It’s that time of year again! The time when you have to face the October 1st diagnosis coding update. If you are like most, you have just become comfortable with the 2017 update of ICD-10 codes and finally have your clinical documentation in order. Well ICD-10 for 2018 is no different.

This year we are faced with 363 NEW codes, 142 DELETED codes, and 250 REVISED codes. Many people refer to the proposed ICD-10 coding changes that are released at the beginning of the new year and assume those will be the changes that come forth in the final draft. This year that is absolutely not the case. In fact most of the revised codes and many of the deleted codes were not in the proposed code set. With that said it is important to refer to the final update posted by the Centers for Medicare and Medicaid Services on June 13, 2017.

What we Found About ICD-10

After reviewing all of the diagnosis coding changes for 2018 we found that it spans several specialties. However, there were major changes that really stood out. Myocardial Infarction (MI) codes were added. Now clinical documentation must state what type of MI the patient had and the code is to be selected based on that type of MI. Several new codes were added for heart failure, adding additional detail to the exact type of heart failure the patient has (takes me back to ICD-9 when it was stated you must be specific to the type of heart failure and the reality was that they still accepted the non-specific codes at that time), not in ICD-10 so beware.

For 2018, gynecologists will now be able to code for the specific antenatal screening test administered to their patients using 17 new Z codes. In light of the opioid addiction crisis changes were seen in this area as well — new codes were added to describe substance abuse remission. Diabetes and Neoplasms also had several coding changes for 2018. In regard to deleted codes — several codes for anorectal abscesses were deleted, along with several codes in the head injury section. Thumb subluxation and dislocation also underwent several code deletions.

Please be advised that clinical documentation must be updated to ensure the documentation in the medical record supports the diagnosis code billed. Since ICD-10 codes are so specific, and since it is imperative to choose the most specific ICD-10 code to ensure maximum reimbursement, clinical documentation must also reflect this level of clinical detail. What we see historically is that many times providers get in the habit of “just documenting enough because it is something they are very familiar with and treat all the time”. It will be critical to find which codes will affect your practice as well as what is expected to be documented in the medical record to reflect that specificity.

If you have any questions related to your specific specialty, contact us.