes that providers are aware of the expanded conditions and are sure to document them so the appropriate code can be captured.  Some of the codes affected include:

  • E784 (Other hyperlipidemia) was deleted and replaced with:  
    • E7841 (Elevated Lipoprotein(a))
    • E7849 (Other hyperlipidemia)
  • I638 (Other cerebral infarction) was deleted and replaced with:
    • I6381 (Other cerebral infarction due to occlusion or stenosis of small artery)
    • I6389 (Other cerebral infarction)
  • K613 (Ischiorectal abscess) was deleted and replaced with:
    • K6131 (Horseshoe abscess)
    • K6139 (Other ischiorectal abscess)
    • K615 (Supralevator abscess)
    • K82A1 (Gangrene of gallbladder in cholecystitis)
    • K82A2 (Perforation of gallbladder in cholecystitis)
  • K352 (Acute appendicitis with generalized peritonitis)  was deleted and replaced with:
    • K3520 (Acute appendicitis with generalized peritonitis, without abscess)
    • K3521 (Acute appendicitis with generalized peritonitis, with abscess)
  • K353 (Acute appendicitis with localized peritonitis)  was deleted and replaced with:
    • K3530 (Acute appendicitis with localized peritonitis, without perforation or gangrene)
    • K3531 (Acute appendicitis with localized peritonitis and gangrene, without perforation)
    • K3532 (Acute appendicitis with perforation and localized peritonitis, without abscess)
    • K3533 (Acute appendicitis with perforation and localized peritonitis, with abscess)
  • K3589  (Other acute appendicitis) was deleted and replaced with:
    • K35890 (Other acute appendicitis without perforation or gangrene)
    • K35891 (Other acute appendicitis without perforation, with gangrene)
  • R8299 (Other abnormal findings in urine)  was deleted and replaced with :
    • R82991 (Hypocitraturia)
    • R82992 Hyperoxaluria)
    • R82993 (Hyperuricoscuria)
    • R82994 (Hypercalciuria)
    • R82998 (Other abnormal findings in urine)

Three’s a Crowd

Triplets got some attention this time around with pregnancy codes, as did quadruplets. Code expansion took place in the O301XX series now reflecting trimester status for triplets, the O302XX series reflecting trimester status for quadruplets and the O308XX series was added for other specified multiple gestation trimester status.

O860 (Infection of obstetric surgical wound) also got an overhaul within the obstetric section of ICD-10. The code has been expanded out to include the location of the wound with codes O8600-O8604.

Mental Health

Some new codes were introduced related to mental and behavioral disorders, including the addition of F1223 (Cannabis dependence with withdrawal) and F1293 (Cannabis use, unspecified with withdrawal) as well as the replacement of F53 (Puerperal psychosis) with F530 (Postpartum depression) and F531 (Puerperal psychosis). Both changes reflect a need for reporting these codes given the changing laws of cannabis use and consumption and the ongoing open dialogue of the challenge related to postpartum depression that many woman experience.

Parsing Words

Language for S62XXXX (fracture of middle phalanx) has been revised from medial to middle. While this does not change code assignment, from a workflow perspective it’s important to make sure HIS, templated and coding systems will recognize both phrases and practices need to decide whether to go with one or both terms. 

External Cause Addresses Exploitation

It was interesting to see external cause codes get several additions for poisoning by ecstasy in the T43XXXX series, as well as a slew of new codes addressing human exploitation. Given the struggle and ongoing battle concerning adult and child exploitation and trafficking seen in the news, it was not surprising that this scenario needed to be captured for significant purposes, whether for reporting or data capture when providing patient and encounter context. T74XXXX and T76XXXX codes were added to capture adult and child labor and sexual exploitation external causes.

Obviously with 279 additions, 51 deletions and 143 revisions, we can’t cover them all in this post, but hopefully this gives you a brief overview of what to expect for 2019. Remember that all these changes can be captured and reported based on the quality of documentation. This includes components such as laterality, anatomical location, encounter status, underlying and associated conditions, present signs and symptoms. Documenting these components is essential in obtaining the most accurate code and also for capturing the appropriate diagnosis in our ever-changing times. 

Allison Morgan is a clinical development analyst at 3M Health Information Systems.

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