What happened?
Every year, the World Health Organization (WHO) revises and publishes updates to the ICD-10-CM diagnosis codes. These updates are effective October 1 – September 30. In addition to the ICD-10-CM updates, the Centers for Medicare and Medicaid Services (CMS) and the National Center of Health Statistics (NCHS) provide updates to the Official Guidelines for Coding and Reporting. The guidelines are also approved by the American Hospital Association (AHA) and the American Health Information Management Association (AHIMA).
The updates to the ICD-10-CM codes for FY 2023 include 1,176 new healthcare codes. In addition to the new codes added, the WHO has also deleted 287 diagnosis codes and revised 28. Several of these updates will likely impact Risk Adjustment and HCC diagnosis codes.
ICD-11 is the future and was endorsed by the WHO in 2019 and came into effect in January 2022. However, the U.S. has not currently implemented this code set.
Why is it important?
The transition from a fee-for-service to a value-based healthcare model has driven many of these updates. The new reimbursement model is based upon the quality of care provided. To accurately reflect and capture the acuity of the patient and care provided, the enfaces is on more complete documentation with greater focus on ICD-10-CM code specificity.
Complete and detailed documentation leads to accurate coding, and accurate coding leads to timely claims reimbursement. Accurate documentation also leads to better and more effective patient care and can provide more detailed information to other health care providers who are managing patient care.
How does this impact you?
These updates are effective October 1 – September 30. Adherence to these guidelines when assigning ICD-10-CM diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA).
Below are several examples of the 1,176 new diagnosis codes for FY 2023.
- (D68) Von Willebrand disease now includes type
- (D75) Thrombocytopenia now includes type
- (E87) Metabolic acidosis defined as acute, chronic, or other
- (F01-F03) Dementia now includes severity and type of behavioral disturbance
- (F10-F19) Alcohol and Drug use includes remission status
- (G90.A) New code for Postural orthostatic tachycardia syndrome [POTS]
- (I20.2 & I25.-) New codes for Refractory angina
- (I71) Dissection and Aneurysm now includes location
- (N80) Endometriosis now includes depth, laterality, and location
- (P28) Newborn sleep apnea now includes types
- (Q21) Septal defect new types added
- (T43.6-) New Poisoning, adverse effect etc., by Methamphetamines
- (Z59) New SDoH for transportation, financial insecurity, or material hardship
- (Z79.6-) Long term use of several new substances and agents