ICD-10-CM diagnosis coding updates for 2024
Derm Coding Consult
By Faith C. M. McNicholas, RHIT, CPC, CPCD, PCS, CDC, Manager, Lead Coding and Reimbursement Strategist, September 1, 2023
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The CDC and the National Center on Vital and Health Statistics (NCVHS) have announced the 2024 International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) updates to be implemented on Oct. 1, 2023. The approved updates have a total of 433 code changes, of which only a few will directly impact dermatology diagnosis coding. The good news is that there are no changes or updates to Chapter 12, Diseases of the skin and subcutaneous tissue (L00-L99).
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Follow-up encounters after completed treatment of malignant neoplasm
After a lengthy four-year process, the CDC/NCVHS approved the AADA’s request for new coding guidance that allows reporting patient follow-up encounters after completed treatment for malignant neoplasms, even when there are no additional findings during the encounter.
As a compromise to the original request for eight new diagnosis codes, the 2024 ICD-10-CM coding guidelines have now been updated to allow reporting of Z08 as a primary diagnosis code to report follow-up encounters after completed treatment for malignant neoplasm, medical, or surgery.
This means that dermatology follow-up encounters for patients with a history of malignant neoplasms who do not have any other presenting problems can now be reported with Z08 as the primary diagnosis code on the claim, followed by a diagnosis code describing the appropriate history of malignant neoplasm that was treated.
The following shows the 2024 revised coding guidelines:
Chapter 21 | Specific guidelines |
|---|---|
Factors influencing health status and contact with health services (Z00-Z99)
Note: The chapter-specific guidelines provide additional information about the use of Z codes for specified encounters. a. Use of Z codes in any health care setting. Z codes may be used as either a first-listed (principal diagnosis code in the inpatient setting) or secondary code, depending on the circumstances of the encounter. Certain Z codes may only be used as first-listed or principal diagnosis. b. Z codes indicate a reason for an encounter or provide additional information about a patient encounter. Z codes are not procedure codes. A corresponding procedure code must accompany a Z code to describe any procedure performed. | 8) Follow-up
The follow-up codes are used to explain continuing surveillance following completed treatment of a disease, condition, or injury. They imply that the condition has been fully treated and no longer exists. They should not be confused with aftercare codes, or injury codes with a 7th character for subsequent encounter, that explain ongoing care of a healing condition or its sequelae. Follow-up codes may be used in conjunction with history codes to provide the full picture of the healed condition and its treatment. The follow-up code is sequenced first, followed by the history code. A follow-up code may be used to explain multiple visits. Should a condition be found to have recurred on the follow-up visit, then the diagnosis code for the condition should be assigned in place of the follow-up code. The follow-up Z codes/categories: Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm Codes Z08, Encounter for follow-up examination after completed treatment for malignant neoplasm, and Z09, Encounter for follow up examination after completed treatment for conditions other than malignant neoplasm, may be assigned following any type of completed treatment modality (including both medical and surgical treatments). Z39 Encounter for maternal postpartum care and examination. |
Other changes include:
395 new diagnosis codes
13 revised codes
25 code deletions
Of the 395 recent codes, 123 have been included in Chapter 20, External Causes of Morbidity (V00-Y99). These new codes empower physicians and non-physician clinicians (NPCs) to record and report specific details related to accidents and injuries.
In Chapter 21, which covers Factors Affecting Health Status and Contact with Health Services (Z00-Z99), there have been numerous updates, including those related to Social Determinants of Health (SDoH). These updates were made because CMS recognizes that issues related to SDoH can lead to increased utilization of resources.
To capture a patient’s personal risk factors and reasons for noncompliance with medical treatment and regimen by caregivers, new codes have been introduced. For instance, there are now codes that indicate if a caregiver’s noncompliance is due to financial hardship or some other reason.
Please take note of the additional updates to this section, namely code category Z63. This code pertains to other stressful life events that may impact families and households and can be reported as a reason for non-compliance when applicable.
The following table outlines the revisions and updates to some dermatology-related ICD-10-CM codes and will require inclusion in the practice management coding system, effective Oct. 1, 2023.
ICD-10-CM code | Code descriptor | Revisions/update |
|---|---|---|
A40 | Streptococcal sepsis | Changes to the coding instructions to code first:
• if applicable, postprocedural sepsis (T81.44-) • streptococcal sepsis following infusion, transfusion, or therapeutic injection (T80.22-, T80.29-) |
A41 | Other sepsis | Changes to the coding instructions to code first:
• if applicable, postprocedural sepsis (T81.44-) sepsis following infusion, transfusion, or therapeutic injection (T80.22-, T80.29-) |
A50-A64 | Infections with a predominantly sexual mode of transmission | Revise from Excludes1 to Excludes2: human immunodeficiency virus [HIV] disease (B20)
Note: Excludes1 is a pure excludes note. It means “NOT CODED HERE!” Excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. |
B95-B97 | Bacterial and viral
infectious agents | Add new code B96.83 Acinetobacter baumannii as the cause of diseases classified elsewhere |
D48.1 | Neoplasm of uncertain behavior of connective and other soft tissue | Add new codes as follows: D48.11 Desmoid tumor D48.110 Desmoid tumor of head and neck D48.111 Desmoid tumor of chest wall D48.113 Desmoid tumor of abdominal wall D48.115 Desmoid tumor of upper extremity and shoulder girdle D48.116 Desmoid tumor of lower extremity and pelvic girdle Desmoid tumor of buttock D48.117 Desmoid tumor of back D48.118 Desmoid tumor of other site D48.119 Desmoid tumor of unspecified site D48.19 Other specified neoplasm of uncertain behavior of connective and other soft tissue |
F60-F69 | Disorders of adult personality and behavior | Add inclusion terms: Gender incongruence in adolescents and adults Transgender Gender incongruence of childhood Gender incongruence, unspecified Excludes1: gender identity disorder of childhood (F64.2) |
I80-I89 | Diseases of veins, lymphatic vessels, and lymph nodes, not elsewhere classified | New coding instruction as follows: • Use additional code, if applicable, to specify site and severity of ulcer (L97.-) • Code also, if applicable, associated hypertensive conditions such as: essential (primary) hypertension (I10) hypertensive chronic kidney disease (I12.-) hypertensive heart and chronic kidney disease (I13.-) hypertensive heart disease (I11.-) |
L00-L99 | Diseases of the skin and subcutaneous tissue | Revised code first instruction L53.0 Toxic erythema, poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4) |
R50-R69 | General symptoms and signs | Revised Excludes1: other post infection and related fatigue syndromes (G93.39) |
T80-T88 | Complications of surgical and medical care, not elsewhere classified | Revise Excludes2: poisoning and toxic effects of drugs and chemicals (T36-T65 with fifth or sixth character 1-4) Deleted Excludes1: septic shock (R65.21) |
T88 | Other complications of surgical and medical care, not elsewhere classified | Revise Excludes2 to poisoning and toxic effects of drugs and chemicals (T36-T65 with fifth or sixth character 1-4) |
Z55-Z65 | Persons with potential health hazards related to socioeconomic and psychosocial circumstances | Z58 Problems related to physical environment Z59 Problems related to housing and economic circumstances has a revised Excludes1: to institutional upbringing (Z62.22) New inclusion terms to Z60.8: Other problems related to social environment Inadequate social support Lack of emotional support Revise Z62.21 Child in welfare custody by deleting the inclusion term child in care of non-parental family member and adding child in welfare guardianship Delete Excludes2: problem for parent due to child in welfare custody (Z63.5) Revise Z62.22 Institutional upbringing inclusion term: Child living in group home and add child living in orphanage Add coding instructions to code also, if applicable, child in welfare custody (Z62.21).
Add Z62.23 Child in custody of non-parental relative Add coding instruction to code also, if applicable, child in welfare custody (Z62.21). Z62.24 Child in custody of non-relative guardian has additional coding instruction to code also, if applicable, child in welfare custody (Z62.21) Z62.8 Other specified problems related to upbringing has additional instructions to code also, if applicable: Z62.82 Parent-child conflict has been revised to add: Z62.83 Non-parental relative or guardian-child conflict Excludes1: group home staff-child conflict (Z62.833) Z62.832 Non-relative guardian-child conflict Z62.833 Group home staff-child conflict Updates to Z62.89 Other specified problems related to upbringing include addition of the following new codes: Z65.8 Other specified problems related to psychosocial circumstances to category Z65 Problems related to other psychosocial circumstances At risk for feeling loneliness New codes added to Z91.A Caregiver’s noncompliance with patient’s medical treatment and regimen Caregiver’s underdosing with patient’s medication NOS Z91.82 Personal history of military deployment has a new Excludes2: personal history of military service (Z91.85) and new code Z91.85 Personal history of military service Excludes2: personal history of military deployment (Z91.82) |
Note: The above codes do not reflect an exhaustive list of all the new codes and do not include coding instructions. The AADA’s 2024 Coding and Billing for Dermatology manual’s ICD-10-CM section contains chapter-specific coding instructions pertaining to to the use of these new codes. Make sure you update your resources annually by visiting the AAD Store to purchase your 2024 coding resources.
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