PCC CODING WEBLABJan Blanchard, CPMA

Tuesday, Sept 18, 2018Noon, Eastern

September 2018 Agenda

2019 ICD-10 code updates

Effective 10/1/18

ICD Code Manuals

CMS provides this zip file containing FREE PDFs of the ICD code manuals

● 2019 Code Descriptions in Tabular Order [ZIP, 2MB]● 2019 Code Tables and Index [ZIP, 18MB]● 2019 Addendum [ZIP, 685KB]● 2019 Conversion Table [ZIP, 73KB]● 2019 Coding Guidelines [PDF, 604KB]● 2019 POA Exempt Codes [ZIP, 1MB]

File Names snomedmap snomedmap

Legend

BOLD = New additions

STRIKETHROUGH = deleted selections

ITALICS = Nuances, differences

New Additions

E78.41 Elevated Lipoprotein(a)E78.49 Other hyperlipidemiaF12.23 Cannabis dependence with withdrawal

Cannabis withdrawal - removed from F12.288F12.93 Cannabis use, unspecified with withdrawalF53.0 Postpartum depression

Postnatal depression, NOS Postpartum depression, NOS

F53.1 Puerperal psychosisPostpartum psychosis Puerperal psychosis, NOS

New AdditionsH01.00 Unspecified blepharitis

H01.00A Unspecified blepharitis right eye, upper and lower

eyelids

H01.00B Unspecified blepharitis left eye, upper and lower

eyelids

H01.01 Ulcerative blepharitis

H01.01A Ulcerative blepharitis right eye, upper and lower

eyelids

H01.01B Ulcerative blepharitis left eye, upper and lower

eyelids

New Additions

H10.82 Rosacea conjunctivitis

Code first underlying rosacea dermatitis (L71.-)

H10.821 Rosacea conjunctivitis, right eye

H10.822 Rosacea conjunctivitis, left eye

H10.823 Rosacea conjunctivitis, bilateral

H10.829 Rosacea conjunctivitis, unspecified eye

Appendicitis - K35.2_

K35 Acute appendicitis K35.2 Acute appendicitis with generalized peritonitis

Perforated appendix NOS Ruptured appendix NOS

K35.20 Acute appendicitis with generalized peritonitis, without abscess

(Acute) appendicitis with generalized peritonitis NOS K35.21 Acute appendicitis with generalized peritonitis, with abscess

Appendicitis - K35.3_

THESE…

K35.3 Acute appendicitis with localized peritonitis

Acute appendicitis with or without perforation or

rupture with peritonitis NOS

Acute appendicitis with or without perforation or

rupture with localized peritonitis

Acute appendicitis with peritoneal abscess

Appendicitis - K35.3_BECAME THIS...

K35.30 Acute appendicitis with localized peritonitis, without perforation or gangrene

Acute appendicitis with localized peritonitis NOS

K35.31 Acute appendicitis with localized peritonitis and gangrene, without perforation

K35.32 Acute appendicitis with perforation and localized peritonitis, without abscess

(Acute) appendicitis with perforation NOS Perforated appendix NOSRuptured appendix (with localized peritonitis) NOS

K35.33 Acute appendicitis with perforation and localized peritonitis, with abscess

(Acute) appendicitis with (peritoneal) abscess NOS Ruptured appendix with localized peritonitis and abscess

Appendicitis

K35.8 Other and unspecified acute appendicitis K35.89 Other acute appendicitis

K35.890 Other acute appendicitis without perforation or gangrene K35.891 Other acute appendicitis without perforation, with gangrene (Acute) appendicitis with gangrene NOS

K37 Unspecified appendicitis Excludes1:

-unspecified appendicitis with peritonitis (K35.2-K35.3) -unspecified appendicitis with peritonitis (K35.2-, K35.3-)

M79.1 Myalgia

M79.10 Myalgia, unspecified site

M79.11 Myalgia of mastication muscle

M79.12 Myalgia of auxiliary muscles, head and neck

M79.18 Myalgia, other site

Myalgia

There ARE Changes to O chapter

Do NOT use letter O codes for newborn

or pediatric conditions

Newborn affected by...

P02 Newborn affected by complications of placenta, cord and membranes

P02.7 Newborn affected by chorioamnionitis

Newborn affected by amnionitis Newborn affected by membranitis Newborn affected by placentitis

P02.70 Newborn affected by fetal inflammatory response syndrome

Newborn affected by FIRS

P02.78 Newborn affected by other conditions from chorioamnionitis

Newborn affected by amnionitis Newborn affected by membranitis Newborn affected by placentitis

Newborn affected by...

P04 Newborn affected by noxious substances transmitted via placenta or breast milk

P04.0 Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery

Newborn affected by reactions and intoxications from maternal opiates and tranquilizers administered during labor and deliveryNewborn affected by reactions and intoxications from maternal opiates and tranquilizers administered for procedures during pregnancy or labor and delivery

Excludes2: newborn affected by other maternal medication (P04.1-)

Newborn affected by...

P04.1 Newborn affected by other maternal medicationNewborn affected by cancer chemotherapy Newborn affected by cytotoxic drugs

Code first withdrawal symptoms from maternal use of drugs of addiction, if applicable (P96.1)

Excludes1: maternal use of drugs of addiction (P04.4-)

Excludes2: maternal anesthesia and analgesia in pregnancy, labor and delivery (P04.0) maternal use of drugs of addiction (P04.4-)

Newborn affected by maternal...

P04.11… antineoplastic chemotherapy P04.12 ... cytotoxic drugsP04.13 ... use of anticonvulsants P04.14 ... use of opiatesP04.15 … use of antidepressants P04.16 ... use of amphetamines P04.17 ... use of sedative-hypnotics P04.1A … use of anxiolyticsP04.18 … other maternal medicationP04.19 … use of unspecified medication

Newborn affected by...

P04.4 Newborn affected by maternal use of drugs of addiction P04.40 Newborn affected by maternal use of unspecified drugs of addiction P04.42 Newborn affected by maternal use of hallucinogens

Excludes2: newborn affected by other maternal medication (P04.1-)

P04.8 Newborn affected by other maternal noxious substances P04.81 Newborn affected by maternal use of cannabis P04.89 Newborn affected by other maternal noxious substances

Zika Virus

P35 Congenital viral diseases

P35.4 Congenital Zika virus disease

Q02 Microcephaly

Use Additional code, if applicable, to identify congenital Zika virus disease

Z20.821 Contact with and (suspected) exposure to Zika virus

Punctuation Fixes

Removed a stray “:”P83.81 Umbilical granuloma Excludes2:

: Granulomatous disorder of the skin and subcutaneous tissue, unspecified (L92.9)

Granulomatous disorder of the skin and subcutaneous tissue, unspecified (L92.9)

Removed a stray spaceQ67.5 Congenital deformity of spine Excludes1:

infantile idiopathic scoliosis (M41.0 ) infantile idiopathic scoliosis (M41.0)

Abnormal Urine

THESE…

R82.99 Other abnormal findings in urine

Cells and casts in urine

Crystalluria

Melanuria

Abnormal UrineBECAME THIS…

R82.991 Hypocitraturia R82.992 Hyperoxaluria

Excludes1: Primary hyperoxaluria (E72.53)

R82.993 HyperuricoscuriaR82.994 Hypercalciuria

Idiopathic hypercalciuria

R82.998 Other abnormal findings in urineCells and casts in urine CrystalluriaMelanuria

Poisoning by Ecstasy

T43.64 Poisoning by ecstasyPoisoning by MDMAPoisoning by 3,4-methylenedioxymethamphetamine

T43.641 Poisoning by ecstasy, accidental (unintentional)Poisoning by ecstasy NOS

T43.642 Poisoning by ecstasy, intentional self-harm T43.643 Poisoning by ecstasy, assaultT43.644 Poisoning by ecstasy, undetermined

Exploitation and Abuse - ConfirmedT74.3 Psychological abuse, confirmed

Bullying and intimidation, confirmed Intimidation through social media, confirmed

T74.5 Forced sexual exploitation, confirmed T74.51 Adult forced sexual exploitation, confirmed T74.52 Child sexual exploitation, confirmed

T74.6 Forced labor exploitation, confirmed T74.61 Adult forced labor exploitation, confirmed T74.62 Child forced labor exploitation, confirmed

T76 Adult and child abuse, neglect and other maltreatment, suspected

Exploitation and Abuse - SuspectedT76.3 Psychological abuse, suspected

Bullying and intimidation, suspected Intimidation through social media, suspected

T76.5 Forced sexual exploitation, suspected

T76.51 Adult forced sexual exploitation, suspected T76.52 Child sexual exploitation, suspected

T76.6 Forced labor exploitation, suspected

T76.61 Adult forced labor exploitation, suspected T76.62 Child forced labor exploitation, suspected

Exam & Observation

Z04 Encounter for examination and observation for other reasons Z04.8 Encounter for examination and observation for other specified reasons

Z04.81 Encounter for examination and observation of victim following forced sexual exploitation

Z04.82 Encounter for examination and observation of victim following forced labor exploitation

Z04.89 Encounter for examination and observation for other specified reasons

Digit to Character

V01-V09 with 5th digit 9

Became:

V01-V09 with 5th character 9

Weather Events

X37 Cataclysmic storm

X37.9 Unspecified cataclysmic storm Excludes1:

collapse of dam or man-made structure causing earth movement (X39.0)

collapse of dam or man-made structure causing earth movement (X36.0)

X38 Flood

Excludes1:collapse of dam or man-made structure causing earth movement (X39.0) collapse of dam or man-made structure causing earth movement (X36.0) tidal wave caused by storm (X37.2)tidal wave caused by storm (X37.42)

X39 Exposure to other forces of nature X39.0 Exposure to natural radiation

Excludes1:

contact with and (suspected) exposure to radon and other naturally occuring radiation (Z77.123)contact with and (suspected) exposure to radon and other naturally occurring radiation (Z77.123)

Weather Events

X39 Exposure to other forces of nature X39.0 Exposure to natural radiation

Excludes1:

contact with and (suspected) exposure to radon and other naturally occuring radiation (Z77.123)

contact with and (suspected) exposure to radon and other naturally occurring radiation (Z77.123)

Z00.12___ Changes

Z00.12 Encounter for routine child health examination

Encounter for development testing of infant or child Immunizations appropriate for ageRoutine developmental screening of infant or child Routine vision and hearing testing

Z13.3 Encounter for screening examination for mental health and behavioral disorders

Z13.30 Encounter for screening examination for mental health and behavioral disorders, unspecified

Z13.31 Encounter for screening for depressionEncounter for screening for depression, adultEncounter for screening for depression for child

or adolescent

Mental Health Screening Mental Health Screening

Z13.32 Encounter for screening for maternal depression

Encounter for screening for perinatal depression

Z13.39 Encounter for screening examination for other mental health and behavioral disorders

Encounter for screening for alcoholismEncounter for screening for intellectual

disabilities

Developmental screening

Z13.4 Encounter for screening for certain developmental disorders in childhoodEncounter for development testing of infant or child

Excludes1: routine development testing of infant or child (Z00.1-)Excludes2: encounter for routine child health examination (Z00.12-)

Z13.40 Encounter for screening for unspecified developmental delays

Z13.41 Encounter for autism screening

Z13.42 Encounter for screening for global developmental delays (milestones)Encounter for screening for developmental handicaps in early childhood

Z13.49 Encounter for screening for other developmental delays

Unavailability of Vaccine

Z28.83 Immunization not carried out due to

unavailability of vaccine

Delay in delivery of vaccine

Lack of availability of vaccine

Manufacturer delay of vaccine

History Additions

Z62.813 Personal history of forced labor or sexual exploitation in childhood

Z83.43 Family history of other disorder of lipoprotein metabolism and other lipidemias Z83.430 Family history of elevated lipoprotein(a)

Family history of elevated Lp(a) Z83.438 Family history of other disorder of lipoprotein metabolism and other lipidemia

Z91.42 Personal history of forced labor or sexual exploitation

Language Corrections

Finger Fractures: medial to middle

Babystroller to Baby stroller

Motorscooter to Motor scooter

Snow boarding to Snowboarding

Naturally occuring to Naturally occurring

Defribillator to defibrillator

Language Changes

H04.201 Unspecified epiphora, right lacrimal gland

>>H04.201 Unspecified epiphora, right side

H04.202 Unspecified epiphora, left lacrimal gland

>>H04.202 Unspecified epiphora, left side

H04.203 Unspecified epiphora, bilateral lacrimal glands

>>H04.203 Unspecified epiphora, bilateral

H04.209 Unspecified epiphora, unspecified lacrimal gland

>>H04.209 Unspecified epiphora, unspecified side

External Cause Addenda Coming Attractions

V8.6 Beta Deployment:

Mid October, 2018

V.6 General Deployment:

Sunday, November 4, 2018

Roadmap - Version 8.6

*PROPOSED* EHR Highlights:

● ICD-10s in Flowsheet● Mandated code set updates:

a. LOINCb. VISc. NDCd. RVU

● Verify Eligibility● Custom Report Categories

Roadmap - Version 8.6

*PROPOSED* EHR Highlights:

● New Reports

a. Obesity follow-up

b. Predominant conditions & health concerns

● New Dashboard Measure "Immunizations for

Adolescents" (TdaP/Meningococcal/HPV)

Resources

● AAP's Private Payer Advocacy Templates for

Appeal Letters

Next Coding Weblab:

Wed, Oct 17, 2018 1pm Eastern

What Questions Do You Have?

How do I code for…?

What do I do when carriers deny because…?

How can I find a code for…?

Shouldn’t my payers process … ?

Jan Blanchard, CPC, CPMAPediatric Solutions Consultant

PCC Control Your Future.

 jan@pcc.comwww.pcc.com