The Center for Disease Control and Prevention has published the FY17 New ICD-10-CM changes which will become effective on Oct. 1, 2016. Although implementation of ICD-10-CM occurred in October 2015, the code set has been frozen for five years and was scheduled to end one year after the implementation.  There were only limited code updates throughout the past several years to capture new technologies and diagnoses.

There are a total of 1,943 new codes, 422 revised codes, and 305 deleted codes that are slated for the upcoming preliminary changes. During the March 2016 ICD-10 Coordination and Maintenance Committee meeting, additional code proposals were presented for consideration for implementation on Oct. 1, 2016; however, they are not included in the current document.

One noted change is that there will be new combination codes for diabetes and manifestations. The most significant changes will be found in Chapter 19 regarding the appropriate coding for neck, skull, facial bones, and calcaneal fractures. Being considered are new codes for abnormal findings in urine collection “to better capture the unique characteristics of these abnormal findings and to help with research and public health1.

Overuse of unspecified codes

The overuse of unspecified codes continues to be of concern throughout. Although the Centers for Medicare & Medicaid Services (CMS) has not issued any additional guidance regarding the grace period and the use of unspecified codes, it is important to understand your overall usage of these codes and if Local or National Coding Policies addresses these. It is also important to understand if denials are a result of unspecified code usage or medical necessity.

In ICD-10-CM, the use of sign/symptoms and unspecified codes has acceptable, even necessary, uses. While you should document the diagnosis to the highest degree of specificity as supported in the medical record documentation, in some instances signs/symptoms or unspecified codes are the best choice to accurately reflect the healthcare encounter. ICD-10-CM will still have “unspecified” subcategories for use.

Planning for ICD-10-CM throughout 2015 focused on improved clinical documentation and we continue to emphasize the importance of this practice. Remember that ICD-10-CM is a clinical modification of the World Health Organization’s ICD-10, which consists of a diagnostics classification system. It includes a higher level of detail needed for morbidity classification and diagnostics specificity in the United States. It contains more than 68,000 codes and together with CPT, can provide more meaningful details about the quality of care. That data will be used to track the outcome of patient care with the ultimate goal being a demonstration of improved clinical decision making and outcomes.

The ICD-10 Coordination and Maintenance Committee meet twice a year with an upcoming meeting Sept. 13-14, 2016. Proposals were due by July 15, 2016.


References:

ICD-10-CM Coordination and Maintenance Committee

1ICD-10 Coordination and Maintenance Committee Meeting March 9-10, 2016 page 10.

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About the author

Mary Jo Gross, CPC, CANPC of Compliance – Anesthesia and Pain Management, McKesson Business Performance Services