By Karen M. Kostick, RHIT, CCS, CCS-P
This article highlights the 2012 ICD-10-CM update as approved by the ICD-9-CM Coordination and Maintenance Committee. The 2012 ICD-10-CM update includes the addition of new codes that already exist in ICD-9-CM, implemented in the FY 2012 ICD-9-CM update or recently incorporated into ICD-10 through the World Health Organization (WHO) Update Reference Committee. In addition, ICD-10-CM Index and Tabular modifications were updated to reflect the 2012 draft ICD-10-CM Official Guidelines for Coding and Reporting, present medical terminology, and present clinical practice.
Chapter 1: Certain infectious and parasitic diseases (A00-B99)
Codes were expanded under new subcategories to improve specific drug-resistant infection reporting:
- A41.0 Sepsis due to Staphylococcus aureus
- A49.0 Staphylococcal infection, unspecified site
- B95.6 Staphylococcus aureus as the cause of diseases classified elsewhere
The new codes describe methicillin-susceptible Staphylococcus aureus (A41.01, A49.01, B95.61) and methicillin-resistant Staphylococcus aureus (A41.02, A49.02, B95.62). An additional code from category Z16, Resistance to antimicrobial drugs, is to be assigned with the new codes to identify resistance to antimicrobial drugs. This category was expanded in 2012 to identify specific drugs.
Chapter 2: Neoplasms (C00-D49)
To support reportable malignant skin cancers to central cancer registries, all of the subcategories under category C44, Other and unspecified malignant neoplasm of skin, were expanded with new codes to differentiate between reportable and non-reportable skin cancers. The majority of skin cancers, which are either basal or squamous cell, are classified as non-reportable conditions to central cancer registries.
Category D17, Benign lipomatous neoplasm, was expanded to identify common sites, such as angiomyolipomas-a benign neoplasm-in male urology patients. The new codes include:
- D17.71 Benign lipomatous neoplasm of kidney
- D17.72 Benign lipomatous neoplasm of other genitourinary organ
- D17.79 Benign lipomatous neoplasm of other sites
Chapter 5: Mental and behavior, Behavioral and Neurodevelopmental disorders (F01-F99)
A new subcategory has been created to describe dementia, unspecified (F03.9). This subcategory is further expanded to the fifth-digit level to describe dementia occurring both with and without behavioral disturbance (F03.90, F03.91).
A unique code, F48.2, was developed for use with pseudobulbar affect (PBA) in order to better assist with increased recognition, improved diagnosis, and advanced management of PBA. Since PBA occurs secondary to neurologic disease and injury, the new code includes a "Code first" note to indicate that the underlying condition-such as amyotrophic lateral sclerosis, multiple sclerosis (MS), or late effect of CVA-should be coded first.
Chapter 6: Diseases of the nervous system (G00-G99)
Several revisions and updates were made to category G40, Epilepsy and recurrent seizures, to reflect the classification seizures and epilepsies as defined by the International League Against Epilepsy (ILAE). New subcategory examples include Absence epileptic syndrome (G40.A) and Juvenile myoclonic epilepsy (G40.B), which are further expanded to specify epilepsy as intractable or non-intractable and with or without status epilepticus. The revised subcategory G40.8, Other epilepsy and recurrent seizures, added an inclusion term for Landau-Kleffner Syndrome and new codes for Lennox-Gastaut Syndrome (G40.811-G40.814). Code G89.29, other chronic pain, was created to report the chronic pain related to other conditions, such as the implantation of a spinal neurostimulator or an intrathecal infusion pump. Also, the new code is necessary to apply the chapter-specific pain code guidelines included in the draft titled 2012 ICD-10-CM Official Guidelines for Coding and Reporting.
Chapter 7: Diseases of the eye and adnexa (H00-H59)
A new seventh character code is to be assigned to each code in subcategory H40.1, Open-angle glaucoma; H40.2, Primary angle-closure; H40.3, Glaucoma secondary to eye trauma; H40.4, Glaucoma secondary to eye inflammation; H40.5, Glaucoma secondary to other eye disorders; and H40.6, Glaucoma secondary to drugs. The seventh digits to be assigned include "0" stage unspecified, "1" mild stage, "2" moderate stage, "3" severe stage, and "4" indeterminate stage. Per ICD-10-CM coding guidelines, the seventh character "4" is used for glaucoma where the stage cannot be clinically determined. It should not be confused with the seventh character "0," unspecified, which would be assigned when there is no documentation regarding the stage of glaucoma.
Chapter 9: Diseases of the circulatory system (I00-I99)
New codes were added to describe coronary atherosclerosis due to calcified coronary lesion (I25.84), saddle embolus of pulmonary artery with acute cor pulmonale (I26.02), and saddle embolus of pulmonary artery without acute cor pulmonale (I26.92).
Category I48, atrial fibrillation and flutter, was expanded to specify additional codes based on the clinical guidelines for classification and management of atrial fibrillation published by the American College of Cardiology, the American Heart Association, and the European Society of Cardiology guidelines for classification and management of atrial fibrillation.
Chapter 10: Diseases of the respiratory system (J00-J99)
Several new codes were added to describe respiratory disorders. Category J09X, Influenza due to identified novel influenza A virus, includes codes to specify with pneumonia (J09.X1), with other respiratory manifestations (J09.X2), and with gastrointestinal manifestations (J09.X3).
Category J84, Other interstitial pulmonary diseases, was significantly expanded with new codes to provide further specificity under subcategories J84.0, Alveolar and parieto-alveolar conditions; J84.1, Other interstitial pulmonary diseases with fibrosis; and J84.8, Other specified interstitial pulmonary diseases.
Category J93 revised title, pneumothorax and air leak, and includes new codes to report conditions such as primary spontaneous pneumothorax (J93.11), secondary spontaneous pneumothorax (J93.11), and persistent air leak (J93.82).
Chapter 11: Diseases of the digestive system (K00-K945)
Subcategory K31.8, Other specified diseases of stomach and duodenum, includes a unique code for gastroparesis (K31.84).
Category K43, Ventral hernia, includes new codes for additional types of ventral hernias such as code K43.2 for incisional hernia without obstruction or gangrene, and code K43.4 for parastomal hernia with gangrene.
The new category K64, Hemorrhoids and perianal venous thrombosis, includes the reclassification of hemorrhoids from Chapter 9, diseases of the circulatory system. The new codes (K64.0-K64.9) have been expanded to reflect present clinical terminology and the first, second, third, and fourth degree staging for this condition.
Chapter 14: Diseases of the genitourinary system (N00-N99)
Specific codes were created for genitourinary conditions including urethral false passage (N36.5), nodular prostate without lower urinary tract symptoms (N40.2), nodular prostate with lower urinary tract symptoms (N40.3), cyst of prostate (N42.83), acquired torsion of penis (N48.82), acquired buried penis (N48.83), and cyst of epididymis (N50.3).
Chapter 15: Pregnancy, childbirth and the puerperium (O00-O99A)
A new tabular instructional note has been added to this chapter which states to use an additional code from the new category Z3A, Weeks of gestation, to identify the specific week of the pregnancy. Although present chapter 15 codes for reporting the trimester of the pregnancy continue to provide valuable data, reporting the specific gestational age is presently considered an even more precise indicator of risk. The new category Z3A codes were created as a secondary status code to be used in conjunction with a Chapter 15 code to identify the specific gestational age.
Chapter 17: Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
New codes were created to report congenital coarctation of pulmonary artery (Q25.71), congenital pulmonary arteriovenous malformation (Q25.72), and other congenital malformations of pulmonary artery (Q25.79). New codes have been added for congenital torsion of penis (Q55.63), hidden penis (Q55.64), and congenital hip deformities including congenital coxa valga (Q65.81), congenital coxa vara (Q65.82), and other specified congenital deformities of hip (Q65.89).
Chapter 18: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
The new subcategory R40.24, Glasgow coma scale, total score provides codes for Glasgow coma scale score 13-15 (R40.241), Glasgow coma scale score 9-12 (R40.242), Glasgow coma scale score 3-8 (R40.243).
Chapter 19: Injury, poisoning and certain other consequences of external causes (S00-T88)
A significant tabular modification was made to reflect the 2012 draft official coding and reporting guidelines for adverse effects, directing that when coding an adverse effect of a drug that has been correctly prescribed and properly administered, assign the appropriate code for the nature of the adverse effect followed by the appropriate code for the adverse effect of the drug (T36-T50).
Several new codes were added to describe various complications, such as bloodstream infection due to central venous catheter (T80.211), local infection due to central venous catheter (T80.212), anaphylactic reaction due to serum (T80.51- T80.59), postprocedural shock (T81.10-T81.19), complications due to implanted mesh and other prosthetic materials (T83.71-, T83.72-), complications of stem cell transplant (T86.5), and dehiscence of amputation stump (T87.81).
Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)
In addition to the new Z codes to report resistance to antimicrobial drugs, additional codes were developed to report carrier or suspected carrier of methicillin-susceptible Staphylococcus aureus (Z22.321) and carrier or suspected carrier of methicillin-resistant Staphylococcus aureus (Z22.322).
New personal history codes include personal history of methicillin-resistant Staphylococcus aureus (Z86.14), personal history of gestational diabetes (Z86.32), personal history of venous thrombosis and embolism (Z86.71-), and personal history of anaphylaxis (Z87.892).
New codes were added under category Z89.5, Acquired absence of leg below knee, to further specify a status such as acquired absence of right leg below knee (Z89.511) or acquired absence of left knee (Z89.529).
Centers for Disease Control and Prevention. ICD-9-CM Coordination and Maintenance Committee Meeting Agenda, Part 1. September 15-16, 2010. www.cdc.gov/nchs/data/icd9/Topic_packet_for_Sept2010.pdf.
Centers for Disease Control and Prevention. ICD-9-CM Coordination and Maintenance Committee Meeting Agenda, Part 2. September 15-16, 2010. www.cdc.gov/nchs/data/icd9/Topic_packet_for_Sept2010Part2.pdf.
Centers for Disease Control and Prevention. ICD-9-CM Coordination and Maintenance Committee Meeting Agenda. March 9-10, 2011. www.cdc.gov/nchs/data/icd9/TopicpacketforMarch2011_HA1.pdf.
National Center for Health Statistics. "ICD-10-CM and Draft ICD-10-CM Official Guidelines for Coding and Reporting 2012." International Classifications of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Centers for Disease Control and Prevention Web site. www.cdc.gov/nchs/icd/icd10cm.htm#10update.
Karen Kostick (firstname.lastname@example.org) is a director of professional practice at AHIMA.
Kostick, Karen M..
"ICD-10-CM Update 2012"
Journal of AHIMA