Part 2: Tackle ICD-10-CM 2020 Updates for Chapters 11-17

You know the highlights of ICD-10-CM 2020 updates for Chapters 1-10 from our last blog post. Now let’s dig in to some of the big points from Chapters 11-17. We’ll wrap up with Chapters 18-21 in Part 3.

Remember: These updates are effective Oct. 1, 2019. Be sure your ICD-10-CM resource has the latest codes in case there are corrections or changes before implementation.

Chapter 11: Check Digestive Chapter Note Changes

Remember how many of the updates in ICD-10-CM 2020 Chapters 1-10 were note changes? Chapter 11: Diseases of the digestive system (K00-K95) is no exception.

For instance, K63.5 (Polyp of colon) expands its Excludes1 note for adenomatous polyp of colon from D12.6 (Benign neoplasm of colon, unspecified) to D12.- (Benign neoplasm of colon, rectum, anus and anal canal). To match this change ICD-10-CM 2020 moves the Excludes1 note for K63.5 from D12.6 to D12.-. In other words, all of D12.- now has an Excludes1 note for polyp of colon NOS (K63.5).

Chapter 12: Pick Up on Pressure Ulcer Changes

Think ICD-10-CM can’t possibly think of more pressure ulcer codes to add? Think again! The 2020 update to Chapter 12: Diseases of the skin and subcutaneous tissue (L00-L99) adds a long list of codes with specific options for pressure-induced deep tissue damage. Like other pressure ulcers, you’ll code based on site, such as L89.626 (Pressure-induced deep tissue damage of left heel).

Chapter 13: Update Enthesopathy of Ankle Coding

Along with some updates to the notes in Chapter 13: Diseases of the musculoskeletal system and connective tissue (M00-M99), there are some revisions to enthesopathy codes.

In 2019, when you look up Enthesopathy, ankle and tarsus, specified type NEC, the ICD-10-CM Index points you to the entry for Enthesopathy, foot, specified type NEC. So your search for an ankle code leads you to a foot code.

The ICD-10-CM 2020 Tabular List gets a code descriptor update to match that:

  • 2019: M77.5- (Other enthesopathy of foot)
  • 2020: M77.5- (Other enthesopathy of foot and ankle).

The change affects the five-character codes for unspecified (M77.50), right (M77.51), and left (M77.52).

Chapter 14: Watch These Women’s Health Codes

Among the changes in Chapter 14: Diseases of the genitourinary system (N00-N99) are these new codes:

  • N63.15 (Unspecified lump in the right breast, overlapping quadrants)
  • N63.25 (Unspecified lump in the left breast, overlapping quadrants)
  • N99.85 (Post endometrial ablation syndrome).

Chapter 15: Increase Inclusion Notes Under Fetal Heart Rate Code

Notes and instructions see updates in Chapter 15: Pregnancy, childbirth and the puerperium (O00-O9A). For instance, subsection O36.83- (Maternal care for abnormalities of the fetal heart rate or rhythm) adds inclusion notes so you’ll know quickly that those codes apply to the following:

  • Maternal care for depressed fetal heart rate tones
  • Maternal care for fetal bradycardia
  • Maternal care for fetal heart rate abnormal variability
  • Maternal care for fetal heart rate decelerations
  • Maternal care for fetal heart rate irregularity
  • Maternal care for fetal tachycardia
  • Maternal care for non-reassuring fetal heart rate or rhythm.

Chapter 16: Rearrange Newborn Respiratory Distress Notes

One of the more noteworthy note changes in Chapter 16: Certain conditions originating in the perinatal period (P00-P96) is under P22.- (Respiratory distress of newborn). Instead of having an Excludes1 note at the P22.- category level for respiratory arrest of newborn (P28.81) and respiratory failure of newborn NOS (P28.5), the 2020 ICD-10-CM code set excludes those P28.- conditions in this way:

  • Excludes2 note at P22.0
  • Excludes1 note at P22.8
  • Exludes1 note at P22.9.

Chapter 17: Keep Track of New Congenital Codes

After seeing note change after note change, you might wonder where ICD-10-CM 2020 fit in those 270+ new reportable codes. You’ll find quite a few of them in Chapter 17: Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99).

Category Q66.- (Congenital deformities of feet) will get 24 new codes that allow you to code based on right, left, or unspecified foot. Your final character options differ based on whether the reportable code is five characters and or six characters. For five-character codes, you’ll have 0 (unspecified foot), 1 (right foot), and 2 (left foot), such as Q66.71 (Congenital pes cavus, right foot). But when the code is six characters, your final character options will be 1 (right foot), 2 (left foot), 9 (unspecified foot), such as Q66.222 (Congenital metatarsus adductus, left foot).

Code Q79.6 (Ehlers-Danlos syndrome) will expand to five new five-character options and change to the plural term “syndromes.” The new codes will allow you to report unspecified, classical, hypermobile, vascular, and other using distinct codes.

Code Q87.1 (Congenital malformation syndromes predominantly associated with short stature) will expand to create a new specific code Q87.11 (Prader-Willi syndrome). You’ll use new code Q87.19 (Other congenital malformation syndromes predominantly associated with short stature) for the many other diagnoses that fall under this subcategory.

Coming soon: Watch for Part 3 to finish up this overview of the ICD-10-CM 2020 updates.

What About You?

What do you think of the ICD-10-CM 2020 updates so far? Do you think any of the codes or notes need clarification?


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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