Otolaryngology Coding Alert

Start preparing now, so you’re ready to hit the ground running come October.

It’s that time of year again. The ICD-10-CM annual updates are out, and with hundreds of new and revised codes joining the code set later this year, there’s a lot to unpack before the calendar flips to Oct. 1, 2023.

The nitty gritty: The changes unveiled for fiscal year (FY) 2024 include 395 codes added, 25 existing codes deleted, and 22 code revisions (nine of which are to the short title only). There are also 131 new headers and four revised headers.

Even though otolaryngology isn’t affected as much as other specialties, there are still a few very important additions and revisions for you to consider, as your providers likely manage and treat chronic migraines and foreign body-related complaints. Here’s an overview of key changes you should be familiar with come October.

Navigate New Neurology-Related Codes

ICD-10-CM 2024 introduces 24 new codes to Chapter 6: Diseases of the Nervous System. Many of the new codes added will enable the identification of known conditions with improved specificity.

Parkinson’s disease: The updates include five new codes to report Parkinson’s disease (G20), which will boost code specificity by adding information about dyskinesia and fluctuations.

• G20.A- (Parkinson’s disease without dyskinesia)

o G20.A1 (Parkinson’s disease without dyskinesia, without mention of fluctuations)

o G20.A2 (Parkinson’s disease without dyskinesia, with fluctuations)

• G20.B- (Parkinson’s disease with dyskinesia)

o G20.B1 (Parkinson’s disease with dyskinesia, without mention of fluctuations)

o G20.B2 (Parkinson’s disease with dyskinesia, with fluctuations)

• G20.C (Parkinsonism, unspecified)

Analysis: Remarkably, G20 was the only code for Parkinson’s disease in the ICD-10-CM code book before 2024. These updates will make Parkinson’s coding more specific by adding information about dyskinesia and fluctuations.

According to Gregory Przybylski, MD, chairman of neuroscience at the New Jersey Neuroscience Institute, JFK University Medical Center in Edison, New Jersey, any expansion of the Parkinson’s codes is a positive.

“Greater specificity in Parkinson’s disease is helpful in tracking treatments of this condition. Given that Parkinson’s disease has several manifestations in a patient’s condition and function, greater granularity in the diagnosis codes will help track how the various manifestations of Parkinson’s disease respond to various treatments,” he says.

Chronic migraine with aura: Since otolaryngologists are often the go-to for severe headaches caused by inner ear disease, sinus pressure, and other related conditions, you won’t want to miss the new codes under G43.E- (Chronic migraine with aura) for reporting chronic migraine:

• G43.E0 (Chronic migraine with aura, not intractable)

o G43.E01 (Chronic migraine with aura, not intractable, with status migrainosus)

o G43.E09 (… without status migrainosus)

• G43.E1 (Chronic migraine with aura, intractable)

o G43.E11 (Chronic migraine with aura, intractable, with status migrainosus)

o G43.E19 (… without status migrainosus)

Analysis: The new migraine codes add another layer to the already deep field of G43.- (Migraine) codes. Before 2024, chronic migraine with aura did not have its own code set. Starting Oct. 1, you’ll be able to code for chronic migraine with aura, and you can further specify that diagnosis by answering the intractable/not intractable and status migrainosus questions.

To correctly code chronic migraine with maximum specificity the documentation must include the following details, according to Barbara J. Cobuzzi MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, CMCS, of Tinton Falls, New Jersey:

• Presence or absence of migraine aura
• Whether the migraine is intractable or not intractable
• Whether the patient has status migrainous at the time the provider is seeing them

Examine External Causes ‘Foreign Body Entering Orifice’ Codes

Most of the diagnosis code additions fall under added category W44 (Foreign body entering into or through a natural orifice) in Chapter 20: External Causes of Morbidity. The expansion provides 123 new codes you can report to capture accidents and injuries involving foreign bodies — batteries, plastic objects, glass, magnetic and non-magnetic metal items, rubber bands, food, insets, audio device, etc. — that enter or pass through a natural orifice.

As with most external cause codes, you’ll add a 7th character to these new codes to indicate the type of encounter: A (... initial encounter), D (… subsequent encounter), or S (… sequela).