Pain Management Coding Alert

New ICD-10 allows you to specify patient’s stage of remission.

There’s a new list of ICD-10 codes for 2018, and pain management coders will have to pay attention once again.

The World Health Organization (WHO) added thousands of new and revised codes to the ICD-10 2018 manual, which becomes effective on October 1, 2017.

How many? The WHO added a 3,500 new diagnosis codes to the manual. It also revised 1,800-plus codes and deleted nearly 650 diagnoses. In its 2018 form, ICD-10 will contain 78,705 codes.

While PM coders will have to wrangle with several new codes, many changes to ICD-10 are more subtle; many of the descriptors below already existing codes will expand for greater specificity.

The changes to these codes provide “clarity in guidance for using existing codes,” explains Jan Blanchard, CPC, CPMA, consultant at Vermont-based PCC.

Don’t get overwhelmed by the flurry of activity; the WHO adds codes each year, thus making it easier for coders to paint a complete picture of a patient’s condition. All coders need to do is listen to what the experts say, study up on the new codes relevant to their practices, and be ready to use the new ICD-10 codes before autumn rolls around.

ICD-10 Substance Use Dx Adds Detail

The new ICD-10 edition puts a lot more detail into the code set F10-F19 (Mental and behavioral disorders due to psychoactive substance use) — both in the form of expanded descriptors and new codes.

“The addition of the new ICD-10 codes within Chapter 5 [F10-F19] will allow coders to choose more specific alcohol, drug, and tobacco abuse codes pertaining to state of remission,” reports Yvonne Dillon, CPC, CEDC, director of emergency department services at Bill Dunbar and Associates, LLC in Indianapolis, Indiana.

Cynthia A. Swanson, RN, CPC, CEMC, CHC, CPMA, senior manager of healthcare consulting for Seim Johnson in Omaha, Nebraska, agrees, further explaining that “the addition of the 2018 ICD-10-CM code revisions continue to enhance proper diagnosis coding by incorporating greater clinical details and specificity. Terminology and disease classification updates are more consistent with current clinical practice,” she says.

“Additionally, the updates allow for better data collection and accuracy of patient information,” relays Swanson.

New codes: In 2018, the new codes you’ll want to note include:

• F10.11, Alcohol abuse, in remission
• F11.11, Opioid abuse, in remission
• F12.11, Cannabis abuse, in remission
• F13.11, Sedative, hypnotic or anxiolytic abuse, in remission
• F14.11, Cocaine abuse, in remission
• F15.11, Other stimulant abuse, in remission
• F16.11, Hallucinogen abuse, in remission
• F18.11, Inhalant abuse, in remission
• F19.11, Other psychoactive substance abuse, in remission

Impact: You’ll now be able to more accurately pinpoint the stage of the patient’s substance abuse and recovery. This will give coders yet another tool in the fight to keep their patients’ progress toward recovery on track, says Swanson.

“The new codes will provide greater specificity and clinical accuracy of the patient’s diagnosis,” she says.

Enhanced Descriptors Grace Several Existing Codes

Again, in the F10-F19 section of ICD-10 2018, you’ll find expanded descriptors for many codes. As is the case with new codes, these descriptors will help you pinpoint the location of your patients’ abuse issues.

Example: While the F13.21 (Sedative, hypnotic or anxiolytic dependence, in remission) code has not changed on the surface, notes below it will read thusly in 2018:

• Sedative, hypnotic or anxiolytic use disorder, moderate, in early remission
• Sedative, hypnotic or anxiolytic use disorder, moderate, in sustained remission
• Sedative, hypnotic or anxiolytic use disorder, severe, in early remission
• Sedative, hypnotic or anxiolytic use disorder, severe, in sustained remission

In 2017, there were no notes below F13.21, leaving coders at a loss to explain:

• The severity of the patient’s disorder and
• The patient’s remission status.

There will also be similarly expanded code descriptors for many codes in the F10-F19 set, allowing you to paint a better picture of your patients struggling with substance abuse.