Changes to ICD-10 Documentation Codes Effective October 2022
Q: What are the new documentation codes for 2023?
Answer: The Centers for Disease Control and Prevention (CDC) released the 2023 ICD-10-CM code updates on June 9, 2022, which include 1,176 new, 28 revised, and 287 deleted codes to be used for patient contacts and discharges from October 1, 2022 through September 30, 2023. These apply to all insurers, whether you bill Medicare, Medicaid, Tricare, or a commercial payer. So let’s break down the revisions, deletions, and additions to help you prepare.
New Dementia Codes
The expansion of dementia codes came from a request at the Centers for Disease Control (CDC) September 2021 meeting of the ICD-10-CM Coordination and Maintenance Committee, the National Minority Quality Forum (NMQF) requested expansion of the codes for dementia to include stage and severity and identification of behavioral and psychological symptoms of dementia. According to the NMQF, “Both clinical elements are major factors in patient management strategies.” As a result, the 2023 ICD-10 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 unspecified dementia (F03.9-F03.C4).
The new dementia reporting guidelines emphasize that providers must clearly document the severity of the patient’s condition. If the documentation is incomplete, the programmer should inquire with the vendor or default to the corresponding undefined code. The updated guidelines also instruct that if a patient with dementia is admitted to an inpatient facility and deteriorates during their stay, the coder should assign the highest level of severity reported during the stay.
At the CDC meeting, the Committee provided the following clarifications to help determine the stage of dementia.
Mild dementia: “Clearly visible functional impact on daily life, mainly affecting instrumental activities. No longer fully independent/requires occasional assistance with activities of daily living.’
Moderate dementia: “Extensive functional impact on daily living with impairment of basic activities. He is no longer independent and needs frequent assistance with activities of daily living.’
Severe dementia: “A clinical interview may not be possible. Total dependence due to severe functional impact on daily living with impairment of basic activities, including basic self-care.
Some of the specific new dementia codes include:
- F02.811, Dementia in other disorders 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
Endometriosis code extensions
For those providers seeing patients for endometriosis or maternal care, there are now nearly 400 new codes representing gynecologic conditions. The American College of Obstetricians and Gynecologists (ACOG) has proposed expanding the endometriosis section of the ICD-10-CM code set, and you’ll now see many of the new endometriosis codes with additional specificity to indicate whether the condition is superficial or deep. The definitions below will be critical in choosing the correct code:
Superficial endometriosis: Ectopic growth of endometrial-like tissue that extends 5 mm or less below the peritoneal surface. Lesions may vary in number (single or multiple locations).
Deep infiltrating endometriosis: Ectopic growth of endometrial-like tissue that extends more than 5 mm below the peritoneal surface. Lesions may vary in number (single or multiple locations). These lesions are usually associated with deep fibrosis and adhesions.
If you don’t see the terms “deep” or “superficial” in the doctor’s notes, then look for some indication of how far below the peritoneal surface the tissue extends. This will be essential in choosing the correct code under the new ICD-10-CM codes for 2023. For example, you would report superficial endometriosis of the right ovary with N80.111 and deep endometriosis of the right ovary with 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 malformations). According to these groups, “This proposal will enable better tracking, measurement, and ultimately improved treatment methods for identified fetal abnormalities.”
Clarification of loss of consciousness
For concussion and brain injury codes (eg, concussion, contusion, traumatic brain injury, blast injury, and hemorrhage), more than 100 new 2023 ICD-10-CM codes were added in S06 (Intracranial trauma) range. According to the American Academy of Pediatrics (AAP), patients often present with injuries codeable to category S06 without a clear history of loss of consciousness (LOC), so they requested new codes to include identification of LOC and, if present , how long it lasted.
With the LOC add-on, you will need to know if the patient has lost consciousness in order to select the correct diagnostic code. For example, if a patient lost consciousness with a concussion, you would report a code in the S06.0XA series, while a primary blast brain injury with loss of consciousness of 30 minutes or less would be coded in the S06.8A1 code range. Here are some specific examples:
- S06.0XAA, concussion with unknown status of loss of consciousness, initial encounter
- S06.0XAD, concussion with unknown status of loss of consciousness, subsequent encounter
- S06.0XAS, concussion with unknown status of loss of consciousness, sequelae
New Methamphetamine Overdose Codes
You will find a new code category describing methamphetamine poisoning as well as codes for adverse effects associated with methamphetamine use. In the past, programmers reporting methamphetamine overdoses had to report these services under the general category of “amphetamines,” but using this code made it challenging 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 report them accurately, you need to find in the record whether the overdose was accidental, was or whether the status was indeterminate. These factors will be essential to enable you to choose the right code.
Additional New codes
In addition to the new 2023 ICD-10-CM codes described above, there are many code changes that affect nearly every specialty. Please take a moment to review the following:
The comprehensive CDC ICD-10-CM list can be found here.
Renee Dowling is a compliance auditor for Sansum Clinic, LLC, in Santa Barbara, California.