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Coding Tip of the Month – May 2019

The Proposed Inpatient Prospective Payment System (IPPS) Rule was established on April 23, 2019. The ICD-10-CM code changes contained in the FY 2020 Proposed Rule Tables revealed 273 new codes, 21 deleted and 30 code title revisions. Just under 60% (162) of the new codes are proposed for chapters 19 Injury, poisoning and certain other consequences of external causes (S00-T88) and 20 External causes of morbidity (V00 – Y99). In Chapter 9 Diseases of the circulatory system (I00 – I99) there are four new atrial fibrillation codes and two existing codes (I48.1, I48.2) have been deleted. The new codes and proposed severity levels are:

I48.11 Longstanding persistent atrial fibrillation (CC)

I48.19 Other persistent atrial fibrillation (CC)

I48.20 Chronic atrial fibrillation, unspecified (CC)

I48.21 Permanent atrial fibrillation (CC)

In Chapter 9 new codes are proposed to specify phlebitis and embolisms occurring the peroneal and calf muscle veins. In Chapter 12 Diseases of the skin and subcutaneous tissue (L00 – L99) category L89_Pressure ulcer has been expanded with a sixth character of “6” which indicates pressure-induced deep tissue damage of various anatomic sites. Currently deep tissue injuries code to “pressure ulcer unstageable” however there can be significant clinical differences between unstageable ulcers and deep tissue injuries. These new codes will have a severity status of Complication/Comorbidity (CC).

In addition to the new codes there are 1,493 CC/MCC designation changes for CM codes proposed. Most of the changes (87.2%) involve a reduction in the severity level but there are a handful of codes (12.8%) where the severity level increased.

Some common examples by severity class change have been provided below to provide an overview and some insight into the detail of specific codes changes.

Severity Level Increases:

Non CC to CC:

  • Heparin induced thrombocytopenia (HIT)
  • Stage 1 and 2, unstageable and unspecified pressure ulcers
  • Foreign bodies in respiratory tract with asphyxiation
  • Acute bronchospasm
  • Homelessness

CC to MCC:

  • Bacteremia
  • Candidal esophagitis and enteritis
  • Moderate protein calorie malnutrition
  • Severe persistent asthma with exacerbation

Severity Level Decreases:

MCC to Non CC/MCC:

  • Sickle Cell disease with crisis/complication
  • Cardiac arrest
  • Complicated acute appendicitis

MCC to CC:

  • STEMIs – initial and subsequent
  • Unspecified severe Protein calorie malnutrition
  • Ventricular fibrillation/flutter
  • Stage 3 and 4 pressure ulcers

CC to Non CC:

  • Leukemia and lymphomas
  • Acute blood loss anemia
  • Chronic heart failure
  • Ulcerative colitis and Chron’s disease
  • Stage 4 and 5 CKD
  • BMI 19.9 or less
  • BMI 40.0 – 44.9 and 45.0 – 49.9
  • Transplant status

UASI will again be offering complimentary webviews to provide education on the ICD-10 code updates and IPPS changes once the Final Rule is published. The tables 6A-6K and tables 6P.1c-6P.1e with proposed ICD-10 code changes and severity level changes are available and can be viewed on the CMS FY 2020 IPPS Proposed Rule Home Page: