Part 1: What’s New in ICD-10-CM 2020, Chapters 1-10?

cardiology ICD-10 2020 updates

ICD-10-CM 2020 is out now so you can prepare to start using the new code set Oct. 1, 2019. The Tabular List addenda PDF is 36 pages long to fit in 273 new reportable codes along with new subcategories, deletions, revisions, and some very important instruction changes.

We’ll cover major points from each ICD-10-CM chapter, with Chapter 1 to Chapter 10 in this Part 1 post. You can find complete lists of the changes on the ICD-10-CM sites of the CDC or CMS. And for more ICD-10 2020 news, you can check out our ICD-10-PCS 2020 update blog post. Let’s get started!

Chapter 1: Follow Added RSV Instructions

Among the changes to Chapter 1: Certain infectious and parasitic diseases (A00-B99) are some new instructions for B97.4 (Respiratory syncytial virus as the cause of diseases classified elsewhere).

Along with the addition of inclusion term “RSV as the cause of diseases classified elsewhere,” the update adds these important notes:

  • Code first related disorders, such as:
    • otitis media (H65.-)
    • upper respiratory infection (J06.9)
  • Excludes2:
    • acute bronchiolitis due to respiratory syncytial virus (RSV) (J21.0)
    • acute bronchitis due to respiratory syncytial virus (RSV) (J20.5)
    • respiratory syncytial virus (RSV) pneumonia (J12.1).

Chapter 2: Track New Notes for Neoplasms, Too

For Chapter 2: Neoplasms (C00-D49), there are no code descriptor changes, but there are note changes to consider.

For example: In two cases, what is an Excludes1 note in 2019 will become an Excludes2 note in ICD-10-CM 2020.

  • D04.0 (Carcinoma in situ of skin of lip) swaps from Excludes1 to Excludes2 for “carcinoma in situ of vermilion border of lip (D00.01)”
  • D23 (Other benign neoplasms of skin) swaps from Excludes1 to Excludes2 for “melanocytic nevi (D22.-).”

Chapter 3: Add Non-Anemia and ADA Codes

Ready to finally see some new codes? They start in Chapter 3: Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89).

First is D75.A (Glucose-6-phosphate dehydrogenase (G6PD) deficiency without anemia), which has an Excludes1 note for existing code D55.0 (Anemia due to glucose-6-phosphate dehydrogenase [G6PD] deficiency).

There are also these four new codes for adenosine deaminase (ADA) deficiency, a metabolic disorder that damages the immune system. If you code for this condition check the complete Tabular List to see the many inclusion terms and other notes with these codes:

  • D81.30 (Adenosine deaminase deficiency, unspecified)
  • D81.31 (Severe combined immunodeficiency due to adenosine deaminase deficiency)
  • D81.32 (Adenosine deaminase 2 deficiency)
  • D81.39 (Other adenosine deaminase deficiency).

Chapter 4: Knock Out More Note Changes in Endocrine Chapter

ICD-10-CM 2020 proves over and over that updates are about more than code descriptor changes! Note revisions are again the stars in Chapter 4: Endocrine, nutritional and metabolic diseases (E00-E89).

In this case, the changes to Excludes1 notes hint at additional character requirements on the way for Q79.6 (Ehlers-Danlos syndrome) and Q87.1 (Congenital malformation syndromes predominantly associated with short stature).

Final tip: Check the Index addenda for diagnoses you report. You may discover the need for additional code characters in 2020, or you may see important corrections, like the Zellweger’s syndrome entry replacing Q87.89 (Other specified congenital malformation syndromes, not elsewhere classified) with E71.510 (Zellweger syndrome).

Chapter 6: Update Cyclical Vomiting Descriptors to Add Migraine

The ICD-10-CM 2020 update skips Chapter 5: Mental, Behavioral and Neurodevelopmental disorders (F01-F99) and passes on to Chapter 6: Diseases of the Nervous System.

Along with some note changes, Chapter 6 will see revisions to include “in migraine” in cyclical vomiting codes so the 2020 descriptors will look like this:

  • G43.A0 (Cyclical vomiting, in migraine, not intractable)
  • G43.A1 (Cyclical vomiting, in migraine, intractable).

These changes will help distinguish the migraine codes from new cyclical vomiting code R11.15 (Cyclical vomiting syndrome unrelated to migraine), which you’ll use for cyclic vomiting syndrome NOS and for persistent vomiting, according to inclusion terms with that code.

Chapter 8: Reduce Vertigo Options

We’ll skip Chapter 7: Diseases of the eye and adnexa (H00-H59), which only corrects an Excludes1 note by adding a hyphen, and move to Chapter 8: Diseases of the ear and mastoid process (H60-H95).

In ICD-10-CM 2019, H81.4- (Vertigo of central origin) is a subcategory that requires an additional character to identify the ear involved, such as H81.43 (Vertigo of central origin, bilateral). ICD-10-CM 2020 removes the ear references by making H81.4 a reportable code and deleting H81.41-H81.49 for this diagnosis of central nervous system origin.

Chapter 9: Get Your Heart Pumping With Circulatory Additions

After all those small changes, get ready to take things up a notch with Chapter 9: Diseases of the circulatory system (I00-I99). We can’t cover all of them here (get more details in our Coding Alerts!), but here’s an overview:

  • I21.A1 (Myocardial infarction type 2) changes its “Code also” note to “Code first” for anemia, COPD, paroxysmal tachycardia, and shock.
  • Pulmonary embolism gets two new codes:
    • I26.93 (Single subsegmental pulmonary embolism without acute cor pulmonale)
    • I26.94 (Multiple subsegmental pulmonary emboli without acute cor pulmonale).
  • Atrial fibrillation gets its own set of new codes:
    • I48.11 (Longstanding persistent atrial fibrillation)
    • I48.19 (Other persistent atrial fibrillation), which applies to chronic persistent AFib and persistent AFib NOS.
    • I48.20 (Chronic atrial fibrillation, unspecified)
    • I48.21 (Permanent atrial fibrillation).
  • Phlebitis and thrombophlebitis will get new options for right, left, bilateral, and unspecified peroneal vein and calf muscular vein.
  • Embolism and thrombosis also get new codes for right, left, bilateral, and unspecified peroneal vein and calf muscular vein. You’ll have one set of options for acute and another for chronic.

Chapter 10: Use Respiratory Infection Change to Learn ICD-10-CM Convention

In Chapter 10: Diseases of the respiratory system (J00-J99), ICD-10-CM 2020 adds parentheses around the term acute in J44.0, as shown here: (Chronic obstructive pulmonary disease with (acute) lower respiratory infection).

Parentheses “enclose supplementary words that may be present or absent in the statement of a disease or procedure without affecting the code number to which it is assigned,” according to the ICD-10-CM Official Guidelines for 2019 (the 2020 guidelines have not been posted as of publication time).

Stay tuned: We’ve made it only to Chapter 10. We’ll cover more ICD-10-CM 2020 changes in the next TCI SuperCoder blog post.

What About You?

Are you surprised by any of the ICD-10-CM 2020 updates? Which will be most helpful for you?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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