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Key Changes to ICD-10: FY 2021 Updates

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Scot Nemchik, CCS, CRC, CLSS
September 18, 2020

Right about two weeks from now, we’ll be heading into our sixth year of ICD-10 in the US! Hard to believe. They say that kids grow up fast, and it turns out the same can be said for code sets. Thankfully though, we don’t need to concern ourselves with adolescent code sets getting learner’s permits!

So, what did we learn in the past five years? A lot, if you are asking me. We learned that coders are a resilient group up for a challenge. Seven-character diagnosis codes? No problem. Seven-character multi-axial procedure codes? Bring it on. And everything in between, they’ll eat that for breakfast. Suffice to say that we’ve adapted to change faster than anyone could have predicted, due in large part to the preparation we took so seriously in 2013 and 2014.

Lesson #1: ICD-10-CM and ICD-10-PCS are flexible. These code sets are capable of breaking through one of the primary constraints that plagued ICD-9-CM – the inability to accommodate emerging illnesses. In just the past six months, CMS deployed two new codes to accommodate public health emergencies. U07.1, Vaping-Related Disorder and U07.2, COVID-19. These codes arrived on the scene in a flash, members of an unplanned ICD-10-CM chapter, Codes for Special Use.

Lesson #2: Some codes simply didn’t work. Certain procedure codes involving the omentum (i.e., omentectomy) and saphenous veins (e.g., saphenous vein graft harvest) have been usurped by less- specific versions more appropriate for the upper limits of today’s clinical documentation. This concession came as great news to coders and providers alike by preventing needless trips down unnecessary query rabbit holes.

Lesson #3: Both ICD-10-CM and ICD-10-PCS are works in progress. Each fiscal year since the implementation of these code sets has introduced hundreds, even thousands (see FY 2016) of new codes. All good! This constant growth simply means that we need to continue doing what we’ve been doing all along, learning about new codes and their intended use so we are prepared to assign them with precision when the moment arrives.

Now let’s take a quick look at some of the key changes for this year.

ICD-10-CM for FY 2021

While there are new codes in 16 of 22 ICD-10-CM chapters, over 50% of that volume is concentrated in Chapter 19, Injury, Poisoning, and Certain Other Consequences of External Causes and Chapter 20, External Causes of Morbidity. It’s worth mentioning that classification conventions in these chapters make them vulnerable to exponential growth. Other new codes are sprinkled across 14 other chapters, allowing us to better classify substance abuse, sickle cell disorders, and less-commonly-encountered corneal disorders.

ICD-10-PCS for FY 2021

We have about 550 new ICD-10-PCS codes at our disposal this year. Coders would be wise to brush up on modern use of intravascular lithotripsy, an emerging technology to treat intra-arterial plaque. A quick discussion with the interventional radiology and interventional cardiology teams will help coders ascertain if this treatment modality will be used at their organization. This same discussion may actually compel the providers to document these procedures with precision. Great things can happen when you work across the aisle, coding is no exception! Among other changes, spray-on tans will need to take a back seat to spray-on GI hemorrhage control effective October 1. Again, a quick conversation with providers most likely to use this technique will help coders better understand the relevance of this new code within their respective organizations.

Keep Your Coding Edge

Coders have proven that they are up to the challenge of continuous education and improvement to ensure ongoing coding quality and precision. To help, Ciox offers coding education and services, as well as educational opportunities through our FY 2021 Coding Updates webinar series and our bi-weekly Coding Round Tables. Earn 1 CEU when you attend the live sessions!

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