Get ready for ICD-10 CM 2021 changes – PART 2

Please refer “Get ready for ICD-10 CM 2021 changes – PART 1” in the below link:

https://medscorecoding.com/blogs/f/get-ready-for-icd-10-cm-2021-changes-%E2%80%93-part-1

Diseases of the eye and adnexa (H00-H59):

There are 7 codes deleted, 29 codes added and one code revised in this chapter. The major change occurred in the section of “Hereditary corneal dystrophies” for which the current codes do not have the laterality specifications in its description. Code H18.5 is expanded further to specify the laterality.

Hereditary corneal dystrophies H18.5 – Deleted code

Deleted codes

H18.50 Unspecified hereditary corneal dystrophies

H18.51 Endothelial corneal dystrophy

H18.52 Epithelial (juvenile) corneal dystrophy

H18.53 Granular corneal dystrophy

H18.54 Lattice corneal dystrophy

H18.55 Macular corneal dystrophy

H18.59 Other hereditary corneal dystrophies

New codes:

Below are the new codes to specify the laterality as right eye, left eye and bilateral in the code description.

H18.501 Unspecified hereditary corneal dystrophies, right eye

H18.502 Unspecified hereditary corneal dystrophies, left eye

H18.503 Unspecified hereditary corneal dystrophies, bilateral

H18.509 Unspecified hereditary corneal dystrophies, unspecified eye

H18.511 Endothelial corneal dystrophy, right eye

H18.512 Endothelial corneal dystrophy, left eye

H18.513 Endothelial corneal dystrophy, bilateral

H18.519 Endothelial corneal dystrophy, unspecified eye

(Please refer https://www.cms.gov/medicare/icd-10/2021-icd-10-cmfor full set of new codes)

Irregular eye movement H55.8

There is one code revised and one new code added for the anomalies of smooth pursuit movements (eye). Currently, a deficient smooth pursuit eye movementis reported with ICD-10-CM code H55.89, Other irregular eye movement. To better capture this condition, a new code is created as per the proposals made by American optometric Association.

Revised code:

Revise from: H55.81 Saccadic eye movements

Revise to: H55.81 Deficient saccadic eye movements

New code:

H55.82 Deficient smooth pursuit eye movements

Diseases of the ear and mastoid process (H60-H95):

There are no codes added, deleted or revised in this chapter.

Diseases of the circulatory system (I00-I99)

A big relief to all the coders! There are no codes added, deleted or revised in this chapter as we report most of the codes from this chapter in our daily production hours.

Diseases of the respiratory system (J00-J99)

There are 2 codes deleted, 6 new codes added and 0 revised codes.

Pulmonary eosinophilia, not elsewhere classified: J82 – Deleted code

Code J82 is deleted and a new subcategory J82.8 is introduced to identify the specific types of eosinophilia such as acute and chronic eosinophilic pneumonia.

New codes:

J82.81 Chronic eosinophilic pneumonia

J82.82 Acute eosinophilic pneumonia

J82.83 Eosinophilic asthma

J82.89 Other pulmonary eosinophilia, not elsewhere classified

Other interstitial pulmonary diseases with fibrosis in diseases classified elsewhere: J84.17 – Deleted code

Code J84.17 is deleted and expanded into two new codes as below:

New codes:

J84.170 Interstitial lung disease with progressive fibrotic phenotype in diseases classified elsewhere

J84.178 other interstitial pulmonary diseases with fibrosis in diseases classified elsewhere

Diseases of the digestive system (K00-K95):

There are 5 codes deleted, 11 new codes added and 0 revised code.

Currently there is an existing combination code for ulcerative esophagitis with bleeding at code K22.11; however, there are no combination codes for bleeding associated with reflux esophagitis, specified esophagitis NEC, and unspecified esophagitis. The current codes K20.8 and K20.9 do not describe the presence of bleeding in its code description. Therefore these codes are deleted and expanded into new codes to describe the presence of bleeding in its description.

Other esophagitis K20.8 – Deleted code

New codes:

K20.80 Other esophagitis without bleeding

K20.81 Other esophagitis with bleeding

Esophagitis, unspecified K20.9 – Deleted code

New codes:

K20.90 Esophagitis, unspecified without bleeding

K20.91 Esophagitis, unspecified with bleeding

Gastro-esophageal reflux disease with esophagitis K21.0 – Deleted code

Under K21.0 Gastro-esophageal reflux disease with esophagitis, the associated condition “reflux esophagitis” is deleted and two new codes are added to identify the condition more clearly as with or without bleeding:

New codes:

K21.00 Gastro-esophageal reflux disease with esophagitis, without bleeding K21.01 Gastro-esophageal reflux disease with esophagitis, with bleeding

Other specified functional intestinal disorders K59.8 – Deleted code

Code K59.8 is deleted and expanded into two new codes, one code to identify the condition of Ogilvie syndrome and other one to denote the other specified disorders. Ogilvie’s syndrome, also known as acute colonic pseudo-obstruction, refers to pathologic dilation of the colon without underlying mechanical obstruction, occurring primarily in patients with serious comorbidities. Currently there is no unique code to identify this syndrome and therefore coders used K59.8 to represent this condition. But now, this code has been deleted and a new code K59.81 is added to accurately identify the condition of “Ogilvie syndrome”.

New codes:

K59.81 Ogilvie syndrome

K59.89 Other specified functional intestinal disorders

Hepatic fibrosis K74.0 – Deleted code

Nonalcoholic steatohepatitis (NASH) is a disease that causes fat to build up in the liver, leading to inflammation and fibrosis. Hepatic fibrosis on advanced stage can ultimately lead to liver cirrhosis and failure. The NASH Clinical Research Network (CRN) staging system established a classification that evaluates fibrosis stage from F0 to F4 as follows:

F0 – no fibrosis;

F1 – perisinusoidal or periportal;

F2 – perisinusoidal and portal/periportal;

F3 – bridging fibrosis or pre-cirrhosis; and

F4 – cirrhosis

Liver biopsy has been the gold standard for estimating the extent of inflammation and fibrosis, although the procedure has limitations such as sampling error and variability.

However, there are now non-invasive tests that can be used for assessment of the stages of hepatic fibrosis. These will be helpful in detecting and differentiating early and advanced fibrosis.

Currently there is only one code K74.0 to identify the hepatic fibrosis condition. Therefore proposals were made by the Global Liver Institute, to create specific codes for hepatic fibrosis to differentiate between early and advanced fibrosis, along with a note for these to be coded with NASH.

New codes:

K74.00 Hepatic fibrosis, unspecified

K74.01 Hepatic fibrosis, early fibrosis

Hepatic fibrosis, stage F1 or stage F2

K74.02 Hepatic fibrosis, advanced fibrosis

Hepatic fibrosis, stage F3

Diseases of the skin and subcutaneous tissue (L00-L99):

There are no codes added, deleted or revised in this chapter

Diseases of the musculoskeletal system and connective tissue (M00-M99):

There are 3 codes deleted, 57 new codes added and 0 revised codes.

The deleted code M92.5 Juvenile osteochondrosis of tibia and fibula incorporated two conditions Blount disease and Osgood-schlatter in its category. However these conditions are quite dissimilar in character, prognosis and treatment. Therefore American Academy of Orthopedic Surgeons (AAOS) has requested modifications to the category M92.5 to better distinguish the difference between the two conditions, Blount disease and Osgood-schlatter with the addition of new codes.

Juvenile osteochondrosis of tibia and fibula: M92.5 – Deleted code

Osteochondrosis (juvenile) of proximal tibia [Blount]

Osteochondrosis (juvenile) of tibial tubercle [Osgood-Schlatter]

Tibia vara

Deleted codes:

M92.50 Juvenile osteochondrosis of tibia and fibula, unspecified leg

M92.51 Juvenile osteochondrosis of tibia and fibula, right leg

M92.52 Juvenile osteochondrosis of tibia and fibula, left leg

New codes:

M92.501 Unspecified juvenile osteochondrosis, right leg

M92.502 Unspecified juvenile osteochondrosis, left leg

M92.503 Unspecified juvenile osteochondrosis, bilateral leg

M92.509 Unspecified juvenile osteochondrosis, unspecified leg

M92.511 Juvenile osteochondrosis of proximal tibia, right leg

M92.512 Juvenile osteochondrosis of proximal tibia, left leg

M92.513 Juvenile osteochondrosis of proximal tibia, bilateral

M92.519 Juvenile osteochondrosis of proximal tibia, unspecified leg

M92.521 Juvenile osteochondrosis of tibia tubercle, right leg

M92.522 Juvenile osteochondrosis of tibia tubercle, left leg

M92.523 Juvenile osteochondrosis of tibia tubercle, bilateral

M92.529 Juvenile osteochondrosis of tibia tubercle, unspecified leg

M92.591 Other juvenile osteochondrosis of tibia and fibula, right leg

M92.592 Other juvenile osteochondrosis of tibia and fibula, left leg

M92.593 Other juvenile osteochondrosis of tibia and fibula, bilateral

M92.599 Other juvenile osteochondrosis of tibia and fibula, unspecified leg

Joint related disorders:

There are numerous codes added to reflect “other specified site” in the categories of rheumatoid arthritis, osteoarthritis, pathological and recurrent dislocation, contracture, ankylosis, instability, pain and stiffness of joint.

New subcategories of M26.64 and M26.65 with further expansion of codes to specify the laterality are added to reflect the condition of arthritis and arthropathy of temporomandibular joint respectively.

Based on the proposals of The American Association of Oral and Maxillofacial Surgeons

new codes are created for pathological fracture of “other specified site” due to age-related osteoporosis and pathological fracture of “other specified site” due to drug-induced osteoporosis.

Diseases of the genitourinary system (N00-N99):

There are 15 new codes added, one code deleted, and 0 revised codes.

Chronic kidney disease, stage 3 (moderate): N18.3 – Deleted code

The most frequently used code CKD, stage 3 is now deleted and expanded into three new codes to capture additional stage 3 details. Generally the stages of kidney disease are based on the eGFR number (estimated glomerular filtration rate) which can be predicted using the blood test for creatinine. Stage 3 CKD refers to an eGFR between 30 and 59 which is separated further into two stages:

Stage 3a: It refers to stage having an eGFR between 45 and 59

Stage 3b: It refers to stage having an eGFR between 30 and 44

New codes:

N18.30 Chronic kidney disease, stage 3 unspecified

N18.31 Chronic kidney disease, stage 3a

N18.32 Chronic kidney disease, stage 3b

New codes for Nephritic syndrome with C3 glomerulonephritis:

C3 glomerulopathy (C3G), a newly classified kidney disorder is characterized by the deposition of complement component 3(C3) within the glomeruli. It is comprised of two distinct clinical subtypes: C3 glomerulonephritis (C3GN) and dense deposit disease (DDD). Currently you have the codes to represent the subtype DDD, however there are no specific codes to represent the subtype C3GN. Therefore several new codes are added to specifically identify the C3GN subtype.

N00.A Acute nephritic syndrome with C3 glomerulonephritis

N01.A Rapidly progressive nephritic syndrome with C3 glomerulonephritis

N02.A Recurrent and persistent hematuria with C3 glomerulonephritis

N03.A Chronic nephritic syndrome with C3 glomerulonephritis

N04.A Nephrotic syndrome with C3 glomerulonephritis

N05.A Unspecified nephritic syndrome with C3 glomerulonephritis

N06.A Isolated proteinuria with C3 glomerulonephritis

N07.A Hereditary nephropathy, not elsewhere classified with C3 glomerulonephritis

New codes for Granulomatous Mastitis:

Granulomatous mastitis (GM) is a rare benign inflammatory breast disease that affects mostly women of childbearing age with a history of breastfeeding. Though the etiopathogenesis is still unknown, the inflammation could be the result of a reaction to trauma, metabolic or hormonal processes, autoimmunity and an infection with corynebacterium kroppenstedtii. The current codes in ICD-10 CM reflect the other types of mastitis and new codes are added to identify the diagnosis of granulomatous mastitis.

N61.20 Granulomatous mastitis, unspecified breast

N61.21 Granulomatous mastitis, right breast

N61.22 Granulomatous mastitis, left breast

N61.23 Granulomatous mastitis, bilateral breast

Stay connected for PART 3….

Happy learning! Happy coding!

Resources:

cms.gov/medicare/acute-inpatient-pps/fy-2021-ipps-proposed-rule-home-page

https://pbn.decisionhealth.com/Blogs/Detail.aspx?id=200896
https://www.cdc.gov/nchs/icd/icd10cm_maintenance.htm

Leave a Reply