Anesthesia Coding Alert

Explore new options for chronic migraine, SDoH, external causes, and more.

Hundreds of new diagnosis codes are set to take effect later this year, which means it’s time to put your thinking cap on and study these updates, so you’re ready to hit the ground running come October.

The nitty gritty: The ICD-10-CM code set update for fiscal year (FY) 2024 adds 395 new codes, deletes 25 existing codes, and revises 22 codes (nine of which are to the short title only). There are also 131 new headers and four revised headers.

Keep in mind, as an anesthesia coder, your providers can be involved with care for patients diagnosed with any condition. Instead of focusing on specific sections of ICD-10-CM like subspecialty coders might, you should spend time looking through all the changes since any diagnosis might cross your desk, advises Kelly D. Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Florida.

Here’s an overview of key changes you should be familiar with before the calendar flips to Oct. 1, 2023.

Navigate New Neurology-Related Codes

Several new codes are being added throughout the code set to identify known conditions with improved specificity. ICD-10-CM 2024 introduces 24 new codes to Chapter 6, Diseases of the Nervous System. These updates include five new codes to report Parkinson’s disease (G20), which will boost code specificity by adding information about dyskinesia and fluctuations.

Also of note, under G43.E- (Chronic migraine with aura), you’ll find new subcategories and codes for reporting chronic migraine:

• G43.E0 (Chronic migraine with aura, not intractable)
• G43.E01 (Chronic migraine with aura, not intractable, with status migrainosus)
• G43.E09 (… without status migrainosus)
• G43.E1 (Chronic migraine with aura, intractable)
• G43.E11 (Chronic migraine with aura, intractable, with status migrainosus)
• G43.E19 (… without status migrainosus)

Analysis: The new migraine codes add another layer to the already deep field of G43.- (Migraine) codes. Before 2024, chronic migraine with aura did not have its own code set. Come October, you’ll be able to code for chronic migraine with aura, and you can further specify that diagnosis by answering the intractable/not intractable and status migrainosus questions.

Note chronic migraine is characterized by the presence of a headache 15 or more days per month for at least three months, with at least eight of those headaches being migraines.

Also, aura refers to neurological symptoms that some individuals experience before or during a migraine. Symptom onset is typically gradual and can last a few minutes to an hour. Migraine aura can manifest as various sensory disturbances, such as visual changes, tingling or numbness in the face or limbs, difficulty speaking, or even temporary loss of vision.

Delve Into New Cardiovascular Disease Options

Angina is a common ailment that may be indicative of underlying coronary microvascular dysfunction. This condition is associated with significantly higher rates of major adverse cardiac events, according to code requester Abbot Laboratories Inc. Several new codes were created to track these cardiac conditions.

Also in Chapter 9, Diseases of the Circulatory System, new codes are added for myocardial infarction (I21B), resistant hypertension (I1A.0), and supraventricular tachycardia (I47.10-I47.19). There are additional tabular modifications in this chapter related to the addition of these codes and several code revisions.

Examine External Causes ‘Foreign Body Entering Orifice’ Codes

Most of the diagnosis code additions fall under novel category W44 (Foreign body entering into or through a natural orifice) in Chapter 20, External Causes of Morbidity. The expansion provides 123 new codes you can report to capture accidents and injuries involving foreign bodies — batteries, plastic objects, glass, magnetic and non-magnetic metal items, rubber bands, food, insets, audio device, etc. — that enter or pass through a natural orifice.

As with most external cause codes, you’ll add a 7th character to these new codes — A (... initial encounter), D (… subsequent encounter), or S (… sequela) — to indicate the type of encounter.

Zero In on Z Code Additions

Chapter 21, Factors Influencing Health Status and Contact with Health Services, exhibits the fourth-highest number of changes, with 30 new additions and six codes converted to parent. Remember, Z codes are critical to painting a complete picture of the patient’s circumstances and help gather data on treatment efficacy and the true cost of care.

The newly introduced Z codes encompass various aspects such as personal history of military service, newborn observation for suspected conditions ruled out, carriers of bacteria (Acinetobacter baumannii, Enterobacterales), family history of certain colonic polyps, and caregiver noncompliance.

ICD-10-CM 2024 also enhances the Social Determinants of Health (SDoH) section, providing you with more ways to report notable child-guardian relationships, thanks to new codes like Z62.23 (Child in custody of non-parental relative), Z62.823 (Parent-step child conflict), and Z62.832 (Non-relative guardian-child conflict).

Don’t miss: Other diagnosis code updates for 2024 include:

• Two new codes — sepsis (A41.54) and other diseases (B96.83) caused by Acinetobacter baumannii — in the certain infectious and parasitic diseases (A00-B99) chapter
• Seven new codes added to the diseases of the respiratory system (J00-J99) chapter
• 21 new codes added to the neoplasms (D00-D89) chapter
• 36 new codes added to the diseases of the musculoskeletal system and connective tissue (M00-M99) chapter

Take Steps To Keep Clean Claims and Appropriate Pay

Medicare and many other payers use ICD-10-CM to process claims, relying on diagnosis codes to demonstrate the medical necessity for your anesthesiologist’s services. Also, Medicare quality reporting programs rely on appropriate diagnosis coding to evaluate appropriate procedures — so missing the boat now could impact your bottom line later.

As you prepare to implement the new ICD-10-CM changes on Oct. 1, there are a few things you need to address, says Robin Peterson, CPC, CPMA, manager of professional coding services, Pinnacle Integrated Coding Solutions, LLC in Centennial, Colorado.

First, review current documentation for each of the expanded categories. As your providers are currently documenting, would the verbiage support the level of specificity required to report the new codes? If not, meet with your providers to explain the new codes and increase their awareness of what the documentation requires.

“You will also address the detail that is needed to support the highest level of specificity,” Peterson adds. “Also remember, the current EHR templates providers are using may require updates.” And lastly, any internal billing or charge systems will need to make the new codes available” as of Oct. 1, 2023.