FY2023 ICD-10 updates and Changes for Medical coders

• Chapter 9 (Circulatory) will expand with the addition of 43 new codes including I20.2 (Refractory angina pectoris) and I25.112 (Atherosclerosic heart disease of native coronary artery with refractory anginapectoris).
• Section S00-S09 (Injuries to the head) will see 86 new code additions related to head injuries including concussion codes: S06.0XAA (Concussion with loss of consciousness status unknown, initial encounter), S06.0XAD (Concussion with loss of consciousness status unknown, subsequent encounter) and S06.0XAS (Concussion with loss of consciousness status unknown, sequela).
• Three new codes will be added to category Z55–Z65 (Persons with potential health hazards related to socioeconomic and psychosocial circumstances), including Z59.82 (Transportation insecurity) with inclusion terms: “Excessive transportation time,” “Inaccessible transportation,” “Inadequate transportation,” “Lack of transportation,” “Unaffordable transportation,” “Unreliable transportation and Unsafe transportation”, Z59.86 (Financial insecurity) with inclusion terms: “Bankruptcy,” “Burdensome debt,” “Economic strain,” “Financial strain,” “Money problems,” “Running out of money” and “Unable to make ends meet”, and Z59.87 (Material hardship) with inclusion terms: “Material deprivation,” “Unable to obtain adequate childcare,” “Unable to obtain adequate clothing,” “Unable to obtain adequate utilities” and “Unable to obtain basic needs.”
• Category Z79 (Long term (current) drug therapy) will see the addition of 15 new codes including Z79.85 (Long-term (current) use of injectable non-insulin antidiabetic drugs). A new guideline was added to Chapter 4 (Endocrine, Nutritional, and Metabolic Diseases) advising that if the patient is treated with both insulin and an injectable non-insulin antidiabetic drug, assign codes Z79.4 (Long term (current) use of insulin) and Z79.85 (Long-term (current) use of injectable non-insulin antidiabetic drugs). If the patient is treated with both oral hypoglycemic drugs and an injectable non-insulin antidiabetic drug, assign codes Z79.84 (Long term (current) use of oral hypoglycemic drugs) and Z79.85 (Long-term (current) use of injectable non-insulin antidiabetic drugs).
• A new guideline for underdosing explains that you don’t need to see a change in the patient’s condition to assign an underdosing code. “Documentation that the patient is taking less of a medication than is prescribed or discontinued the prescribed medication is sufficient for code assignment,” according to new language added to the underdosing guideline in chapter 19 (Injury, poisoning and certain other consequences of external causes [S00-T88]).

• Complications of care. You don’t need to see the word “complication” assign a complication code if “the note supports that the condition is clinically significant.” The guidelines include the following 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.”
• Infection-associated hemolytic-uremic (IAHU) syndrome (D59.31). You will assign this new code first when it is the reason for admission and the condition is associated with HIV or sepsis. When IAHU is associated with HIV, B20 is the secondary code. When the condition is associated with sepsis, you will code “the underlying systemic infection and any other conditions (such as severe sepsis)” as secondary diagnoses.
• Cancer of the lymph nodes. When lymph node cancer metastasizes beyond the lymphoid tissue, add the final character “9” to codes from categories C81–C85 to identify extranodal and solid organ sites. You should not assign a code for secondary neoplasm of a solid organ.
• New guidelines for the new dementia codes. The provider must clearly document the severity of the patient’s condition. You will default to the appropriate unspecified code when the documentation isn’t complete, the new subsection for chapter 5 (Mental, Behavioral and Neurodevelopmental disorders [F01–F99]) In addition, if a patient with dementia is admitted to an inpatient facility and gets worse during their stay, you will assign the highest severity level reported during the patient’s stay.
• Round down when calculating gestation weeks. A new subsection in the guidelines for chapter 15 (Pregnancy, childbirth and the puerperium [O00–O9A]) clarifies that a completed week of gestation means a full week and gives the following example, “if the provider documents gestation at 39 weeks and 6 days, the code for 39 weeks of gestation should be assigned, as the patient has not yet reached 40 completed weeks.”
• Clarification for hemorrhaging codes. Another new subsection for chapter 15 clarifies that you should assign O04.6 (Delayed or excessive hemorrhage following [induced] termination of pregnancy) for hemorrhaging that follows an elective abortion. You should not use post-partum code O72.1 (Other immediate postpartum hemorrhage). 
• Code underdosing when documented. A new guideline explains that you don’t need to see a change in the patient’s condition to assign an underdosing code. “Documentation that the patient is taking less of a medication than is prescribed or discontinued the prescribed medication is sufficient for code assignment,” according to new language added to the subsection on underdosing in chapter 19 (Injury, poisoning and certain other consequences of external causes [S00–T88]).
• Assign new code Z71.87 whenever it is part of the visit. A new guideline in the Counseling subsection of chapter 21 (Factors influencing health status and contact with health services [Z00–Z99]) instructs you to assign the code for an encounter for pediatric-to-adult transition counseling whether the counseling is the only reason for the visit or it is provided in addition to other services “such as treatment of a chronic condition.” When the patient comes in for counseling and additional services, you’ll sequence the codes “depending on the circumstances of the encounter.”
• Assign life management and social determinant of health (SDOH) codes when relevant. A new note under Z73 (Problems related to life management difficulty) reminds you to assign codes from this category “when the documentation specifies that the patient has an associated problem.” A similar note for SDOH codes states you can assign as many codes as necessary, but the documentation must specify that “the patient has an associated problem or risk factor.”

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