The Coding Clinic, issued by the American Hospital Association (AHA), serves as the definitive reference for updates and clarifications concerning ICD-10-CM and ICD-10-PCS coding. Released on March 17, the first quarter edition featured new and revised guidelines, modifications to the Alphabetic Index, and a question and answer section addressing complex coding issues.
These updates are not included in the 2025 print version of the ICD-10-CM books. However, the coding advice and guidelines from this Coding Clinic are currently in effect. This article will emphasize significant changes, and it would be beneficial to annotate your books regarding these updates to bridge the gap until the changes are incorporated in the new code books available on October 1, 2025.
Chapter 1: Certain Infectious and Parasitic Diseases
The AHA has once again revised the guidelines for coding COVID-19 infections.
The guidelines concerning the coding of only confirmed cases have eliminated the requirement for “documentation of a positive COVID-19 test result” to validate a diagnosis.
The guidelines for asymptomatic individuals who test positive for COVID-19 have introduced new language indicating that, in such cases, it is necessary to query the provider regarding a COVID-19 diagnosis if there is no documentation from the provider. Additionally, due to the possibility of false positive laboratory results, it is the provider’s duty to confirm and document the diagnosis accordingly. This new language supersedes the previously deleted statement that an asymptomatic individual who tests positive is deemed to have a COVID-19 infection.
The key takeaway from this revision is that we can no longer presume that a patient with a positive COVID-19 test actually has the infection. The coder must consult with the provider to ascertain whether a COVID-19 diagnosis is warranted. The guidelines for Chapter 15: Pregnancy, Childbirth and the Puerperium reflect this change by substituting language about testing positive for COVID-19 with language regarding being diagnosed with it.
The AHA also addressed a query regarding viral myocarditis resulting from acute COVID-19 infection in a patient without a notable history of cardiopulmonary disease. In this instance, the appropriate ICD-10-CM codes to report are U07.1 (COVID-19) and B33.22 (Viral myocarditis). The Centers for Disease Control and Prevention’s National Center for Health Statistics deliberated on this matter during a recent ICD-10 Coordination and Maintenance Committee meeting and subsequently made the following amendment to the Alphabetic Index: Myocarditis virus, viral B33.22
Chapter 4: Endocrine, Nutritional, and Metabolic Diseases
In October 2024, CMS introduced new ICD-10-CM codes for obesity classes (E66.8-), yet the AHA did not provide any associated guidelines at that time. It has now issued new guidelines indicating that obesity codes within category E.66- (Overweight and obesity) encompass codes pertaining to the causes of obesity as well as codes related to the effects of obesity. For instance, E66.1 (Drug-induced obesity) is cited as a cause of obesity, while E66.2 (Morbid [severe] obesity with alveolar hypoventilation) serves as an example of an effect of obesity.
The guidelines further acknowledge the presence of additional codes associated with obesity in various classification categories (e.g., E88.82 [Obesity due to disruption of MC4R pathway]) and codes within the fifth character subcategory O99.21- (Obesity complicating pregnancy, childbirth, and the puerperium). Additionally, the guidelines discuss obesity class, specifying that codes in subcategory E66.81- (Obesity class) necessitate a fifth character to indicate the severity of obesity. It is essential for the provider to document the obesity class in the medical record to facilitate accurate code assignment.
To comprehensively describe the condition, obesity class codes may be reported alongside other obesity codes found in the classifications within Chapters 4 and 15. A critical note regarding this guideline is that when both class 3 obesity and morbid obesity are documented, only the code for class 3 obesity should be assigned, as it is more specific.
The primary takeaway from these guidelines is that codes E66.813 (Obesity, class 3) and E66.01 (Morbid [severe] obesity due to excess calories) should not be used together. Only code E66.813 should be applied. Additionally, the body mass index should be coded if it is known.
AHA also responded to an inquiry regarding diabetes and venous insufficiency. A patient with type 2 diabetes and a history of venous insufficiency and venous stasis dermatitis was admitted due to a venous stasis ulcer accompanied by cellulitis and edema in the left lower leg. The inquiry pertained to whether the venous insufficiency is connected to the diabetes. Generally, venous insufficiency is linked to deeper veins and is not classified as diabetic peripheral angiopathy.
Diabetic peripheral vascular disease is characterized as an arterial condition, not a venous one. Consequently, venous insufficiency and diabetes are not deemed related. The appropriate ICD-10-CM codes to use are I87.2 (Venous insufficiency [chronic] [peripheral]), L97.929 (Non-pressure chronic ulcer of unspecified part of left lower leg with unspecified severity), and E11.9 (Type 2 diabetes mellitus without complications).
Chapter 9: Circulatory System
Mitral Valve Regurgitation with Stenosis of Bioprosthetic Aortic Valve AHA addressed a query concerning a patient who underwent bioprosthetic aortic valve replacement and subsequently developed valve endocarditis, moderate stenosis of the valve, and moderate mitral valve regurgitation. The stenosis of the prosthetic aortic valve is not classified as a disorder of the valve but rather as a complication of the device.
Therefore, only the code for one valve, I34.0 (Nonrheumatic mitral [valve] insufficiency), should be utilized, rather than a code that encompasses both the mitral and aortic valves (I08.0 [Rheumatic disorders of both mitral and aortic valves]).
Initially, assign the ICD-10-CM code I21.4 (NSTEMI), followed by T82.855A (Stenosis of coronary artery stent, initial encounter) for the occluded stents associated with neoatherosclerosis, and include a code from category I25- (Chronic ischemic heart disease) for the coronary artery disease. Bacteremia accompanied by endocarditis of a cardiac valve prosthesis.
The AHA addressed an inquiry regarding a patient suffering from streptococcus viridans bacteremia and endocarditis of a transplanted aortic valve. Begin by assigning the ICD-10-CM code T82.6XXA (Infection and inflammatory reaction due to valve prosthesis, initial encounter), then I33.0 (Acute and subacute infective endocarditis), and B95.4 (Other streptococcus as the cause of diseases classified elsewhere) for the streptococcus viridans infection. It is important to note that bacteremia should not be coded separately, as it is merely a symptom of the endocarditis.