Look Ahead at ICD-10-CM in 2018

Look Ahead at ICD-10-CM in 2018

Chapters 10-21: Tabular List addenda reveals changes that allow for more precise diagnosis coding.

The ICD-10-CM Tabular List of Diseases and Injuries 2018 Addenda provides an overview of the many changes made to the code set for the upcoming year. To prepare for these changes, let’s review what is new, deleted, or revised in chapters 10-21.
Editor’s note: Chapters 1-7 were covered in October’s Healthcare Business Monthly. Chapter 8 has no changes and a summary of chapter 9 was provided in last month’s edition. Where appropriate for clarity, revised text is underlined or has a strikethrough.

Chapter 10: Diseases of the Respiratory System (J00-J99)

There are no new codes in this chapter, but there is one code descriptor change and several changes to notes that require your attention.
Subcategory J09 Influenza due to certain identified influenza viruses adds an Excludes1 note: Influenza A/H1N1 (J10.-).
Subcategory J15 Bacterial pneumonia, not elsewhere classified has a revised code, J15.6 Pneumonia due to other aerobic Gram-negative bacteria, and adds to the list of definitions “Pneumonia due to other aerobic Gram-negative bacteria.”
“Lung diseases due to external agents (J60-J70)” is deleted as an Excludes2 note (Not included here) under subcategory J44 Other chronic obstructive pulmonary disease and added directly under J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation and J44.9 Chronic obstructive pulmonary disease, unspecified.
Under J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection, you are instructed to “Code also to identify the infection,” rather than “Use Additional code to identify the infection.”
“Lung diseases due to external agents (J60-J70)” is also deleted as an Excludes1 note (Not coded here) under J45 Asthma, and added as an Excludes2 note under J45.909 Unspecified asthma, uncomplicated and category J84 Other interstitial pulmonary diseases.
Lastly, in this chapter, under J95.02 Infection of tracheostomy stoma, the Use Additional note is revised from “cellulitis of neck (L03.8)” to “cellulitis of neck (L03.221).”

Chapter 11: Diseases of the Digestive System (K00-K95)

In this chapter, you’ll find several revised code descriptions and notes. There are also several new codes that allow for more specific coding.
New codes K06.01 Gingival recession, localized and K06.02 Gingival recession, generalized allow you to specify a 6th character to indicate whether the recession is: unspecified, minimal, moderate, or severe.
New codes under subcategory K56 Paralytic ileus and intestinal obstruction without hernia and K91.3 Postprocedural intestinal obstruction indicate: unspecified, partial, or complete obstruction.

Chapter 12:Diseases of the Skin and
Subcutaneous Tissue (L00-L99)

New and revised codes in this chapter allow for heightened specificity. For example, subcategory L89 Pressure ulcer revises all definitions to specify the laterality of the pressure ulcer (e.g., L89.019 Pressure ulcer of right elbow, unspecified stage specifies “right elbow” instead of “unspecified elbow”).
New codes under subcategories L97 Non-pressure chronic ulcer of lower limb, not elsewhere classified and L98 Other disorders of skin and subcutaneous tissue, not elsewhere classified specify the specific body part, which side, and either:

With muscle involvement without evidence of necrosis;

With bone involvement without evidence of necrosis; or

With other specified severity.

Chapter 13: Diseases of the Musculoskeletal
System and Connective Tissue (M00-M99)

This chapter includes code descriptor revisions, a few new codes, and some note additions and deletions.
Blocks M04 Autoinflammatory syndromes and M97 Periprosthetic fracture around internal prosthetic joint are deleted, but valid codes within both blocks remain.
Although M33 Dermatopolymyositis is unchanged, the word part “poly” is deleted from codes M33.0- Juvenile dermatomyositis and M33.1 Other dermatomyositis; and M33.93 Dermatopolymyositis, unspecified without myopathy is added. This change is intended to differentiate between the two types of connective tissue diseases.
Under Spondylopathies (M45-M49) are new codes M48.061 Spinal stenosis, lumbar region without neurogenic claudication and M48.062 Spinal stenosis, lumbar region with neurogenic claudication.
Lastly, under category M62 Other disorders of muscle, code M62.5 Muscle wasting and atrophy, not elsewhere classified has a revised Excludes1 note: “progressive muscle atrophy (G12.21).”

Chapter 14: Diseases of the Genitourinary System (N00-N99)

Check revised notes and code definitions in this chapter. There are also a few code descriptor revisions and a handful of new codes.
For example, the Excludes1 note “metabolic disorders classifiable to (E70-E88),” is deleted under N25 Disorders resulting from impaired renal tubular function and added under N25.8 Other disorders resulting from impaired renal tubular function as an Excludes2 note.
Under N35.11 Postinfective urethral stricture, not elsewhere classified, male, 6th character codes are revised to also specify gender (e.g., N35.112 Postinfective bulbous urethral stricture, not elsewhere classified, male). Likewise, 6th character codes under N99.11 Postprocedural urethral stricture, male are revised to also include “male” (e.g., N99.111 Postprocedural bulbous urethral stricture, male).
Under subcategory N63 Unspecified lump in breast, new code N63.0 Unspecified lump in unspecified breast is added, as are codes to indicate an unspecified lump in the right or left breast (N63.1-N63.2), each with 5th character codes to indicate quadrant. Also added are new codes N63.3 Unspecified lump in axillary tail and N63.4 Unspecified lump in breast, subareolar, both with 5th character codes to indicate laterality.

Chapter 15: Pregnancy, Childbirth,
and the Puerperium (O00-09A)

New 6th character codes under O00 Ectopic pregnancy delineate laterality and with or without intrauterine pregnancy (e.g., O00.101 Right tubal pregnancy without intrauterine pregnancy; O00.102 Left tubal pregnancy without intrauterine pregnancy) and with or without ovarian pregnancy (e.g., O00.201 Right ovarian pregnancy without intrauterine pregnancy; O00.202 Left ovarian pregnancy without intrauterine pregnancy).
New 6th character codes added under O36.8 Maternal care for other specified fetal problems delineate trimester:
O36.831 Maternal care for abnormalities of the fetal heart rate or rhythm, first trimester
O36.832 second trimester
O36.833 third trimester
O36.839 unspecified trimester
There is just one note change: The Excludes2 note “Hemorrhage with coagulation defects (O45.-, O46.0-, O67.0, O72.3)” for O99.1 Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism complicating pregnancy, childbirth and the puerperium is deleted and added as an Excludes1 note.

Chapter 16: Certain Conditions Originating
in the Perinatal Period (P00-P96)

This chapter has many revisions and additions/deletions to notes, and added codes.
Under P00.2 Newborn affected by maternal infectious and parasitic diseases, the Excludes1 note “Infections specific to the perinatal period (P35-P39)” is deleted and added as an Excludes2 note.
Aspiration codes P24.01, P24.11, P24.21, P24.31, and P24.81 now direct you to use an additional 5th character “code to identify any secondary pulmonary hypertension, if applicable (I27.2-).”
Under P27 Chronic respiratory disease originating in the perinatal period, the Excludes1 note, “respiratory distress of newborn (P22.0-P22.9),” is deleted and added as an Excludes2 note.
Two definitions are deleted for P29.3 Persistent fecal circulation: “Delayed closure of ductus arteriosus” and “(Persistent) pulmonary hypertension of newborn.” And three definitions for P83.8 Other specified conditions of integument specific to newborn are deleted: bronze baby syndrome, neonatal scleroderma, and urticaria neonatorum.
New codes, definitions, and associated notes are:
P29.30 Pulmonary hypertension of newborn
Persistent pulmonary hypertension of newborn
P29.38 Other persistent fetal circulation
Delayed closure of ductus arteriosus
P78.84 Gestational alloimmune liver disease
Neonatal hemochromatosis
Excludes1: hemochromatosis (E83.11-)
P83.81 Umbilical granuloma
Excludes2: Granulomatous disorder of the skin and subcutaneous tissue, unspecified (L92.9)
P83.88 Other specified conditions of integument specific to newborn
Bronze baby syndrome
Neonatal scleroderma
Urticaria neonatorum
P91.81 Neonatal encephalopathy
P91.811 Neonatal encephalopathy in diseases classified elsewhere
Code first underlying condition, if known, such as:
ongenital cirrhosis (of liver) (P78.71)
intracranial non-traumatic hemorrhage of newborn (P52.-)
kernicterus (P57.-)
P91.819 Neonatal encephalopathy, unspecified
P91.88 Other specified disturbances of cerebral status of newborn

Chapter 17: Congenital Malformations, Deformations, and
Chromosomal Abnormalities (Q00-Q99)

Changes in this chapter include revised notes, code description revisions, and new codes. The new codes are found under subcategory Q53 Undescended and ectopic testicle:
Q53.111 Unilateral intraabdominal testis
Q53.112 Unilateral inguinal testis
Q53.13 Unilateral high scrotal testis
Q53.211Bilateral intraabdominal testes
Q53.212Bilateral inguinal testes
Q53.23Bilateral high scrotal testes
Q82.2 is revised to Congenital cutaneous mastocytosis and “urticaria pigmentosa” is deleted from the definitions. Three definitions are added: congenital diffuse cutaneous mastocytosis; congenital maculopapular cutaneous mastocytosis; and congenital urticaria pigmentosa. “Malignant mastocytosis (C96.2)” is deleted from the Excludes1 note for this code, and the following are added:
Cutaneous mastocytosis NOS (D47.01)
Diffuse cutaneous mastocytosis (with onset after newborn period) (D47.01)
Malignant mastocytosis (C96.2-)
Systemic mastocytosis (D47.02)
Urticaria pigmentosa (non-congenital) (with onset after newborn period) (D47.01)

Chapter 18: Symptoms, Signs, and
Abnormal Clinical and Laboratory
Findings, Not Elsewhere Classified (R00-R99

Predominant changes in this chapter are added definitions and Exclude1 and 2 note additions and deletions to existing codes. There are also a few added codes.
New codes are:
R06.03 Acute respiratory distress
R39.83 Unilateral non-palpable testicle
R39.84 Bilateral non-palpable testicles

Chapter 19: Injury, Poisoning, and Certain Other
Consequences of External Causes (S00-T88)

There are many changes in this chapter, from minor revisions to improve the consistency of language in the definitions (e.g., S00.531 Contusion of lip and S00.532 Contusion of oral cavity) and notes, to entirely new codes.
S04.0 Injury of optic nerve and pathways now indicates to use an additional code “to identify any visual field defect or blindness (H53.4-, H54.4-).”
Under S04.03 Injury of optic tract and pathways and S04.04 Injury of visual cortex, sixth character codes are revised to indicate “side” instead of “eye.”
S06 Intracranial injury adds a detailed note: 7th characters D and S do not apply to codes in category S06 with 6th character 7 – death due to brain injury prior to regaining consciousness, or 8 – death due to other cause prior to regaining consciousness.
“Middle” replaces “medial” in codes S62.62 – S62.65 and code S92.52 Fracture of medial middle phalanx of lesser toe(s).
Subluxation and dislocation codes S63.13-S63.146 are deleted.
T07 Unspecified multiple injuries and T14 Injury of unspecified body region indicate to add the appropriate 7th character:
A = Initial encounter
D = Subsequent encounter
S = Sequela
T27.3-T28.9 add a code first note (T51-T65) to identify chemical and intent.
T80.69 Other serum reaction due to other serum adds a note to code also, if applicable, “arthropathy in hypersensitivity reactions classified elsewhere (M36.4).”

Chapter 20: External Causes of Morbidity (V00-T99)

The most notable change in this chapter is the code additions to allow more specificity in the types of vehicles involved in land transport accidents (V80-V89). New four-character codes specify whether the vehicle was a 3- or 4-wheeled all-terrain vehicle (ATV) or a dirt bike or motor/cross bike.

Chapter 21: Factors Influencing Health Status and
Contact with Health Services (Z00-Z99)

Several codes have been added in this chapter, and just as definitions are added to existing codes.
Z36.0-Z36.9 is added to account for encounters for antenatal screening for various issues (e.g., Z36.4 Encounter for antenatal screening for fetal growth retardation). Code Z40.03 Encounter for prophylactic removal of fallopian tube(s) is also new for 2018.
There are also some note changes, so review this chapter carefully. For example: Z03 Encounter for medical observation for suspected diseases and conditions ruled out deletes the definition “newborn observation for suspected condition, ruled out (P00-P04)” and adds “encounter for observation and evaluation of newborn for suspected diseases and conditions ruled out (Z05.0-).”
Subcategory Z05 Encounter for observation and evaluation of newborn for suspected diseases and conditions ruled out is now applicable to “newborns, within the neonatal period (the first 28 days of life), who are suspected of having an abnormal condition, but without signs or symptoms, and which, after examination and observation, is ruled out.” And Excludes2: “Newborn observation for suspected condition, related to exposure from the mother or birth process (P00-P04)” is deleted.
Note that Z40.02 Encounter for prophylactic removal of ovary has been revised to include both ovaries and fallopian tubes.
Two Excludes1 notes are deleted:
Z43.0-Z43.1 Encounter for attention to artificial openings/gastrostomy deletes “artificial opening status only, without need for care (Z93.-)”
Z45 Encounter for adjustment and management of implanted device deletes “presence of prosthetic and other devices (Z95-Z97).”
“Presence of prosthetic and other devices (Z95-Z97)” is added instead to the Excludes2 note for Z45.018 Encounter for adjustment and management of other part of cardiac pacemaker.
Z48 Encounter for other postprocedural aftercare adds Excludes1 note “encounter for aftercare following injury – code to Injury, by site, with appropriate 7th character for subsequent encounter.”
Z69.010 Encounter for mental health services for victim of parental child abuse adds four definitions:

Encounter for mental health services for victim of child abuse by parent

Encounter for mental health services for victim of child neglect by parent

Encounter for mental health services for victim of child psychological abuse by parent

Encounter for mental health services for victim of child sexual abuse by parent

Z69.011 Encounter for mental health services for perpetrator of parental child abuse adds three definitions:

Encounter for mental health services for perpetrator of parental child neglect

Encounter for mental health services for perpetrator of parental child psychological abuse

Encounter for mental health services for perpetrator of parental child sexual abuse

Z71.8 Other specified counseling deletes the Excludes2 note, “counseling for genetics (Z31.5)” and “counseling for procreative management (Z31.6-).” Also under Z71.8, Z71.82 Exercise counseling and Z71.83 Encounter for nonprocreative genetic counseling are added.
Z83.71 Family history of colonic polyps deletes the Excludes1 note and adds Excludes2 note, “family history of malignant neoplasm of digestive organs (Z80.0).”
Z91 Personal risk factors, not elsewhere classified adds Excludes2 note, “female genital mutilation status (N90.81-).” Also under this subcategory, Z91.84 Oral health risk factors is added with codes Z91.841-Z91.843 and Z91.849 to specify whether dental caries are low, moderate, high, or unspecified risk.
Z95 Presence of cardiac and vascular implants and grafts deletes the Excludes1 note and adds, Excludes 2 note “complications of cardiac and vascular devices, implants and grafts (T82.-).”
This is just an overview of the changes. Be sure to review the Tabular Addenda for 2018 in its entirety.


Amy Pritchett
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Amy C. Pritchett, BSHA, CPC, CPMA, CPC-I, CANPC, CASCC, CEDC, CRC, CDEO, CCS, ICDCT-CM/PCS, C-AHI, has been a coder/auditor for over 20 years with her most recent position being held at Change Healthcare as a Manger of the Facility Coding Services Division. She has many years of experience in several different areas of coding and serves as an interim instructor in her hometown of Mobile, Ala. She shares her expertise in publications and as a lecturer at conferences such as Coding-Con for The Coding Institute. She has served as President and Vice President of the Mobile, Ala., local chapter and serves as Secretary for the 2017 year.

No Responses to “Look Ahead at ICD-10-CM in 2018”

  1. Andrew C says:

    That was a lot of work to get all this info. Thank you for compiling it all for us!