I know it’s the same coffee as last week, but it has become my new obsession for the Summer.
Let’s jump right into the changes/updates to the 2023 chapter-specific guidelines.
C. Chapter-Specific Coding Guidelines
Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99), U07.1, U09.9
a. Human Immunodeficiency Virus (HIV) Infections
2) Selection and sequencing of HIV codes
(a) Patient admitted for HIV-related condition
The chapter-specific rule is to assign principal (primary) diagnosis B20 when patients are admitted for an HIV-related condition and additional diagnosis code(s) for all documented HIV-related condition(s).
2023 has an exception:
If the admission is hemolytic-uremic syndrome and it is documented as associated with HIV disease, assign principal (primary) diagnosis D59.31 and secondary diagnosis B20.
D59.31 is a new ICD-10-CM code for 2023. We will review the new, deleted, and revised codes next week.
- HIV managed by antiretroviral medication
2023 guideline specifies “antiretroviral” medication and includes HIV-related illness or AIDS.
3) Sequencing of severe sepsis
For infection-associated hemolytic-uremic syndrome with severe sepsis, see guideline I.C.1.d.9.
4) Sepsis or severe sepsis with a localized infection
For infection-associated hemolytic-uremic syndrome with severe sepsis, see guideline I.C.1.d.9.
This is I.C.1.d.9: (New guideline)
9) Hemolytic-uremic syndrome associated with sepsis
If hemolytic-uremic syndrome is documented as associated with sepsis, assign D59.31 (new code for 2023) as the principal (primary) diagnosis. The underlying systemic infection and other conditions should be coded as additional diagnoses.
g. Coronavirus infections
1) COVID-19 infection (infection due to SARS-CoV-2)
(n) Underimmunization for COVID-19 Status (new guideline published for 2023), but the codes have been available for reporting since April 1, 2022
Chapter 2: Neoplasms (C00-D49)
General Guidelines
- Admission/Encounter for treatment of primary site
I had to read this one a few times to understand the change.
Before 2023, the guideline focused on the treatment directed at the malignancy. For 2023, if the malignancy is the reason for the admission/encounter and treatment is directed at the primary site, the primary malignancy will be reported as the principal/primary diagnosis. The exception remains the same. If chemotherapy, immunotherapy, or external beam radiation therapy is the reason for the admission/encounter, report the Z-code as primary.
t. Secondary malignant neoplasm of lymphoid tissue
This guideline is new for 2023 and addresses malignant neoplasm of lymphoid tissue that metastasizes beyond the lymph nodes. For 2023, do not assign a code for the secondary neoplasm of the affected solid organ. Instead, coders should assign a code from category C81 through C85 with a final character “9.4.
Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00-E89)
- Diabetes mellitus
3)Diabetes mellitus and the use of insulin, oral hypoglycemics, and injectable non-insulin drugs
For 2023, instead of “oral medications and insulin,” the guideline specifies oral hypoglycemic drugs and insulin. In addition, it directs us to another new code for 2023, Z79.85, for Long-term (current) use of injectable non-insulin antidiabetic drugs.
Chapter 5: Mental, Behavioral, and Neurodevelopmental disorders (F01 – F99)
b. Mental and behavioral disorders due to psychoactive substance use
1) In Remission
For 2023, this section now includes the addition of new codes that are assigned “.91” to describe “in remission”. I’ll provide more detail of these new codes next week.
d. Dementia (new guideline for 2023)
There are many new codes for this category in 2023.
If providers do not document the severity of Dementia (and coders cannot query the providers), coders are directed to assign the appropriate code for unspecified severity.
For inpatient stays, when patients are admitted with a specific level of severity, and it progresses to a higher level, coders should assign the code for the highest severity level reported during the stay.
Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A)
- General Rules for Obstetric Cases
7) Completed weeks of gestation
This guideline clarifies how to assign code for “completed” weeks of gestation with an example. We are instructed to code only the whole weeks, not the “days” (24 weeks, 4 days).
- Termination of Pregnancy and Spontaneous abortions (new guideline for 2023)
- Hemorrhage following elective abortion
Do not assign code O72.1 – this code is reported for postpartum hemorrhage. Likewise, do not assign code Z33.2 when the patient experiences a complication (post-elective abortion hemorrhage). The correct code is O04.6.
Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)
e. Adverse Effects, Poisoning, Underdosing, and Toxic Effects
5) The occurrence of drug toxicity is classified in ICD-10-CM as follows:
(c) Underdosing
I’m just going to provide the quote, “Documentation of a change in the patient’s condition is not required in order to assign an underdosing code. Documentation that the patient is taking less of a medication than is prescribed or discontinued the prescribed medication is sufficient for code assignment.”
Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)
10) Counseling
“Code Z71.87, Encounter for pediatric-to-adult transition counseling, should be assigned when pediatric-to-adult transition counseling is the sole reason for the encounter or when this counseling is provided in addition to other services, such as treatment of a chronic condition. If both transition counseling and treatment of a medical condition are provided during the same encounter, the code(s) for the medical condition(s) treated and code Z71.87 should be assigned, with sequencing depending on the circumstances of the encounter.”
17) Social Determinants of Health
This guideline has been updated for 2023 to include the language, problems or risk factors related to social determinants of health.
Coders should assign all SDOH codes to describe the problems or risk factors only when the providers document that the patient has an associated problem or risk factor.
Next week, we will review the 2023 ICD-10-CM code additions, deletions, and revisions.
Yes, I’ll be sipping more Starbucks® Bottled Caramel Frappuccino® Coffee Drink.
Coffee With a Medical Coding Auditor 