Be aware of these small but important changes.

The newest ICD-10-CM codes are posted. Remember that these new codes go live on Oct. 1, 2022 and must be used as of this date — don’t wait until January to start if one of the new codes applies.

The good news for eye care is that our Eye and Adnexa area (Chapter 7 in ICD-10) has no changes at all. However, you do need to be aware of some important things in the 2023 ICD-10 Guidelines. Also, some other chapters have diagnosis code changes that aren’t in our Eye chapter, which may be applicable if your doctors deal with some uncommon systemic conditions. The Z codes (Chapter 21) also have some subtle changes that I will call out below.

Accessing the changes

First, you can access the codes for 2023 at the Medicare CMS.gov ICD-10 site¹. Once there, you’ll notice five download files (four are ZIP files containing more than one item).

Specifically, be aware of two files. The first is the “FY 2023 ICD-10-CM Coding Guidelines” PDF. Anything in this file with a change from one year to the next is called out in bold, underline, or italic, so it is easy to see the differences in this file for 2023 use.

The second useful download here is a ZIP folder titled “2023 Addendum.” Download this folder to view five files with all the changes from 2022 to 2023. Of these, the most useful to me is named “icd10cm_tabular_addenda_2023.” This PDF file shows only the new or changed ICD-10 codes for 2023 — and it is only 76 pages long.

You may notice Chapter 7 is “missing” in this file — and that’s a good thing, as we have no changes for 2023 as previously mentioned.

Guideline refresher

The Guidelines for 2023 have some subtle but important things to know. Most of the document has nothing new, but since payers have become more focused on proper use of ICD-10, the specifics are worth re-emphasizing — especially as it has come up in certain payer rejections of claims. Sometimes the payer has been correct and other times not, so being able to quote the Guidelines properly is important.

The Guidelines for Laterality (I.B.13) state:

“… When a patient has a bilateral condition and each side is treated during separate encounters, assign the “bilateral” code (as the condition still exists on both sides), including for the encounter to treat the first side. For the second encounter for treatment after one side has previously been treated and the condition no longer exists on that side, assign the appropriate unilateral code for the side where the condition still exists (e.g., cataract surgery performed on each eye in separate encounters). The bilateral code would not be assigned for the subsequent encounter, as the patient no longer has the condition in the previously-treated site. If the treatment on the first side did not completely resolve the condition, then the bilateral code would still be appropriate ...”

Some coders are not familiar with the Guidelines on “Documentation of Complications of Care” (I.B.16); they think it is always necessary to add a complication code — but it is not. The Guidelines state:

“… the documentation must support that the condition is clinically significant. It is not necessary for the provider to explicitly document the term “complication.” For example, if the condition alters the course of the surgery as documented in the operative report, then it would be appropriate to report a complication code ...”

New or changed codes

The Tabular Addenda file mentioned above notes some new guidance in Chapter 2 (Neoplasms) and new codes in Chapter 21 (Factors influencing health status and contact with health services).

In Chapter 2, there is more clarity on Primary and Secondary site designation and when to use each. Some of the conditions our doctors see patients for are not a primary malignancy. The guidance under “Admission/Encounter for treatment of primary site” is the following:

• If the malignancy is chiefly responsible for occasioning the patient admission/encounter and treatment is directed at the primary site, designate the primary malignancy as the principal/first-listed diagnosis.
• The only exception to this guideline is if the administration of chemotherapy, immunotherapy or external beam radiation therapy is chiefly responsible for occasioning the admission/encounter. In that case, assign the appropriate Z51.-- code as the first-listed or principal diagnosis, and the underlying diagnosis … as a secondary diagnosis.”

Then, under “Admission/Encounter for treatment of secondary site,” it states:

• “When a patient is admitted because of a primary neoplasm with metastasis and treatment is directed toward the secondary site only, the secondary neoplasm is designated as the principal diagnosis even though the primary malignancy is still present.”

For Chapter 21, there are small changes of note to these code sets:

• In the Z59.8 area: “Transportation insecurity”, “Financial insecurity”, and “Material hardship”. While not common, these might be relevant in some cases — but only as secondary diagnoses per the instructions.
• Z94.4 (use of insulin), Z79.84 (use of oral hypoglycemic), and Z79.85 (use of injectable non-insulin) codes are unchanged, but there is a new Excludes2 instruction for each that states these may not apply to the other antidiabetic drugs. Remember that CMS says² an 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. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.”
• There are a host of new Z79.6 codes that apply when the patient is on immunomodulators and immunosuppressants.
• Finally, there are many new (and more specific) “Noncompliance” codes for patients and caregivers in the Z91 area.

Summary

Changes in ICD-10-CM are small for this year; the Eye code chapter has nothing new, but be sure to check for other codes and guidance.

Lastly, I have retired from active consulting practice. Mary Pat Johnson, COMT, CPC, CPMA, will be taking over the Ophthalmic Professional Coding column, and I am sure you will enjoy her insight. I have enjoyed writing for OP and answering your emails.

As always, “good coding to you.” OP

REFERENCES:

1. Centers for Medicare & Medicaid. 2023 ICD-10-CM. https://www.cms.gov/medicare/icd-10/2023-icd-10-cm . Accessed July 11, 2022.
2. Centers for Medicare & Medicaid. ICD-10-CM Official Guidelines for Coding and Reporting FY 2022 2023 (October 1, 2022 - September 30, 2023). 2023 ICD-10-CM. https://www.cms.gov/medicare/icd-10/2023-icd-10-cm . Accessed July 11, 2022.