Radiology Coding Alert

Get ready for October 1 code changes.

In addition to pumpkins, hot apple cider, and falling leaves, medical coders can look forward to new ICD-10-CM codes as the calendar turns to autumn. The 2024 ICD-10-CM code set features 501 new and 26 revised codes, and radiology coders should sit up and take notice of the updates to the code set.

Luckily, Radiology Coding Alert experts have pored over the hundreds of new and revised codes to deliver the news you need to know.

Observe New Osteoporosis Codes

Providers perform dual-energy X-ray absorptiometry (DXA) scans to help determine a patient’s fracture risk and allow providers to diagnose several bone-related health problems, such as osteoporosis. The 2024 ICD-10-CM code set includes several new pelvic osteoporosis with current pathological fracture codes.

The two new code subcategories covering the diagnoses include:

• M80.0B- (Age-related osteoporosis with current pathological fracture, pelvis)
• M80.8B- (Other osteoporosis with current pathological fracture, pelvis)

“The differences between code subcategories M80.0B- and M80.8B- involve the cause of the osteoporosis,” says Taylor Berrena, COC, CPC, CPB, CRC, CPMA, CEMC, CFPC, CHONC, coder II at MD Anderson Cancer Center at Cooper in Yorktown, Virginia.

Remember: A pathological fracture is a type of fracture that occurs in a bone that has been weakened by an underlying disease or condition. This fracture is different from a typical fracture that occurs due to trauma or injury. In a pathological fracture, the bone breaks more easily because it has been compromised by an existing condition, such as osteoporosis or a tumor.

You’ll report M80.8B- “if the cause of the osteoporosis is for a reason other than the natural aging process, such as if it is due to drugs, disuse, following a postoophorectomy, due to postsurgical malabsorption, following a traumatic injury, or for another reason per the ICD-10-CM code set instructional notes,” Berrena says.

You’ll need 6th and 7th characters to complete each code in the subcategories. The 6th character indicates the laterality of the fracture — “1” for right pelvis, “2” for left pelvis, and “9” for unspecified pelvis.

The 7th character designates the type of encounter or if the patient is experiencing a late effect. You’ll choose from the following 7th character options to complete your code:

• A = initial encounter for fracture
• D = subsequent encounter for fracture with routine healing
• G = subsequent encounter for fracture with delayed healing
• K = subsequent encounter for fracture with nonunion
• P = subsequent encounter for fracture with malunion
• S = sequela

Report Contrast Adverse Effects Starting October 1

Radiology coders should also pay attention to the code additions in the Table of Drugs and Chemicals. Effective October 1, you can report unintended reactions of gadolinium in the patient with T56.82- (Toxic effect of gadolinium).

Depending on the type of reaction, you’ll assign one of the following codes:

• T56.821- (Toxic effect of gadolinium, accidental (unintentional))
• T56.822- (Toxic effect of gadolinium, intentional self-harm)
• T56.823- (Toxic effect of gadolinium, assault)
• T56.824- (Toxic effect of gadolinium, undetermined)

Note: Each of the codes listed above require a 7th character to be completed. You’ll need to choose between 7th characters A, D, and S to complete the code.

Gadolinium is a contrast agent that providers use in magnetic resonance imaging (MRI) and other imaging scans to help make abnormal tissue easier to visualize on the scans. The provider will inject gadolinium-based contrast agents (GBCAs) into the patient’s bloodstream to enhance the visibility of certain tissues or blood vessels during an MRI scan. These contrast agents contain gadolinium ions that interact with the magnetic field of the MRI machine, producing a clearer and more detailed image.

Adding T56.82- to the 2024 ICD-10-CM code set could be a result of the potential risks of the heavy metal contrast.

“I believe this stems from the U.S. Food and Drug Administration (FDA) report requiring new class warnings and other safety measures for all gadolinium-based contrast agents. It was determined gadolinium stays in the patient’s body for months to years after being received and has been linked to adverse health effects in patients with kidney issues,” says Kristen R. Taylor, CPC, CHC, CHIAP, associate partner of Pinnacle Enterprise Risk Consulting Services.

Determine How to Report Desmoid Tumor Diagnoses

Desmoid tumor is another new code subcategory in the 2024 code set. A Desmoid tumor is a rare type of tumor that develops in the connective tissue, which is the tissue that supports and connects various structures in the body. These tumors can occur anywhere in the body, but they most commonly develop in the abdominal wall, shoulder, or thigh. Radiologists may use computed tomography (CT), magnetic resonance imaging (MRI), or ultrasound imaging scans to evaluate the tumor’s location and its size.

If your provider issues a finding of a Desmoid tumor, you’ll assign one of the following codes from the D48.11- (Desmoid tumor) code subcategory, depending on the affected body area:

• D48.110 (Desmoid tumor of head and neck)
• D48.115 (Desmoid tumor of upper extremity and shoulder girdle)
• D48.116 (Desmoid tumor of lower extremity and pelvic girdle)
• D48.117 (Desmoid tumor of back)
• D48.118 (Desmoid tumor of other site)
• D48.119 (Desmoid tumor of unspecified site)