I82.569, Chronic embolism and thrombosis of unspeci-
fied calf muscular vein
Pressure ulcers (L89-) have 25 new codes for reporting pres-
sure-induced deep tissue pressure injury (DTPI). These new
codes specify the anatomic site (including laterality) and are
reported for pressure-induced ulcers and/or injuries that are
beyond stage 4 though not unstageable. In the FY 2019 version
of ICD-10-CM, these DTPI were coded as unstageable, which
limited the ability to track and report these cases more specifi-
cally. The new codes for the elbow are:
L89.006, Pressure-induced deep tissue damage of unspecified elbow
L89.016, Pressure-induced deep tissue damage of right elbow
L89.026, Pressure-induced deep tissue damage of left elbow
Congenital deformities of the feet, in category Q66, are being
expanded adding an additional 24 codes for laterality to the existing subclassification. For example, Q66.01, Congenital talipes
equinovarus, right foot would now be used instead of the default diagnosis code of Q66.0.
Ehlers-Danlos syndrome now has codes for classical (Q79.61),
hypermobile (Q79.62), vascular (Q79.63), other (Q79.69), and
unspecified (Q79.60). In the FY 2019 version of ICD-10-CM,
Ehlers-Danlos syndrome was a single code of Q79.6.
Orbital fractures have more codes to report the specific location
of the orbital fracture. The section has been expanded by adding
60 new codes for reporting fractures of the orbital roof, medial
orbital wall, and lateral orbital wall in addition to unspecified
fracture of the orbit. The sixth character will represent laterality
and seventh character will represent the encounter and fracture
type/status. A patient with a left side medial orbital wall fracture
returning for a subsequent encounter due to delayed healing will
now be captured with the ICD-10-CM code S02.832G.
Poisoning, adverse effects, and underdosing of multiple unspecified drugs has a new set of codes for reporting situations
when the documentation demonstrates multiple drugs, medicaments, and/or biological substances as the cause of poisoning, adverse effects, or underdosing, but the specific type
or name of the drug, medicament, or biological substance is
not available or documented. The new code range is T50.911-
through T50.916- with seventh characters of A, D, or S assigned
based on the documentation.
External cause codes have been added for reporting injuries
sustained as a result of an encounter with law enforcement or
during any encounter with legal intervention. There are 75 new
codes outlined by the type of weapon, person injured, and encounter under category Y35-.
Smaller Volume New Codes To Note
Adenosine deaminase deficiency (ADA) (D81.3) was expanded
to provide further specificity of the types as either unspecified
(D81.30), severe (D81.31), type 2 (D81.32), or type 1/other (D81.39).
Heatstroke and sunstroke (T67.0) has been expanded to
provide additional codes for exertional and other heatstroke
or sunstroke. This subcategory requires a seventh character
for reporting the encounter as initial (A), subsequent (D), or
Personal history of in-situ neoplasm (subcategory Z86.00) was
expanded and additional codes added for more anatomic sites
such as genital organs (Z86.002); oral cavity, esophagus and
stomach (Z86.003); and digestive organs (Z86.004).
Updates to Official Guidelines for Coding and
A new guideline has been added to provide guidance on correct
coding for iatrogenic injuries. Chapter 19 injury codes should
not be assigned when the injury occurs as a result of a medical
intervention. Coders should use the appropriate complication
code to report these injuries. Further clarification is also provided with new verbiage under the complications guidelines
(I.C. 19.g. 5) that directs the use of body system chapter complication codes for intraoperative or postprocedural complications unless the alphabetic index specifically indexes the complication to a T code in chapter 19.
Coding for physeal fractures is clarified in a new guideline
(I.C. 19.c. 3). Only a single code for the type of physeal fracture is
assigned and a separate code would NOT be added to identify
the bone that is fractured.
A key statement for Z68 was added for reporting body mass index (BMI) under guideline I.C. 21.c. 3. The new guideline states
that “BMI codes should only be assigned when there is an associated, reportable diagnosis (such as obesity). Do not assign BMI
codes during pregnancy.” This supports the recent guidance published in Coding Clinic in the fourth quarter 2018 issue on pages
78-79 that BMI should only be captured when there is an associated, reportable diagnosis.
In Section II, Selection of Principal Diagnosis and Section
III, Reporting Additional Diagnoses, “compatible with” and
“consistent with” have been added to the Uncertain Diagnosis
guidelines as uncertain terms. These terms were also added
to Section IV, Diagnostic Coding and Reporting Guidelines for
The expansion of subcategories and subclassifications to provide further specificity continues to support the expanded use of
healthcare data across the continuum of care. Coders are encouraged to download and review the complete addenda for the full set
of changes to the alphabetic and tabular indices as well as the FY
2020 ICD-10-CM Official Guidelines for Coding and Reporting. ¢
Centers for Disease Control and Prevention. International
Classification of Diseased, Tenth Revision, Clinical
Modification (ICD-10-CM). https://www.cdc.gov/nchs/icd/
National Pressure Ulcer Advisory Panel. “ICD 10 Codes to Now
Include Deep Tissue Pressure Injury.” News release, July 25,
Monica Watson ( Monica.email@example.com) is director of coding
services at Centauri Health Solutions.