Changes for ICD-10 documentation codes that will take effect in October 2022.
Question: What are the new documentation codes for 2023?
Answer: The Centers for Disease Control and Prevention (CDC) issued the ICD-10-CM code of 2023 updates on June 9, 2022, which include 1,176 new, 28 revised, and 287 deleted codes to be used for patient encounters and discharges occurring from October 1, 2022 through September 30, 2023. They apply to all insurers, whether you’re billing Medicare, Medicaid, Tricare, or a commercial payer. Let’s break down the revisions, deletions, and additions to help you prepare.
New dementia codes
An expansion of the dementia codes came from a request at the Centers for Disease Control (CDC) from September 2021 Meeting of the ICD-10-CM Coordination and Maintenance Committeethe National Minority Quality Forum (NMQF) called for an expansion of the dementia codes to include the stage, severity, and identification of behavioral and psychological symptoms of dementia. According to the NMQF, “Both of these clinical elements are important factors in patient management strategies.” As a result, the ICD-10 2023 code set now includes nearly 100 new dementia-related codes. You can now report conditions such as vascular dementia (F01.5-F01.C4), dementia in other diseases (F02.8-F02.C4), and dementia not otherwise specified (F03.9-F03.C4).
The new dementia reporting guidelines emphasize that providers must clearly document the severity of a patient’s condition. If the documentation is incomplete, the coder should consult the vendor or default to the appropriate unspecified code. The updated guidelines also state that if a patient with dementia is admitted to an inpatient facility and worsens during their stay, the coder should assign the highest severity level reported during the stay.
In the CDC meetingThe Committee provided the following clarifications to help determine the stage of dementia.
mild dementia: “Functional impact clearly evident in daily life, mainly affecting instrumental activities. No longer fully independent/requires occasional assistance with activities of daily living.”
moderate dementia: “Wide functional involvement in daily life with impairment of basic activities. He is no longer independent and requires frequent assistance with activities of daily living.”
severe dementia: “The clinical interview may not be possible. Complete dependence due to severe functional impairment in daily life with impairment of basic activities, including basic self-care.
Some of the new dementia-specific codes include:
- F02.811 Dementia in other diseases classified elsewhere, unspecified severity, with agitation
- F02.A11, dementia in other diseases classified elsewhere, mild, with agitation
- F02.B11, dementia in other diseases classified elsewhere, moderate, with agitation
Extensions of the Endometriosis Code
For those providers who care for patients for endometriosis or maternal care, there are now nearly 400 new codes that represent OB/GYN conditions. The American College of Obstetricians and Gynecologists (ACOG) has proposed an expansion to the endometriosis section of the ICD-10-CM code set, and you will now see many of the new endometriosis codes with increased specificity to detail if the condition is superficial or deep. The following definitions will be critical to choosing the correct code:
superficial endometriosis: Ectopic growth of endometrium-like tissue that extends 5 mm or less below the peritoneal surface. The lesions may vary in number (single or in multiple locations).
Deeply infiltrating endometriosis: Ectopic growth of endometrium-like tissue that extends more than 5 mm below the peritoneal surface. The lesions may vary in number (single or in multiple locations). These lesions are commonly associated with deep fibrosis and adhesions.
If you don’t see the terms “deep” or “superficial” in your doctor’s notes, look for some indication of how far the tissue has extended below the peritoneal surface. This will be essential for selecting the correct code under the new 2023 ICD-10-CM codes. For example, you will report superficial endometriosis of the right ovary as N80.111 and deep endometriosis of the right ovary will be coded as N80.121.
ACOG and the Society for Maternal-Fetal Medicine (SMFM) also requested new codes for fetal abnormalities (eg, central nervous system (CNS) abnormalities, chromosomal abnormalities, and fetal abnormalities and harm). According to these groups, “this proposal will allow better monitoring, measurement and, ultimately, better treatment modalities for identified fetal abnormalities.”
Clarification of loss of consciousness
For concussion and brain injury codes (eg, concussions, contusions, traumatic brain injuries, blast injuries, and hemorrhages), more than 100 new 2023 ICD-10-CM codes were added in S06 (intracranial injury) range. According to the American Academy of Pediatrics (AAP), patients often present with lesions that are coded to category S06 without a clear history of loss of consciousness (LOC), so they requested new codes to include LOC identification and, if present, how long did it last?
With the addition of LOC, you will need to know if a patient has lost consciousness in order to select the correct diagnostic code. For example, if a patient lost consciousness due to a concussion, they would report a code from the S06.0XA series, whereas a primary blast injury of the brain with loss of consciousness lasting 30 minutes or less would be coded in the code range S06.8A1. Here are some specific examples:
- S06.0XAA, concussion with unknown loss of consciousness, initial encounter
- S06.0XAD, concussion with unknown loss of consciousness, subsequent encounter
- S06.0XAS Concussion with unknown loss of consciousness, sequela
New Methamphetamine Overdose Codes
You will find a new code category that describes methamphetamine poisoning, as well as codes for adverse effects related to methamphetamine use. In the past, coders reporting methamphetamine overdoses had to report these services under the umbrella category of “amphetamines,” but the use of that code made it difficult for public health authorities to track methamphetamine overdoses.
You will find new codes in this category under the new T43.65 (Methamphetamine poisoning, adverse effect, and underdosing due to self-harm or assault) range. To accurately report them, you must find out from the record whether the overdose was accidental, accidental, or the status is undetermined. These factors will be essential in allowing you to select the correct code.
Additional New Codes
In addition to the new 2023 ICD-10-CM codes described above, there are many code changes that affect almost all specialties. Please take some time to review the following:
The complete list of CDC ICD-10-CM can be found here.
Renee Dowling is a Compliance Auditor for Sansum Clinic, LLC, in Santa Barbara, California.