Every medical coder and biller knows that the best way to justify medical necessity in your claims system is to use the right diagnosis codes. And while the 2024 ICD-10-CM codes were released last fall, CMS recently issued an April update that could turn your coding processes upside-down.
Check out several April 2024 ICD-10-CM changes that you must know if you want to keep collecting for your services.
Look for New Instructions on Asthma Coding
If your practice sees patients with asthma or pneumonia, it’s a good idea to take note of the changes in chapter 10 of the ICD-10-CM code set. For example, if you look at J45 (Asthma), you’ll see that several of the Excludes2 notes have been revised, and other COPD (J44.89) has been added to the Excludes2 list.
In addition, you may be familiar with the Excludes1 note under the J12 (Viral pneumonia, not elsewhere classified) listing. This included exclusions for such conditions as congenital pneumonia, lipid pneumonia, aspiration pneumonia and more. However, that’s about to change. CMS has adjusted that and changed it to an Excludes2 note.
Why this matters: An Excludes1 note differs from an Excludes2 note in a significant way. With an Excludes1 listing, you should never report the codes together, whereas you may be able to report them together if they’re listed as an Excludes2 note.
For instance: Suppose a patient presents to your office with viral pneumonia. You’ve already been treating that patient for congenital pneumonia, which means they likely have a chronic case of congenital pneumonia and an acute case of viral pneumonia. In the past, you wouldn’t have been able to report both due to the Excludes1 note, but now that CMS has changed it to an Excludes2 note, you may be able to report both ICD-10-CM codes if the documentation supports it.
Clarify Mpox Code
If you’re accustomed to searching for an Mpox code and coming up short, that’s because the ICD-10-CM code set didn’t include this term. It does include the full name of Monkeypox (B04), but many coders search it using the abbreviation because that’s how physicians document it in the medical record.
That’s about to change, with the ICD-10-CM now adding the word Mpox under the code listing for B04, so whether you search for the full word or the abbreviation, you’ll be able to find the right code.
Optimize Sepsis Coding With Updated Guidelines
If you see a patient with sepsis due to a postprocedural infection, it’s important to know how the April 2024 ICD-10-CM changes will impact your code sequencing decision. CMS provides additional options, with the changes in bold, as follows:
“For sepsis following a postprocedural wound (surgical site) infection, a code from T81.41 to T81.43, Infection following a procedure, T81.49, Infection following a procedure, other surgical site, or a code from O86.00 to O86.03, Infection of obstetric surgical wound, or code O86.09, Infection of obstetric surgical wound, other surgical site, that identifies the site of the infection should be sequenced first, if known.”
For example, suppose you treat a patient who has sepsis due to an infection following childbirth. In this case, you might report O86.09 followed by T81.49 on your claim form.
Mid-year is a great time to ensure that you’re up-to-date on all of the latest ICD-10-CM codes. Get a comprehensive look at this year’s code set with key tips from coding expert Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, during her online training, Don’t Miss the 2024 ICD-10-CM Codes. Register today!
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