Code changes for ICD-10 documents effective October 2022.
Question: What are the new documentation codes for 2023?
Answer: The Centers for Disease Control and Prevention (CDC) released the 2023 ICD-10-CM code updates on June 9, 2022, which includes 1,176 new, 28 revised, and 287 deleted codes for use in patient meetings and hospital discharges from October 1, 2022 Until September 30, 2023. Applies to all insurance companies, whether you are a Medicare, Medicaid, Tricare, or business payer. So let’s separate reviews, deletions, and additions to help you prepare.
New dementia codes
The expansion of dementia codes came from a request at the September 2021 CDC Coordination and Maintenance Committee meeting ICD-10-CM, the National Minority Quality Forum (NMQF) requesting the expansion of dementia codes to include stage, severity, and identification of behavioral and psychological symptoms of dementia. According to the NMQF, “Both of these two clinical components are key factors in patient management strategies.” As a result, the 2023 ICD-10 code set now includes approximately 100 new related codes that you can now report for conditions such as vascular dementia (F01. and dementia indeterminate (F03.9-F03.C4).
New guidelines for reporting dementia emphasize that caregivers must clearly document the severity of a patient’s condition. If the documentation is incomplete, the programmer must query the provider or the appropriate undefined token default. The updated guidelines also instruct that if a patient with dementia is admitted to an inpatient facility and their condition worsens during their stay, the programmer should set the highest reported severity level during the stay.
At the Centers for Disease Control and Prevention meeting, the committee provided the following clarifications to help determine the stage of dementia.
mild dementia: A clearly visible functional effect on daily life, mainly affecting mechanistic activities. No longer fully independent/requires occasional help with activities of daily living.”
mild dementia: “Extensive functional impact on daily life with impairment in basic activities. No longer independent and requiring frequent assistance in activities of daily living.”
Severe dementia “Clinical interview may not be possible. Complete dependence due to severe functional impact on daily life with impairment in basic activities, including basic self-care.”
Some of the specific new dementia codes include:
- F02.811, Dementia in other diseases classified elsewhere, severity not specified, with agitation
- F02.A11 Dementia in other diseases classified elsewhere, mild, with agitation
- F02.B11, Dementia in other diseases classified elsewhere, moderate, with agitation
Endometriosis code expansion
For providers reviewing endometriosis or maternal care, there are now approximately 400 new icons representing obstetrics. The American College of Obstetricians and Gynecologists (ACOG) has proposed an expansion of the endometriosis section of the ICD-10-CM codec, and you will now see several new endometriosis codes with more specification of the details of whether the condition is superficial or deep. The definitions below will be crucial in choosing the right code:
Superficial endometriosisAn ectopic growth of endometrial tissue that extends 5 mm or less below the peritoneal surface. Lesions can vary in number (single or in multiple locations).
Deep endometrial infiltrationAn ectopic growth of endometrial tissue more than 5 mm below the peritoneal surface. Lesions can vary in number (single or in multiple locations). These lesions are usually associated with deep fibrosis and adhesions.
If you don’t see the terms “deep” or “superficial” in your doctor’s notes, look for any indication of how far the tissue extends beneath the peritoneal surface. This will be essential in selecting the correct code under the new 2023 ICD-10-CM codes. For example, you will report superficial endometriosis of the right ovary with N80.111, and deep endometriosis of the right ovary will be coded as N80.121.
ACOG and the Society for Maternal Fetal Medicine (SMFM) have also requested new codes for fetal malformations (eg, central nervous system (CNS) malformations, chromosomal abnormalities, fetal anomalies and damages). According to these groups, “This proposal will enable the tracking, measurement and eventual improvement of treatment methods for specific fetal abnormalities.”
Explanation of loss of consciousness
For concussion and brain injury codes (for example, concussions, bruises, TBI, blast injuries and hemorrhages), more than 100 new 2023 ICD-10-CM codes have been added in S06 (intracranial injuryAccording to the American Academy of Pediatrics (AAP), patients often have injuries coded S06 without a clear history of loss of consciousness (LOC), so they asked for new codes that include identifying the LOC and, if present, how long it lasted.
With the addition of the LOC, you will need to know if the patient has lost consciousness in order to determine the correct diagnostic code, for example, if the patient has lost consciousness due to a concussion, it will report a code from the S06.0XA string, while the injury Initial brain loss of 30 minutes or less will move to code set S06.8A1, here are some specific examples:
- S06.0XAA Concussion with loss of consciousness Unknown condition Initial encounter
- S06.0XAD, concussion with loss of consciousness Unknown condition, subsequent encounter
- S06.0XAS, concussion with loss of consciousness condition unknown, result
New meth overdose codes
You’ll find a new code class that describes methamphetamine poisoning, as well as codes for adverse effects related to methamphetamine use. In the past, programmers who reported methamphetamine overdoses had to report these services to the generic “amphetamine” category, but the use of this code made it difficult for public health authorities to track methamphetamine overdoses.
You will find new codes in this category under the new T43.65 (Intoxication with adverse effects and methamphetamine underdose resulting from self-harm or assault) Domain. To report it accurately, you must find in the registry if the overdose was accidental, was, or if the condition was unspecified. These factors will be necessary to allow you to select the correct code.
additional new icons
In addition to the new 2023 ICD-10-CM codes described above, there are several code changes that affect nearly every discipline. Take some time to review the following:
The CDC’s comprehensive ICD-10-CM list can be found here.
Renee Dowling is a compliance auditor at Sansum Clinic, LLC, in Santa Barbara, California.