Review the 2019 ICD-10-CM Code Changes

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

Amy Pritchett

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.
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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