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Andrew Montalvo · Dec 6, 2021

What’s New for ICD-10 in 2022?

Every year when fall arrives, it’s not only the leaves that are changing: once again, we need to be prepared for the new ICD-10 changes that become effective every October 1. It’s the day when the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS) enforce newly updated changes to the International Classification of Diseases 10th Revision, Clinical Modification (ICD-10-CM) Official Guidelines for Coding and Reporting and the ICD-10 code set, including new, revised, and retired codes.

ICD-10-CM is published by the United States to classify diagnoses, morbidities, and reasons for patient visits in every healthcare setting. It is based on ICD-10, which is the classification of diseases, conditions, and injuries published by the World Health Organization (WHO). In addition, it’s important for healthcare providers and coders to use the guidelines and reporting requirements as companion documentation to the official version of the ICD-10-CM.

Practice Fusion is dedicated to helping independent medical practices, who are using their electronic health record (EHR), be prepared for the annual changes to the ICD-10 coding set. In this article, we’ll highlight some of the important ICD-10 changes that may impact healthcare providers and coders through September 30, 2022.

New ICD-10 codes

For the fiscal year (FY) 2022, CMS and the NCHS added 165 new codes versus the whopping 485 additions that we saw in FY 2021. You can find the complete list of added, deleted, and revised diagnostic codes in the IPPS Final Rule for FY 2022 in tables 6A, 6C, and 6E.

The specific additions, revisions, and updated guidelines offer an interesting window into the events of last year in several areas, including the following:

  • Public health (e.g., recognizing that some patients who have had COVID-19 may develop sequela as well as a new COVID-19 infection, introducing the use of the new U09.9 code for “post COVID-19 condition, unspecified,” along with the existing U07.1 code for COVID-19)
  • Collaboration between different stakeholders to enhance the accuracy of and to update medical terminology and associated conditions (e.g., the collaboration of the Sjögren’s Foundation in partnership with the American College of Rheumatology to revise and update Sjögren’s ICD-10 terminology)
  • Ongoing medical advances (e.g., the addition of codes including Z92.850 for personal history of Chimeric Antigen Receptor T-cell therapy and Z92.86 for personal history of gene therapy) to recognize new treatments and technologies

New MCC and CC codes

We’ll begin by discussing ICD-10 codes that are designated as major complications or comorbidity (MCC) codes or a complication or comorbidity (CC) when used as a secondary diagnosis. MCC or CC codes are representative of patients who require more resources for their care, leading to higher reimbursements. If providers and coders use such codes as principal diagnoses, the codes will be considered as only non-CCs. For FY 2022, ICD-10 includes nine new codes belonging to the MCC category and 11 new codes designated as CC codes.

The new MCC and CC codes for FY 2022 include the following:

  • J12.82: Pneumonia due to coronavirus disease 2019 (MCC)
  • M35.8: Other specified system involvement of connective tissue (CC)
  • S06.A0XA: Traumatic brain compression without herniation, initial encounter (MCC)
  • S06.A1XA: Traumatic brain compression with herniation, initial encounter (MCC)
  • M35.07: Sjögren’s syndrome with central nervous system involvement (CC)
  • M31.10: Thrombotic microangiopathy, unspecified (MCC)
  • M31.11: Hematopoietic stem cell transplantation-associated thrombotic microangiopathy (MCC)
  • M31.19: Other thrombotic microangiopathy (MCC)
  • G04.82: Acute flaccid myelitis (MCC)
  • G92.03: Immune effector cell-associated neurotoxicity syndrome, grade 3 (CC)
  • G92.04: Immune effector cell-associated neurotoxicity syndrome, grade 4 (CC)
  • G92.05: Immune effector cell-associated neurotoxicity syndrome, grade 5 (CC)
  • G92.8: Other toxic encephalopathy (MCC)
  • G92.9: Unspecified toxic encephalopathy (MCC)
  • A79.82: Anaplasmosis (CC)
  • C56.3: Malignant neoplasm of bilateral ovaries (CC)
  • C79.63: Secondary malignant neoplasm of bilateral ovaries (CC)
  • C84.7A: Anaplastic large cell lymphoma, ALK-negative, breast (CC)
  • I5A: Non-ischemic myocardial injury (non-traumatic) (CC)

New ICD-10 COVID code

For FY 2022, there is a new code for providers to report conditions resulting secondary to COVID-19 infection (sequelae):

  • U09.9: Post COVID-19 condition, unspecified

The new code above joins the six new codes that were added on January 1, 2021:

  • J12.82: Pneumonia due to coronavirus disease 2019 (MCC)
  • M35.81: Multisystem inflammatory syndrome (CC)
  • M35.89: Other specified system involvement of connective tissue (CC)
  • Z11.52: Encounter for screening for COVID-19
  • Z20.822: Contact with and (suspected) exposure to COVID-19
  • Z86.16: Personal history of COVID-19

New codes for diseases of the nervous system

ICD-10 now includes an additional 10 new codes in this category, with many classified as MCC or CC codes (please see above). The new codes in this category include the following:

  • G04.82: Acute flaccid myelitis (MCC)
  • G44.86: Cervicogenic headache
  • G92.00: Immune effector cell-associated neurotoxicity syndrome, grade unspecified
  • G92.01: Immune effector cell-associated neurotoxicity syndrome, grade 1
  • G92.02: Immune effector cell-associated neurotoxicity syndrome, grade 2
  • G92.03: Immune effector cell-associated neurotoxicity syndrome, grade 3 (CC)
  • G92.04: Immune effector cell-associated neurotoxicity syndrome, grade 4 (CC)
  • G92.05: Immune effector cell-associated neurotoxicity syndrome, grade 5 (CC)
  • G92.8: Other toxic encephalopathy (MCC)
  • G92.9: Unspecified toxic encephalopathy (MCC)

New codes for diseases of the digestive system

For FY 2022, ICD-10 now includes 13 new codes in this category:

  • K22.81: Esophageal polyp
  • K22.82: Esophagogastric junction polyp
  • K22.89: Other specified disease of esophagus
  • K31.A0: Gastric intestinal metaplasia, unspecified
  • K31.A11: Gastric intestinal metaplasia without dysplasia, involving the antrum
  • K31.A12: Gastric intestinal metaplasia without dysplasia, involving the body (corpus)
  • K31.A13: Gastric intestinal metaplasia without dysplasia, involving the fundus
  • K31.A14: Gastric intestinal metaplasia without dysplasia, involving the cardia
  • K31.A15: Gastric intestinal metaplasia without dysplasia, involving multiple sites
  • K31.A19: Gastric intestinal metaplasia without dysplasia, unspecified site
  • K31.A21: Gastric intestinal metaplasia with low-grade dysplasia
  • K31.A22: Gastric intestinal metaplasia with high-grade dysplasia
  • K31.A29: Gastric intestinal metaplasia with dysplasia, unspecified

New codes for diseases of the musculoskeletal system and connective tissue

The Sjögren’s Foundation](https://www.sjogrens.org/news/2021/new-icd-10-codes-for-sjogrens-in-effect-as-of-october-1st) in partnership with the American College of Rheumatology led an effort to appropriately revise and update U.S. ICD-10 coding. For FY 2022, seven additional Sjögren syndrome codes are included to capture additional disease manifestations.

Previously, the code for Sjögren was categorized under the heading “Sicca syndrome.” However, Sjögren is not synonymous with sicca (meaning dryness); rather, sicca is a symptom that may be associated with Sjogren, which is an autoimmune rheumatic disease. Sjögren may be associated with many manifestations, including inflammatory arthritis, sicca, nervous system involvement, and others.

The new and revised Sjögren ICD-10 codes include the following:

  • Revised, M35.0: Sjögren syndrome (previously named Sicca syndrome [Sjögren’s syndrome])
  • Added: Sicca syndrome
  • Added: Excludes 1: Dry mouth, unspecified (R68.2)
  • Revised, M35.00: Sjögren’s syndrome, unspecified
  • Revised, M35.01: Sjögren’s syndrome with keratoconjunctivitis
  • Revised, M35.02: Sjögren’s syndrome with lung involvement
  • Revised, M35.03: Sjögren’s syndrome with myopathy
  • Revised, M35.04: Sjögren’s syndrome with tubulo-interstitial nephropathy
  • New code, M35.05: Sjögren’s syndrome with inflammatory arthritis
  • New code, M35.06: Sjögren’s syndrome with peripheral nervous system involvement
  • New code, M35.07: Sjögren’s syndrome with central nervous system involvement (CC)
  • New code, M35.08: Sjögren’s syndrome with gastrointestinal involvement
  • New code, M35.0A: Sjögren’s syndrome with glomerular disease
  • New code, M35.0B: Sjögren’s syndrome with vasculitis
  • New code, M35.0C: Sjögren’s syndrome with dental involvement
  • New code, M35.09: Sjögren’s syndrome with other organ involvement

For FY 2022, ICD-10 also now includes new codes to specify non-radiographic axial spondyloarthritis by specific site, to further characterize low back pain, and to classify microangiopathies.

  • M31.10: Thrombotic microangiopathy, unspecified (MCC)
  • M31.11: Hematopoietic stem cell transplantation-associated thrombotic microangiopathy (MCC)
  • M31.19: Other thrombotic microangiopathy (MCC)
  • M45.A1: Non-radiographic axial spondyloarthritis of occipito-atlanto-axial region
  • M45.A2: Non-radiographic axial spondyloarthritis of cervical region
  • M45.A3: Non-radiographic axial spondyloarthritis of cervicothoracic region
  • M45.A4: Non-radiographic axial spondyloarthritis of thoracic region
  • M45.A5: Non-radiographic axial spondyloarthritis of thoracolumbar region
  • M45.A6: Non-radiographic axial spondyloarthritis of lumbar region
  • M45.A7: Non-radiographic axial spondyloarthritis of lumbosacral region
  • M45.A8: Non-radiographic axial spondyloarthritis of sacral and sacrococcygeal region
  • M45.AB: Non-radiographic axial spondyloarthritis of multiple sites in spine
  • M54.50: Low back pain, unspecified
  • M54.51: Vertebrogenic low back pain

New codes for certain conditions originating during the perinatal period

ICD-10 now contains eight new codes regarding neonatal screening and a new code regarding newborns affected by contact with positive maternal group B streptococcus:

  • P00.82: Newborn affected by (positive) maternal group B streptococcus (GBS) colonization
  • P09.1: Abnormal findings on neonatal screening for inborn errors of metabolism
  • P09.2: Abnormal findings on neonatal screening for congenital endocrine disease
  • P09.3: Abnormal findings on neonatal screening for congenital hematologic disorders
  • P09.4: Abnormal findings on neonatal screening for cystic fibrosis
  • P09.5: Abnormal findings on neonatal screening for congenital heart disease
  • P09.6: Abnormal findings on neonatal screening for neonatal hearing loss
  • P09.8: Other abnormal findings on neonatal screening
  • P09.9: Abnormal findings on neonatal screening, unspecified

New codes for symptoms, signs, and abnormal clinical laboratory findings

ICD-10 now has 14 additional codes in this category, including more specific codes for coughs:

  • R05.1: Acute cough
  • R05.2: Subacute cough
  • R05.3: Chronic cough
  • R05.4: Cough syncope
  • R05.8: Other specified cough
  • R05.9: Cough, unspecified
  • R35.81: Nocturnal polyuria
  • R35.89: Other polyuria
  • R45.88: Non-suicidal self-harm
  • R63.30: Feeding difficulties, unspecified
  • R63.31: Pediatric feeding disorder, acute
  • R63.32: Pediatric feeding disorder, chronic
  • R63.39: Other feeding difficulties
  • R79.83: Abnormal findings of blood amino-acid level

New codes for injuries, poisonings, and certain other consequences of external causes

For FY 2022, ICD-10 has added 45 new codes in this category. They include codes classifying traumatic brain compression with and without herniation and poisonings, adverse effects, and underdosing regarding synthetic cannabinoids and cannabis.

  • S06.A0XA: Traumatic brain compression without herniation, initial encounter (MCC)
  • S06.A0XD: Traumatic brain compression without herniation, subsequent encounter
  • S06.A0XS: Traumatic brain compression without herniation, sequela
  • S06.A1XA: Traumatic brain compression with herniation, initial encounter (MCC)
  • S06.A1XD: Traumatic brain compression with herniation, subsequent encounter
  • S06.A1XS: Traumatic brain compression with herniation, sequela
  • T40.711A: Poisoning by cannabis, accidental (unintentional), initial encounter
  • T40.711D: Poisoning by cannabis, accidental (unintentional), subsequent encounter
  • T40.711S: Poisoning by cannabis, accidental (unintentional), sequela
  • T40.712A: Poisoning by cannabis, intentional self-harm, initial encounter
  • T40.712D: Poisoning by cannabis, intentional self-harm, subsequent encounter
  • T40.712S: Poisoning by cannabis, intentional self-harm, sequela
  • T40.713A: Poisoning by cannabis, assault, initial encounter
  • T40.713D: Poisoning by cannabis, assault, subsequent encounter
  • T40.713:S Poisoning by cannabis, assault, sequela
  • T40.714.A: Poisoning by cannabis, undetermined, initial encounter
  • T40.714.D: Poisoning by cannabis, undetermined, subsequent encounter
  • T40.714.S: Poisoning by cannabis, undetermined, sequela
  • T40.715.A: Adverse effect of cannabis, initial encounter
  • T40.715.D: Adverse effect of cannabis, subsequent encounter
  • T40.715.S: Adverse effect of cannabis, sequela
  • T40.716.A: Underdosing of cannabis, initial encounter
  • T40.716.D: Underdosing of cannabis, subsequent encounter
  • T40.716.S: Underdosing of cannabis, sequela
  • T40.721.A: Poisoning by synthetic cannabinoids, accidental (unintentional), initial encounter
  • T40.721.D: Poisoning by synthetic cannabinoids, accidental (unintentional), subsequent encounter
  • T40.721.S: Poisoning by synthetic cannabinoids, accidental (unintentional), sequela
  • T40.722.A: Poisoning by synthetic cannabinoids, intentional self-harm, initial encounter
  • T40.722.D: Poisoning by synthetic cannabinoids, intentional self-harm, subsequent encounter
  • T40.722.S: Poisoning by synthetic cannabinoids, intentional self-harm, sequela
  • T40.723.A: Poisoning by synthetic cannabinoids, assault, initial encounter
  • T40.723.D: Poisoning by synthetic cannabinoids, assault, subsequent encounter
  • T40.723.S: Poisoning by synthetic cannabinoids, assault, sequela
  • T40.724.A: Poisoning by synthetic cannabinoids, undetermined, initial encounter
  • T40.724.D: Poisoning by synthetic cannabinoids, undetermined, subsequent encounter
  • T40.724.S: Poisoning by synthetic cannabinoids, undetermined, sequela
  • T40.725.A: Adverse effect of synthetic cannabinoids, initial encounter
  • T40.725.D: Adverse effect of synthetic cannabinoids, subsequent encounter
  • T40.725.S: Adverse effect of synthetic cannabinoids, sequela
  • T40.726.A: Underdosing of synthetic cannabinoids, initial encounter
  • T40.726.D: Underdosing of synthetic cannabinoids, subsequent encounter
  • T40.726.S: Underdosing of synthetic cannabinoids, sequela

New codes for factors influencing health status and contact with Health Services

Twenty-two new codes are now included in ICD-10 within this classification:

  • Z59.00: Homelessness, unspecified
  • Z59.01: Sheltered homelessness
  • Z59.02: Unsheltered homelessness
  • Z59.41: Food insecurity
  • Z59.48: Other specified lack of adequate food
  • Z59.811: Housing instability, housed, with risk of homelessness
  • Z59.812: Housing instability, housed, homelessness in past 12 months
  • Z59.819: Housing instability, housed, unspecified
  • Z59.89: Other problems related to housing and economic circumstances
  • Z91.51: Personal history of suicidal behavior
  • Z91.52: Personal history of non-suicidal self-harm
  • Z92.850: Personal history of Chimeric Antigen Receptor T-cell therapy
  • Z92.858: Personal history of other cellular therapy
  • Z92.859: Personal history of cellular therapy, unspecified
  • Z92.86: Personal history of gene therapy

ICD-10 updated Guidelines for Coding and Reporting

In addition to noting the new ICD-10 codes discussed above, it’s crucial that providers and coding staff also review the updated guidelines to ensure that they’re selecting the proper codes and supporting them within their documentation. The following highlights some of the most noteworthy updates:

Laterality

With ICD-10, enhancing specificity within coding and documentation continues to be a primary objective. For example, regarding laterality, section I.B.13 in the updated guidelines discourages use of the “unspecified” side, emphasizing that providers should only do so under limited circumstances when it’s not possible to receive clarification. Per the new guidelines, providers can obtain laterality from other clinicians’ documentation. If there is conflicting documentation concerning laterality, the provider who is documenting the current encounter should query the other provider in question.

Documentation by Other Clinicians

Section I.B.14 further specifies that “Documentation by Clinicians Other than the Patient’s Provider” applies to situations where other clinicians are permitted to provide medical record documentation for the assignment of certain codes. These may be factors associated with a diagnosis where the clinician has not included details. Acceptable clinicians are those involved in the patient’s care based on accreditation and regulatory policies. Coders may assign codes for the following:

  • Body mass index (BMI)
  • Blood alcohol level
  • Depth of non-pressure chronic ulcers
  • Glasgow coma scale
  • Laterality
  • NIH stroke scale (NIHSS)
  • Pressure ulcer stage
  • Social determinants of health (SDOH)

Section I.C.21.c17 within the guidelines enables coders to capture social determinant of health (SDOH) ICD-10 codes from documentation included in the medical record from any clinicians engaged in the patient’s care, such as nurses, social workers, case managers, and community health workers. Code assignment may also be based on a patient’s self-reported documentation if it was signed by and added to the medical record by a clinician. SDOH codes are comprised primarily by Z55 – Z65 codes:

  • Z55: Problems related to education and literacy
  • Z56: Problems related to employment and unemployment
  • Z57: Problems related to occupational exposure to risk factors
  • Z58: Problems related to physical environment
  • Z59: Problems related to housing and economic circumstances
  • Z6o: Problems related to social environment
  • Z62: Problems related to upbringing
  • Z63: Problems related to primary support group, including family circumstances
  • Z64: Problems related to certain psychosocial circumstances
  • Z65: Problems related to other psychosocial circumstances

Further, section IB.19d indicates that using Z codes is appropriate if there is “additional information relevant to a patient encounter.” Z codes may significantly affect a patient’s condition and healthcare management and therefore may well be clinically relevant.

COVID-19 updates

Unfortunately, the COVID-19 pandemic is still with us, and breakthrough infections may develop even in some of those who have been fully vaccinated. It’s therefore unsurprising that the ICD-10 guidelines provide updated guidance regarding COVID-19 coding:

  • COVID-19 can cause persistent COVID symptoms after a patient clears their active COVID infection. If a patient develops sequelae after recovery from an active COVID-19 infection, providers and coders should first code the specific symptoms, signs, or sequela, followed by code U09.9 for “Post COVID-19 condition, unspecified.” However, this code should not be used to code symptoms associated with active COVID-19 infection.
  • If a patient has sequelae secondary to a previous COVID-19 infection and then develops a new COVID-19 infection, providers and coders should use U09.9 with code U07.1 (COVID-19) and specific codes for conditions associated with previous and new COVID-19 infection

Diabetes

If a patient with diabetes is being treated with insulin as well as oral hypoglycemic medication, the ICD-10 guidelines previously instructed that providers and coders should only code for the long-term use of insulin. In contrast, with the 2022 guidelines, providers and coders are now instructed to capture both insulin and other antidiabetic medications (e.g., injectable non-insulin medications and oral hypoglycemics).

Breast-implant associated anaplastic large cell lymphoma (BIA-ALCL)

BIA-ALCL is an extremely rare non-Hodgkin’s lymphoma that may develop around breast implants. It is not breast cancer, but rather a cancer of the immune system. Per the updated ICD-10 guidelines, providers and coders should use the new code C84.7A for anaplastic large cell lymphoma, ALK-negative, breast, not a complication code.

Conclusion

The ongoing efforts to increase the specificity and accuracy of ICD-10 codes and enhance clinical documentation continue to improve the quality of reported data, coordination and continuity of care, and patient outcomes.