Review the 2019 ICD-10-CM Code Changes

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  • December 2, 2018
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Review the 2019 ICD-10-CM Code Changes

In addition to updated guidelines summarized in November’s Healthcare Business Monthly (“Change Is Here: Review the 2019 ICD-10-CM Guideline Updates,” pages 32-36) the 2019 ICD-10-CM code book gains 279 new codes, revises 143 codes, and deletes 51 codes. To help you prepare for the year ahead, here’s a quick, chapter-by-chapter rundown of the notable changes.

Chapters with No Changes

There are no changes in Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99), Chapter 3: Diseases of the Blood and Blood-forming Organs and Certain Disorders Involving the Immune Mechanism (D50-D89), and Chapter 8 Diseases of the Ear and Mastoid Process (H60-H95). Chapter 10: Diseases of the Respiratory System (J00-J99) has one minor revision to correct formatting.

Chapter 2: Neoplasms (C00-D49)

There are 45 codes added to describe neoplasm sites of the right or left, upper or lower eyelids. As a result, 19 less-specific codes are deleted.

Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E00-E89)

Six codes are added:
E72.81    Disorders of gamma aminobutyric acid metabolism
E72.89    Other specified disorders of amino-acid metabolism
E75.26    Sulfatase deficiency
E78.41    Elevated Lipoprotein (a)
E78.49    Other hyperlipidemia
E88.02    Plasminogen deficiency
Two codes are deleted: E72.8 and E78.4.
Code E67.1 was revised to correct the spelling of “hypercarotenemia” and E72.53 (hyperoxaluria) now specifies “primary.”

Chapter 5: Mental, Behavioral and Neurodevelopment Disorders (F01-F99)

Five codes are added:
F12.23    Cannabis dependence with withdrawal
F12.93    Cannabis use, unspecified with withdrawal
F53.0      Postpartum depression
F53.1      Puerperal psychosis
F68.A      Factitious disorder imposed on another
Code F53 is deleted and F68.10-F68.13 are revised to indicate factitious disorder imposed on self … (new text is underlined).

Chapter 6: Diseases of the Nervous System (G00-G99)

Four codes are added in the G51.31-G51.39 range for right, left, bilateral, and unspecified clonic hemifacial spasm and four codes added in the G71.00- G71.09 range describe the types of muscular dystrophy.
The less-specific codes are deleted: G51.3 and G71.0.

Chapter 7: Diseases of the Eye and Adnexa (H00-H59)

A total of 42 new codes are added to include the addition of upper and lower eyelids.

Chapter 9: Diseases of the Circulatory System (I00-I99)

Four codes are added:
I63.81     Other cerebral infarction due to occlusion or stenosis of small artery
I63.89     Other cerebral infarction
I67.850   Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
I67.858   Other hereditary cerebrovascular disease
Code I63.8 is deleted, and four cerebral infarction codes are revised: I63.219 and I63.239 change “arteries” to “artery” and the word “due” is added to I63.333 and I63.343.

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

There are 15 new codes:
K35.20    Acute appendicitis with generalized peritonitis, without abscess
K35.21    Acute appendicitis with generalized peritonitis, with abscess
K35.30    Acute appendicitis with localized peritonitis, without perforation or gangrene
K35.31    Acute appendicitis with localized peritonitis and gangrene, without perforation
K35.32    Acute appendicitis with perforation and localized peritonitis, without abscess
K35.33    Acute appendicitis with perforation and localized peritonitis, with abscess
K35.890 Other acute appendicitis without perforation or gangrene
K35.891 Other acute appendicitis without perforation, with gangrene
K61.31    Horseshoe abscess
K61.39    Other ischiorectal abscess
K61.5      Supralevator abscess
K82.A1   Gangrene of gallbladder in cholecystitis
K82.A2   Perforation of gallbladder in cholecystitis
K83.01    Primary sclerosing cholangitis
K83.09    Other cholangitis
Five less-specific codes are deleted as a result of these new codes, which offer improved specificity of acute appendicitis, ischiorectal abscess, and cholangitis.

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

There are three revised codes (new text is underlined):
L98.495 Non-pressure chronic ulcer of skin or other sites with muscle involvement without evidence of necrosis
L98.496 Non-pressure chronic ulcer of skin of other sites with bone involvement without evidence of necrosis
L98.498 Non-pressure chronic ulcer of skin of other sites with other specified severity

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

Four codes are added:
M79.10 Myalgia, unspecified site
M79.11 Myalgia of mastication muscle
M79.12 Myalgia of auxiliary muscles, head and neck
M79.18 Myalgia, other site
Less specific code M79.1 Myalgia is deleted.

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

Seventeen codes are added:
N35.016              Post-traumatic urethral stricture, male, overlapping sites
N35.116              Post infective urethral stricture, not elsewhere classified, male, overlapping sites
N35.811              Other urethral stricture, male, meatal
N35.812              Other urethral bulbous stricture, male
N35.813              Other membranous urethral stricture, male
N35.814              Other anterior urethral stricture, male, anterior
N35.816              Other urethral stricture, male, overlapping sites
N35.819              Other urethral stricture, male, unspecified site
N35.82   Other urethral stricture, female
N35.911              Unspecified urethral stricture, male, meatal
N35.912              Unspecified bulbous urethral stricture, male
N35.913              Unspecified membranous urethral stricture, male
N35.914              Unspecified anterior urethral stricture, male
N35.916              Unspecified urethral stricture, male, overlapping sites
N35.919              Unspecified urethral stricture, male, unspecified site
N35.92   Unspecified urethral stricture, female
N99.116              Postprocedural urethral stricture, male, overlapping sites
With the addition of these more specific codes, N35.8 and N35.9 are deleted.

Chapter 15: Pregnancy, Childbirth and the Puerperium O00-O94)

Codes are added in the ranges O30.131-O30.139 Triplet pregnancy, trichorionic/triamniotic, (first, second, third and unspecified trimester) and O30.231-O30.239 Quadruplet pregnancy (first, second, third and unspecified trimester).
Other new codes include:
O86.00   Infection of obstetric surgical wound, unspecified
O86.01   Infection of obstetric surgical wound, superficial incisional site
O86.02   Infection of obstetric surgical wound, deep incisional site
O86.03   Infection of obstetric surgical wound, organ or space site
O86.04   Sepsis following an obstetrical procedure
O86.09   Infection of obstetric wound, other surgical site
The less-specific code O86.0 is deleted.

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

There are 25 new codes involving newborn complications related to maternal drug use, metabolic disorders in the newborn, and newborns affected by the Zika virus:
P02.70    Newborn affected by fetal inflammatory response syndrome
P02.78    Newborn affected by other conditions from chorioamnionitis
P04.11    Newborn affected by maternal antineoplastic chemotherapy
P04.12    Newborn affected by maternal cytotoxic drugs
P04.13    Newborn affected by maternal use of anticonvulsants
P04.14    Newborn affected by maternal use of opiates
P04.15    Newborn affected by maternal use of antidepressants
P04.16    Newborn affected by maternal use of amphetamines
P04.17    Newborn affected by maternal use of sedative-hypnotics
P04.18    Newborn affected by maternal other maternal medication
P04.19    Newborn affected by maternal use of unspecified medication
P04.40    Newborn affected by maternal use of unspecified drugs of addiction
P04.42    Newborn affected by maternal use of hallucinogens
P04.81    Newborn affected by maternal use of cannabis
P04.89    Newborn affected by other maternal noxious substances
P35.4      Congenital Zika virus disease
P74.21    Hypernatremia of newborn
P74.22    Hyponatremia of newborn
P74.31    Hyperkalemia of newborn
P74.41    Alkalosis of newborn
P74.421 Hyperchloremia of newborn
P74.422 Hypochloremia of newborn
P74.49    Other transitory electrolyte disturbance of newborn
The less-specific codes for these conditions are deleted: P02.7, P04.1, P04.8, P74.2, P74.3, and P74.4.

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

Seven codes are added:
Q51.20   Other doubling of uterus, unspecified
Q51.21   Other complete doubling of uterus
Q51.22   Other partial doubling of uterus
Q51.28   Other doubling of uterus, other specified
Q93.51   Angelman syndrome
Q93.59   Other deletions of part of a chromosome
Q93.82   Williams syndrome
Two less-specific codes are deleted: Q51.2 and Q93.5.

Chapter 18: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, NEC (R00-R99)

There are 10 codes are added:
R82.991 Hypocitraturia
R82.992 Hyperoxaluria
R82.993 Hyperuricosuria
R82.994 Hypercalciuria
R82.998 Other abnormal findings in urine
R93.811 Abnormal radiologic findings on diagnostic imaging right testicle
R93.812 Abnormal radiologic findings on diagnostic imaging of left testicle
R93.813 Abnormal radiologic findings on diagnostic imaging of testicles, bilateral
R93.819 Abnormal radiologic findings on diagnostic imaging of unspecified testicle
R93.89    Abnormal findings on diagnostic imaging of other specified body structures
The two less-specific codes for these conditions are deleted: R82.99 and R93.8.
Five codes in the range of R40.2330-R40.2334 (coma scale) are revised to correct the omission of the word “flexion” in the descriptors.

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

A total of 54 codes are added, to include:
T43.641-T43.644 – Poisoning by ecstasy (accidental, intentional, assault, undetermined) (initial, subsequent, sequela)
T74.51X-T766.2X – Adult, child forced sexual exploitation/labor exploitation (confirmed) (suspected) (initial, subsequent, sequela)
T81.40X-T81.43X – Infections following a procedure (initial, subsequent, sequela)
T81.44X-T81.49X – Sepsis following a procedure (initial, subsequent, sequela)
Three codes representing infection following a procedure (initial, subsequent, sequela) are deleted: T81.4XXA-S.
There are 87 revised codes: Many of the revisions result from the replacement of “medial” with “middle” in the fractures of the phalanx in subcategory codes S62.626A-S62.659S.

Chapter 20: External Causes of Morbidity (V00-Y99)

A single code is added:
Y07.6      Multiple perpetrators of maltreatment and neglect

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

Seventeen new codes are added:
Z04.81    Encounter for examination and observation of victim following forced sexual exploitation
Z04.82    Encounter for examination and observation of victim following forced labor exploitation
Z04.89    Encounter for examination and observation for other specified reasons
Z13.30    Encounter for screening examination for mental health and behavioral disorders, unspecified
Z13.31    Encounter for screening for depression
Z13.32    Encounter for screening for maternal depression
Z13.39    Encounter for screening for other mental health and behavioral disorders
Z13.40    Encounter for unspecified developmental delay
Z13.41    Encounter for autism screening
Z13.42    Encounter for screening for global developmental delays (milestones)
Z13.49    Encounter for screening for other developmental delays
Z20.821 Contact with and (suspected) exposure to Zika virus
Z28.83    Immunization not carried out due to unavailability of vaccine
Z62.813 Personal history of forced labor or sexual exploitation in childhood
Z83.430 Family history of elevated lipoprotein(a)
Z83.438 Family history of other disorder of lipoprotein metabolism and other lipidemia
Z91.42    Personal history of forced labor or sexual exploitation
Two less-specific codes are deleted: Z04.8 and Z13.4.
Stay up to date on the newest code set changes for 2019 by monitoring the AAPC Knowledge Center, the Centers for Medicare & Medicaid Services (CMS), and American Hospital Association for any addendums or errata to the new codes that may follow.
If you haven’t purchased an ICD-10-CM code book or updated your encoder subscription, do so now. Not only were these codes changed, but there were changed to guidelines, coding instructions, indexes, and other elements of the code set.

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.

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