Effective Oct. 1, 2022, you must start reporting the new 2023 ICD-10-CM codes — and with more than 1,000 new diagnosis coded added to your available options, you’ll want to use that time wisely to be completely sure you are ready.
As you know, CPT codes answer the “what happened?” question when you see a patient. However, ICD-10-CM codes denote the “why?” which is the most essential way you can prove medical necessity for the services your practice provides. And if you don’t demonstrate medical necessity, you’ll forfeit reimbursement and lose money.
On June 9, the Centers for Disease Control and Prevention (CDC) issued updates to the ICD-10-CM code set reflecting more than 1,400 changes to your diagnosis coding options. You must start using the new 2023 ICD-10-CM codes now, whether you’re ready or not.
Regardless of whether you are billing Medicare, Medicaid, private insurers, or TRICARE you must use these new ICD-10-CM code changes when submitting your claims. To make sure you’re ready, check out the following breakdown of the revisions, deletions, and additions to help you get a leg up before it is too late.
Expansion to Dementia Coding Options
You’ll find nearly 100 new codes related to dementia that went into effect Oct. 1, helping you report conditions like vascular dementia (F01.5-F01.C4), dementia in other diseases (F02.8-F02.C4), and unspecified dementia (F03.9-F03.C4). The National Minority Quality Forum requested these new codes during the Sept. 2021 ICD-10 Coordination and Maintenance Committee Meeting.
The organization noted that the existing dementia codes “do not identify the stage of severity and also do not fully identify behavioral and psychological symptoms of dementia (BPSD). Both of these clinical elements are major factors in patient management strategies.”
To report these new codes, you must have documentation regarding the dementia stage, or you won’t know how to code the encounter. Check this guidance from the ICD-10-CM Committee Meeting:
- Mild dementia: “Clearly evident functional impact on daily life, affecting mainly instrumental activities. No longer fully independent/requires occasional assistance with daily life activities.”
- Moderate dementia: “Extensive functional impact on daily life with impairment in basic activities. No longer independent and requires frequent assistance with daily life activities.”
- Severe dementia: “Clinical interview may not be possible. Complete dependency due to severe functional impact on daily life with impairment in basic activities, including basic self-care.”
Knowing these stages will be imperative to choosing the right code and collecting accurate reimbursement, because each new dementia code is reported based on the sage. For instance, mild unspecified dementia will be coded to F03.A, whereas severe unspecified dementia should be reported with F03.C.
Ob-Gyn Code List Expands
If you see patients for endometriosis or maternal care, you’ll find almost 400 new codes representing ob-gyn conditions. The American College of Obstetricians and Gynecologists (ACOG) has been proposing expansion to the endometriosis section of the ICD-10-CM code set since 2020, and those requests finally appear to be taking effect.
Essentially, many of the new endometriosis codes provide further specificity by allowing you to specify whether the condition is superficial or deep. Knowing how these terms are defined will guide your code selection effective Oct. 1, with the following definitions key to choosing the right code:
- Superficial endometriosis: “Ectopic growth of endometrial-like tissue that extends 5mm or less below the peritoneal surface. Lesions can vary in number (singular or in multiple locations).”
- Deeply infiltrating endometriosis: “Ectopic growth of endometrial-like tissue that extends greater than 5mm below the peritoneal surface. Lesions can vary in number (singular or in multiple locations). These lesions are commonly associated with deep fibrosis and adhesions.
If you don’t see the terms “deep” or “superficial” in the physician’s notes, then look for any indication of how far below the peritoneal surface the tissue extended. This will be essential in selecting the right code under the new 2023 ICD-10-CM codes. For instance, you’ll report superficial endometriosis of the right ovary with N80.111, whereas deep endometriosis of the right ovary will code to N80.121.
ACOG and the Society for Maternal Fetal Medicine also requested new codes for fetal anomalies, and the latest diagnosis code set appears to have granted those wishes. “These physicians currently document these conditions during patient assessments but have no method of capturing the data with any reasonable specificity using the current code set,” they noted.
New codes that will help practices gain specificity in this area when the provider sees a pregnant woman whose baby is suspected of having conditions like Trisomy 21 (O35.13), facial anomalies (O35.A), Turner Syndrome (O35.14), and many other conditions.
New Concussion, Brain Injury Codes
You’ll also discover more than 100 new 2023 ICD-10-CM codes in the S06 (Intracranial injury) range, describing such conditions as concussions, contusions, traumatic brain injuries, blast injuries, and hemorrhages.
Several of the new head injury codes were requested by the American Academy of Pediatrics in September of 2021 to reflect whether or not patients experienced a loss of consciousness during their injuries. Therefore, it will be imperative to know whether a patient lost consciousness.
For instance, if a patient had a loss of consciousness with a concussion, you’ll report a code from the S06.0XA series, whereas a primary blast injury of the brain with loss of consciousness of 30 minutes or less will code out to the S06.8A1 range of codes.
The blast injury codes were requested by the Department of Defense and the Department of Veterans Affairs in March 2021, and these injuries often affect service members.
Find New Meth Overdose Codes
Emergency department coders will find a whole new code category describing poisoning by methamphetamines, as well as codes for adverse effects relating to meth use. In the past, coders reporting meth overdoses had to report these services from the general “amphetamines” category, but use of that code made it challenging for public health authorities to track meth overdoses.
You’ll find new codes in this category under the new T43.65 (Poisoning by, adverse effect of and underdosing of methamphetamines performed due to self-harm or assault) range. To report them accurately, you should find in the record whether the overdose was accidental, was, or if the status is undetermined. These factors will be essential in allowing you to select the correct code.
New Codes Describe Electric Bike Injuries
If you see a patient injured in an electric bicycle accident, you currently need to report the “external cause of injury” with a motorcycle code, but several organizations, including the American College of Surgeons, requested new ICD-10-CM codes to describe injuries sustained on e-bicycles, and they are very detailed in allowing you to show more detail about what happened.
For instance, if a patient presents following an accident when their e-bike collided with a pedal cycle in a park, you’ll report a code from the V21.21 category (Unspecified electric [assisted] bicycle rider injured in collision with pedal cycle in nontraffic accident). For this reason, your practice’s medical records must be as thorough as possible to ensure that your coding and billing team can select the right codes.
Additional New Codes Impact Lymphoma, Atherosclerosis, and More
In addition to the new 2023 ICD-10-CM codes outlined here, you’ll find hundreds of additional code changes impacting nearly every specialty. Select codes you’ll want to review include:
- Revisions to over a dozen T-cell lymphoma codes (C84.4 series)
- New codes for candidiasis of the vulva and vagina (B37.- series)
- More specificity thanks to new codes for hemolytic-uremic syndrome (D59.3 series)
- Expansion of the codes for Von Willebrand disease (D68.0 series)
- Several new codes describing short stature (E34.3 series)
- Expansion of the acidosis codes (E87.2 series)
- New codes describing use of alcohol, opioids, cannabis, cocaine, and other substances (F10.9 series)
- Codes added that describe limb girdle muscular dystrophy (G71.03 series)
- An expansion of the atherosclerosis category (I25.- series)
- New codes describing muscle wasting of the back (M62.5A series)
- More than 20 additional codes describing slipped upper femoral epiphysis (M93.0 series)
- New codes for newborn sleep disorders (P28.- series)
- Patient noncompliance with provider’s orders (Z91.1 series)
To get a firm grasp of all of the new ICD-10-CM code changes and guideline shifts that hit Oct. 1, 2023, check out the online training session, New 2023 ICD-10-CM Codes, presented by Kim Huey MJ, CHC, CPC, CCS-P, PCS, CPCO. During the 60-minute training, you’ll find out which new codes are debuting, which are being deleted, and which guideline updates you must know to submit clean claims.
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