Diagnosis code changes allow more specificity for lymphoma, diabetes, and other conditions

Information about diagnosis code changes in this year's annual ICD-10-CM update is now available. Many of the changes, which are effective Oct. 1, allow clinicians to code conditions with more specificity. Those most likely to interest family physicians and their practices include the following:

• Chapter 2, “Neoplasms (C00-D49),” has added many new codes to specify various neoplasms in remission. For example, C81.0A describes “Nodular lymphocyte predominant Hodgkin lymphoma, in remission.”
• In Chapter 4, “Endocrine, nutritional, and metabolic diseases (E00-E89),” some of the diabetes mellitus code families (e.g., E08, E09, E11, E13) have added notes instructing clinicians to use an additional code to identify the use of injectable non-insulin antidiabetic drugs (Z79.85). Some codes in those families also now instruct clinicians to use an additional code for hypoglycemia level, if applicable, from an all-new set of codes that start with E16.A. The chapter also includes new sets of codes for “Type 1 diabetes mellitus, presymptomatic” (E10.A-) and “Obesity class” (E66.81-).
• Chapter 5, “Mental, Behavioral, and Neurodevelopmental disorders (F01-F99),” contains multiple new codes under F50.-, “Eating disorders,” that allow clinicians to specify severity and whether the disorder is in remission.
• For patients with Crohn’s disease (K50) or ulcerative colitis (K51), there is a new instruction to use additional codes to identify associated fistulas, if applicable. Additions to the anal fistula (K60.3-), anorectal fistula (K60.5-), and rectal fistula (K60.4-) code families will then allow clinicians to be more specific about the fistula in question.
• Code Z59.7, “Insufficient social insurance and welfare support,” is being divided into two new codes: Z59.71, “Insufficient health insurance coverage,” and Z59.72, “Insufficient welfare support.”

These are just some of the many changes effective Oct. 1. Review the codes you use most often to see what other additions, deletions, or revisions may be relevant to your practice. Using correct diagnosis codes will help avoid potential claim denials.

— Kent Moore, AAFP Senior Manager for Payment Strategies

Posted on July 19, 2024