ICD-10-CM diagnosis coding updates for 2023
Derm Coding Consult
By Faith C. M. McNicholas, RHIT, CPC, CPCD, PCS, CDC, Manager, Lead Coding and Reimbursement Strategist, October 1, 2022
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The Centers for Disease Control and Prevention and the National Center for Health Statistics (CDC/NCHS) has announced the 2023 International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) updates to be implemented on Oct. 1, 2022. The approved updates have a total of 1,490 code changes, of which only a few will directly impact dermatology diagnoses coding. The overall changes include:
1,175 new diagnosis codes
28 revised codes
287 invalidated codes
Increase in Social Determinants of Health-related (SDoH) diagnoses codes
The house of medicine continues to encourage documentation and reporting of SDoH-related circumstances to ensure data collection is enhanced and can be used to help address the wide health disparities and inequities in society. To that end, there are three new codes added to categories Z55-Z65 - Persons with potential health hazards related to socioeconomic and psychosocial circumstances, which include other problems related to housing and economic circumstances, transportation insecurity, and material hardship.
New categories to report: Factors influencing patient health status
The CDC/NCHS has also approved 15 new codes for CY 2023 to be included in Chapter 21: Z00-Z99 – Factors influencing health status and contact with health services. Codes in Chapter 21 of the ICD-10-CM coding manual are typically characterized as informational codes and may not be reported as principal or first-listed codes unless under specific circumstances. However, these codes are important in health care data collection because they provide additional information that supports the medical necessity as to why the patient is receiving health care services.
Of interest to dermatology is category Z79 – long term [current] drug therapy which includes new codes for long-term [current] use of immunosuppressive biologic agents, antineoplastics, and chemotherapeutic agents.
The following list outlines the new ICD-10-CM codes that may be important to your dermatology practice and will require inclusion in the practice management coding system, effective Oct. 1, 2022.
| ICD-10-CM code | Code descriptor |
|---|---|
Q85.81 |
PTEN tumor syndrome PHTS PTEN hamartoma tumor syndrome PTEN related Cowden syndrome Code also, if applicable, genetic susceptibility to malignant neoplasm (Z15.0-) |
Q85.82 |
Other Cowden syndrome |
Q85.83 |
Von Hippel-Lindau syndrome Code also manifestations |
Q85.89 |
Other phakomatoses, not elsewhere classified Peutz-Jeghers syndrome Sturge-Weber(-Dimitri) syndrome |
Z59.82 |
Transportation insecurity Excessive transportation time Inaccessible transportation Inadequate transportation Lack of transportation Unaffordable transportation Unreliable transportation Unsafe transportation |
Z59.86 |
Financial insecurity Bankruptcy Burdensome debt Economic strain Financial strain Money problems Running out of money Unable to make ends meet Excludes2: extreme poverty (Z59.5) low income (Z59.6) material hardship, not elsewhere classified (Z59.87) |
Z59.87 |
Material hardship Material deprivation Unable to obtain adequate childcare Unable to obtain adequate clothing Unable to obtain adequate utilities Unable to obtain basic needs Excludes2: extreme poverty (Z59.5) |
Z71.87 |
Encounter for pediatric-to-adult transition counseling Code also chronic condition, if applicable, such as: autism spectrum disorder (F84.0) congenital malformations of the circulatory system (Q20-Q28) cystic fibrosis (E84-) sickle-cell disorder (D57-) |
Z71.88 |
Encounter for counseling for socioeconomic factors |
Z79.60 |
Long term (current) use of unspecified immunomodulators and immunosuppressants |
Z79.61 |
Long term (current) use of immunomodulator Long term (current) use of apremilast Long term (current) use of immunomodulatory imide drug Long term (current) use of lenalidomide Long term (current) use of pomalidomide |
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| ICD-10-CM code | Code descriptor |
|---|---|
Z79.620 |
Long term (current) use of immunosuppressive biologic Long term (current) use of adalimumab Long term (current) use of etanercept Long term (current) use of infliximab Long term (current) use of monoclonal antibodies |
Z79.621 |
Long term (current) use of calcineurin inhibitor Long term (current) use of cyclosporine Long term (current) use of tacrolimus |
Z79.622 |
Long term (current) use of Janus kinase inhibitor Long term (current) use of tofacitinib |
Z79.623 |
Long term (current) use of mammalian target of rapamycin (mTOR) inhibitor Long term (current) use of sirolimus |
Z79.624 |
Long term (current) use of inhibitors of nucleotide synthesis Long term (current) use of azathioprine Long term (current) use of mycophenolate Long term (current) use of purine synthesis (IMDH) inhibitors |
Z79.630 |
Long term (current) use of alkylating agent Long term (current) use of chlorambucil Long term (current) use of cisplatin Long term (current) use of cyclophosphamide |
Z79.631 |
Long term (current) use of antimetabolite agent Long term (current) use of 5-fluorouracil Long term (current) use of 6-mercaptopurine Long term (current) use of cytarabine Long term (current) use of methotrexate |
Z79.632 |
Long term (current) use of antitumor antibiotic Long term (current) use of bleomycin Long term (current) use of doxorubicin Long term (current) use of mitomycin |
Z79.633 |
Long term (current) use of mitotic inhibitor Long term (current) use of paclitaxel Long term (current) use of plant alkaloids Long term (current) use of vinblastine Long term (current) use of vincristine |
Z79.634 |
Long term (current) use of topoisomerase inhibitor Long term (current) use of etoposide Long term (current) use of irinotecan Long term (current) use of topotecan |
Z91.1 |
Patient’s noncompliance with medical treatment and regimen Excludes2: caregiver noncompliance with patient’s medical treatment and regimen (Z91.A-) |
Z91.110 |
Patient's noncompliance with dietary regimen due to financial hardship |
Z91.118 |
Patient’s noncompliance with dietary regimen for other reason Inability to comply with dietary regimen |
Z91.119 |
Patient’s noncompliance with dietary regimen due to unspecified reason |
Z91.190 |
Patient’s noncompliance with other medical treatment and regimen due to financial hardship |
Z91.198 |
Patient’s noncompliance with other medical treatment and regimen for other reason |
Z91.199 |
Patient’s noncompliance with other medical treatment and regimen due to unspecified reason |
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| ICD-10-CM code | Code descriptor |
|---|---|
Z91.A1 |
Caregiver’s noncompliance with patient’s dietary regimen Caregiver’s inability to comply with patient’s dietary regimen Code also, if applicable, food insecurity (Z59.4-) |
Z91.A10 |
Caregiver’s noncompliance with patient’s dietary regimen due to financial hardship |
Z91.A18 |
Caregiver’s noncompliance with patient’s dietary regimen for other reason |
Z91.A2 |
Caregiver’s intentional underdosing of patient’s medication regimen Code first underdosing of medication (T36-T50) with fifth or sixth character 6 |
Z91.A20 |
Caregiver’s intentional underdosing of patient’s medication regimen due to financial hardship |
Z91.A28 |
Caregiver’s intentional underdosing of medication regimen for other reason |
Z91.A3 |
Caregiver’s unintentional underdosing of patient’s medication regimen Code first underdosing of medication (T36-T50) with fifth or sixth character 6 |
Z91.A4 |
Caregiver’s other noncompliance with patient’s medication regimen Caregiver’s underdosing of patient’s medication NOS |
Z91.A5 |
Caregiver’s noncompliance with patient’s renal dialysis |
Z91.A9 |
Caregiver’s noncompliance with patient’s other medical treatment and regimen Caregiver’s nonadherence to patient’s medical treatment |
Note: The above codes do not reflect an exhaustive list of all the new codes and do not include coding instructions. Please review the AADA Coding and Billing for Dermatology manual, ICD-10-CM section, for chapter-specific coding instructions pertaining to the use of these new codes.
The following code categories have been revised as follows:
| ICD-10-CM code | 2022 code descriptor | 2023 revision |
|---|---|---|
L81 |
Other disorders of pigmentation Excludes1: Peutz-Jeghers syndrome (Q85.8) |
Excludes1: Peutz-Jeghers syndrome (Q85.89) |
Q82 |
Other congenital malformations of skin Excludes1: Sturge-Weber (-Dimitri) syndrome (Q85.8) |
Excludes1: Sturge-Weber (-Dimitri) syndrome (Q85.89) |
Q85.8 |
Other phakomatoses, not elsewhere classified |
Q85.89 |
Visit the Coding Resource Center for more guidance and additional coding resources.
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