Tis the Season to Update Medical Codes

September 25, 2017

The air is getting brisk, and soon autumn leaves will fall. It seems appropriate, almost metaphorical, to change our medical code sets, doesn’t it?


Winter is coming. Like it or not, changes across every code set are on the horizon—and every hospital, physician practice, medical provider, and payer billing system will need to incorporate them. Are you ready?


More Changes for ICD-10-CM than Initially Proposed


The countdown is on, with 2018 ICD-10-CM updates becoming effective on October 1st. The Centers for Medicare & Medicaid Services (CMS) released over 800 ICD-10-CM code changes for the fiscal year 2018, which include 454 additions, 142 deletions, and over 200 revisions.


Some noteworthy medical coding changes include:


Cardiology changes involve some new codes for myocardial infarction and heart failure, as well as longstanding persistent atrial fibrillation (I48.11) and permanent atrial fibrillation (I48.21).


CMS defines a Type 1 MI as the prototypic “heart attack,” which includes both ST Elevation MI (STEMI) and Non ST Elevation MI (NSTEMI) events. A Type 2 MI is defined as secondary to ischemic imbalance, which occurs when a condition other than coronary artery disease results in the imbalance between myocardial oxygen supply and/or demand. For instance, coronary vasospasm and/or endothelial dysfunction, anemia, chronic obstructive pulmonary disease, or shock can cause a Type 2 MI. Coders should welcome this distinction, as treatment guidelines for a Type 1 MI and Type 2 MI differ.


The code set also has new codes accommodating types of right heart failure, including acute (I50.811), chronic (I50.812), acute on chronic (I50.813) and unspecified (I50.810). Other code changes identify right heart failure due to left heart failure (I50.814), biventricular heart failure (I50.82), high output heart failure (I50.83), and end-stage heart failure (I50.84) for patients no longer responding to medication.


DSM-5. Starting Oct. 1, it will be possible to select from nine new ICD-10-CM codes when a patient is in remission from abuse of a variety of substances, including alcohol, opioids, cannabis, and nicotine. Codes for substance abuse remission will now classify the severity of abuse as mild, moderate, or severe for better alignment of ICD-10-CM codes with the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).


Obstetrics. Antenatal screening codes have 17 new Z codes to expand reporting options of screening tests to determine fetal growth retardation and chromosomal abnormalities.


Mega ICD-10-PCS Gets Bigger


Also effective on October 1st, ICD-10-PCS adds 3,562 new codes, raising the official number to a whopping 78,705 codes! This accounts for 646 deletions in 2018. As well, 2048 codes in the set have been revised.


The majority of new codes address streamlining body part values for greater clarity in the Medical and Surgical section, which accounts for 68,000+ of PCS codes. Changes will also add endoscopic approaches to several tables to make them more accessible and enhance completeness.


New and revised updates to the official guidelines were made for clarification purposes. For example, the wording “or otherwise not completed” was added to section B3.3 Discontinued or incomplete procedures to indicate that the intended procedure need not be discontinued but can be ‘otherwise not completed’ for a variety of reasons.


A new guideline B4.1.C has been added to provide clarification that if a procedure is performed on a continuous section of a tubular body part, you code the portion of the tubular body part furthest from the point of entry.


New tables have been added, and revisions have been made to existing tables as well. Some of the highlights include the addition and deletion of many device codes, approaches, body parts and qualifiers.


Anticipated 2018 CPT® Code Changes


No sooner will you have acclimated to ICD-10- CM and ICD-10-PCS code changes when the AMA will announce its final 2018 CPT® code changes, effective January 1st. These involve 177 new, 60 revised, and 79 deleted codes. Changes primarily impact coding for cardiology, radiology, physical medicines, respiratory, E/M, anesthesia, and pathology. Noteworthy changes specifically address bone biopsy, mammography, hemodialysis access, vaccines, drug testing, and moderate sedations.


As in past years, many of the new codes have been created due to bundling mandates from the AMA’s Relativity Assessment Workgroup (RAW) to identify potentially misvalued services. Code pairs identified as being performed in conjunction 75% or more of the time have been bundled. These include procedures such as endovascular repair of infrarenal aorta and endovenous ablation of incompetent veins.

A new code also will describe a combined bone marrow biopsy and aspiration study. In addition, Category III codes for cryoablation treatment of pulmonary tumors and transperineal placement of biodegradable material will be converted to Category I code status.

Diagnostic Radiology. Chest x-ray codes 71010, 71015, 71020, 71021, 71022, 71023, 71030, 71034, and 71035 will be deleted and four new codes added to report chest x-ray procedures using the number of views (versus view-specific descriptors). 

Physical Medicine. The Work Relative Value Units (WRVUs) proposed by CMS provide a general increase in reimbursement for most of therapy codes. As well, the Practice Expense RVUs for each code were maintained or increased. In total, 19 codes often used by occupational therapists were presented to the AMA Health Care Professionals Advisory Committee (HCPAC). Three additional codes referring to orthotic and prosthetic services were presented, including a new code (977X1) that replaces the orthotic prosthetic checkout code (97762) depicting orthotic and prosthetic subsequent encounters. Of these codes, 9 received increases in value, and 13 maintained their WRVU values:

  • 97112: Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and proprioception, from .45 to .50
  • 97113: Aquatic therapy with therapeutic exercise, from .44 to .48
  • 97116: Gait training, from .40 to .45
  • 97533: Sensory integrative techniques, from .44 to .48
  • 97537: Community/work reintegration, from .45 to .48
  • 97542: Wheelchair management, from .45 to .48
  • 97760: Orthotic Management and Training, from .45 to .50
  • 97761: Prosthetic Training, from .45 to .50
  • 977X1 (replaces 97762): Orthotic(s)/prosthetic(s) management and/or training subsequent encounter, from .25 (97762) to .48 (977X1) 

Author bio: Deborah Marsh, JD, MA, CPC, CHONC, is a senior content specialist for TCI SuperCoder, working on everything from online tool enhancements and data updates to social media and blog posts. Deborah joined TCI in 2004 as a member of TCI’s respected Coding Alert editorial team


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