By: Bruce Pegg
In our last post, we looked at significant changes to the circulatory disease, skin disease, and congenital malformation ICD-10-CM codes that are poised to take effect on Oct. 1, 2019 in our previous post. But you don’t have to be a seasoned coder to realize that those changes are just the tip of the iceberg. … Continue reading Dig a Little Deeper Into the 2020 ICD-10-CM Revisions (Part 2)
In our last post, we looked at significant changes to the circulatory disease, skin disease, and congenital malformation ICD-10-CM codes that are poised to take effect on Oct. 1, 2019 in our previous post.
But you don’t have to be a seasoned coder to realize that those changes are just the tip of the iceberg. In this final blog post reviewing the additions, deletions, and revisions to the 2020 diagnosis codes, we’ll look at some important additions to the injury and external cause chapter, then highlight a number of the revisions to the encounter codes that form the bulk of this year’s addenda.
Adding These New Injury Codes Won’t Hurt a Bit
Along with the new S02.- (Fracture of skull and facial bones) codes and the new T67.0- (Heatstroke and sunstroke) ICD-10-CM codes that we reported about last month, you’ll also see additions to the T50.9- (Poisoning by, adverse effect of and underdosing of other and unspecified drugs, medicaments and biological substances) code group. They include:
- T50.911- (Poisoning by multiple unspecified drugs, medicaments and biological substances accidental (unintentional))
- T50.912- (… intentional self-harm)
- T50.913- (… assault)
- T50.914- (… undetermined)
- T50.915- (Adverse effect of multiple unspecified drugs, medicaments and biological substances)
- T50.916- (Underdosing of multiple unspecified drugs, medicaments and biological substances).
Get to Know These Encounter Code Changes as Well
Lastly, no matter what your specialty, you’ll be sure to find something of significance in the multiple changes to the encounter codes found in this round of revisions. Here are some of the most important.
Eyes and vision: There are some new choices in the Z01.0- (Encounter for examination of eyes and vision) subcategory. ICD-10 has introduced separate codes to document a failed vision screening without abnormal findings (Z01.020) and with abnormal findings (Z01.021). Like the current codes, there is also a note that tells you to use an additional code if you do report Z01.021 to specify what those abnormal findings are.
Tuberculosis: You’ll also find three new codes that will enable you to identify when a patient with latent, as opposed to active, tuberculosis has encountered health services. ICD-10-CM has added Z11.7 (Encounter for testing for latent tuberculosis infection) to distinguish the encounter from Z11.1 (Encounter for screening for respiratory tuberculosis), which is now accompanied with a note that specifies you should use the code for patients with the active form of the condition.
Additionally, beginning Oct. 1, you will be able to add Z22.7 (Latent tuberculosis) to identify a patient who is a carrier of the disease. The code also comes with an Excludes1 note that specifies you cannot use it in conjunction with R76.11 (Nonspecific reaction to tuberculin skin test without active tuberculosis) and R76.12 (Nonspecific reaction to cell mediated immunity measurement of gamma interferon antigen response without active tuberculosis).
And you will also be able to use Z86.15 (Personal history of latent tuberculosis infection) if that is what the patient’s medical history indicates.
Neoplasm history: The addition of Z86.15 mentioned above is one of a number of changes to the Z86.- (Personal history of certain other diseases) codes. Mostly, these take the form of new notes to the Z86.00- (Personal history of in-situ neoplasm) codes, which remind you that the conditions are classifiable to their corresponding D00-D09 (In situ neoplasm) codes, as well as new, more specific code options, such as Z86.003 (Personal history of in-situ neoplasm of oral cavity, esophagus and stomach).
BMI: Lastly, there is a small but very significant change to the notes for the Z68.- (Body mass index [BMI]) codes. The 2020 ICD-10-CM code set will change the age parameters for both the pediatric and adult BMI codes, with the upper cutoff for the pediatric codes being lowered from 20 years of age to 19, and the lower cutoff for the adult codes being lowered from 21 years to 20.
The change brings the codes into line with the Centers for Disease Control (CDC) BMI age parameters, which use two separate calculators to determine the BMI for children and teens ages 2-19 and adults aged 20 and older.
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