Radiology Coding Alert

Hit the ground running in October by planning ahead for these ICD-10 changes.

Oct. 1, 2017 will bring about another set of new and revised code changes to the CMS 2018 ICD-10-CM.

Specifically, you will be required to incorporate 363 new codes, 142 deletions, and more than 250 revised codes into your coding repertoire. While this year offers substantially fewer new diagnosis codes than last year, there’s enough radiology-relevant material that you should consider beginning your 2018 ICD-10 preparations sooner, rather than later.

Read on for the most pertinent, specialty-specific changes to the ICD-10-CM.

New Codes You Should Know

You can make a case that almost all of the newly proposed diagnosis codes apply to the radiology specialty. This list of codes incorporates almost every anatomical site in the body. You will find some codes to be entirely new additions to the ICD-10-CM, but keep an eye out for other codes that have only changed the descriptor, not the actual code itself. Consider this list of new radiology-specific codes you’ll likely be using with a high degree of frequency:

All Substance Abuse Codes Now Include Remission

One of the more discussed changes to the ICD-10-CM is the addition of remission codes for substance abuse diagnoses, rather than substance dependence diagnoses. This will require physicians and practitioners to include a greater degree of detail when documenting a patient’s substance abuse and/or dependence.

A strong understanding on how to differentiate between abuse and dependence is also important. “Substance abuse and substance dependence are two very different things,” explains Amanda Corney, MBA, medical billing operations manager for Medical Resources Management in Rochester, New York. “ICD-10 defines abuse (or harmful use) as ‘a pattern of psychoactive substance use that is causing damage to health.’ On the other hand, a patient dependent on a substance will exhibit ‘a cluster of physiological, behavioral, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviors that once had greater value,’” Corney relays.

As for remission, ICD-10 does not offer any strict set of criteria to determine when a patient achieves remission. Following the guidelines provided by the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), a provider can code remission status if no criteria for dependence or abuse has been met for at least one month.

Codes: ICD-10 2018 lists these codes for substance abuse under “In remission (early) (sustained)”:

• F10.10, Alcohol abuse (non-dependent)
• F11.11, Opioid abuse
• F12.11, Cannabis abuse
• F13.11, Sedative abuse, hypnotic or anxiolytic abuse
• F14.11, Cocaine abuse
• F15.11, Stimulant abuse
• F16.11, Hallucinogen abuse
• F18.11, Inhalant abuse

Note Subtle Changes in Prophylactic Organ Removal Admissions

Two new prophylactic measure codes will also be incorporated beginning in October. What was once formerly admission for sole removal of the ovaries will now include the removal of the fallopian tubes and/or ovaries.

Codes: ICD-10 2018 lists these codes for fallopian tube removal under “Admission (for)”:

• Z40.03, Fallopian tube removal
• Z40.02, Fallopian tube removal, with ovaries

Look for 2 New Apnea Codes

You will want to take note of two specific changes when coding apnea of any specified nature. Primary central sleep apnea now comes with an idiopathic label, when documented, along with the addition of an entirely new diagnosis code for hypopnea.

Codes: ICD-10 2018 lists these codes for “Apnea, apneic (of) (spells)”:

• G47.31, Idiopathic primary central sleep apnea
• G47.33, Hypopnea

Neonatal Encephalopathy Gets its Own Code

What coders previously had to document as P91.60 (Hypoxic ischemic encephalopathy [HIE], unspecified), nontraumatic neonatal encephalopathy now gets its own set of P codes. You’ll want to code P91.811 when the physician documents any origin of the encephalopathy other than birth trauma.

Codes: ICD-10 2018 lists these codes under “Encephalopathy (acute)”:

• P91.819, Neonatal encephalopathy, unspecified
• P91.811, Neonatal encephalopathy in diseases classified elsewhere

ICD-10 to Designate MI by Type

As of Oct. 1, coding myocardial infarctions (MIs) will now give you the option to differentiate by type, when the physician specifies type. In fact, the name designation will change entirely from “ST elevation and non-ST elevation myocardial infarction” to simply “Myocardial infarction.”

Codes: ICD-10 2018 lists these codes under “Infarct, infarction”:

• 121.9, Type 1 myocardial infarction
• 121.A1, Type 2 myocardial infarction
• 121.A9, Types 3, 4, and 5 myocardial infarction