It’s fall and the 2020 ICD-10 changes have arrived

Nov. 6, 2019 / By Allison Morgan, MS, CPC

The coders version of the fall equinox has arrived with 2020 ICD-10 changes taking effect as of October 1. While mother nature herself is cooling down and we all get ready for sweater weather, the ICD-10 changes this year seemed to come in rather discreetly, with particular ranges of codes seeing some adjustments.

Overall, with 271 additions and 21 deletions in 2020, we are in very much the same range of changes as last year. What did decrease dramatically were the number of revisions, with only 30 in 2020 compared to 172 in 2019. The total number of codes to choose from is now 72,184. Some of the highlights to this year’s changes included:

• Chapter 3:3 to report ADA Deficiency was deleted so it could be expanded out to include more detailed options. This disorder, which causes immunodeficiency in patients, now includes four codes to account for severity and other factors.
• Chapter 8: Vertigo has historically been reported by central origin of the right ear or left ear, bilateral or unspecified. However, in 2020 the four existing vertigo codes have been scrapped and replaced with one code. H81.4 will now report the condition Vertigo of central origin without establishment of laterality.
• Chapter 9: A robust expansion of codes took place. There were 24 new codes in the I80 and I82 ranges, targeting Phlebitis and Thrombophlebitis, Acute Embolism and Thrombosis, Chronic Embolism and Thrombosis. The reporting of clots in the vein and blockages in a blood vessel has been expanded to have options to report more specific locations, including the calf muscular vein and peroneal vein, along with the associated laterality. Several codes are already reported with vein specificity and laterality like tibial vein and iliac vein, but providers need to be aware of these new reportable vein locations.

In addition, codes I48.1 and I48.2 for persistent and chronic A-fib were deleted and replaced with A-fib codes that establish whether the A-fib is longstanding persistent, other persistent, chronic or permanent.

• Chapter 12: Deep tissue damage received 25 new codes which we will now see in the L89 code range. The new codes establish pressure-induced deep tissue damage of a specified body part. This means reporting of the tissue damage needs to include the body part along with laterality. Locations such as the back should also be specified as upper, lower or sacral region, as this is now specified when reporting this condition with the new codes.
• Chapter 14: On the heels of the expansion of lump codes, which established location of the lump based on quadrants, we now have the option to report if the lump overlaps the quadrant. The new N63 breast lump codes include N63.15 and N63.25. Be aware of how providers are reporting lump location when it does overlap or is not isolated to one quadrant.
• Chapter 19: This chapter got several additions, including 60 new fracture codes related to the orbit, orbital roof and orbital wall surrounding the eye. Twelve new codes in the T50 series were established to specify additional routes of poisoning. Codes were added in the Y range establishing a new series of codes related to legal intervention when a person is injured.
• Chapter 21: Two new encounter codes for eye and vision exams following failed vision screening were added, as well as three new codes for latent tuberculosis.
• Seven new codes were added to the Z86 series establishing personal history of in situ neoplasm or melanoma in-situ. Keep in mind these seven new Z86 codes differentiate the location of the neoplasm, so when documenting history of, be sure to include the anatomical site for further specificity with code suggestion.

As these are only some of the changes introduced, be sure coders and providers are educated as to the documentation required to support these codes. If you have not already done so, now is the time to become familiar with ICD-10 updates over your favorite pumpkin spiced drink while embracing the fall season!

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