For the last two years, health information management (HIM) professionals were faced with the daunting task of implementing thousands of new ICD-10 codes as part of the annual code updates. This year, we are dealing with hundreds, rather than thousands, of new codes, but even with fewer changes, preparation and education will be the keys to successfully using the new codes and following new guidelines come October 1.

FY 2019 ICD-10-CM Updates

Although there are only 279 new ICD-10-CM codes this year (compared to nearly 2,000 just two years ago), the changes are impactful and will help us capture greater code specificity and some new concepts. A few highlights include:

  • New expanded codes for postoperative wound infections to increase specificity, including superficial incisional surgical site infection, deep incisional surgical site infection
  • Other transitory neonatal electrolyte and metabolic distances category were expanded to include new codes for conditions such as P74.21, Hypernatremia of Newborn
  • A new, specified code has been added to capture ecstasy poisoning.

The updates also address the public health concern involving human trafficking, including a new code concept for adult and child forced sexual exploitation. The International Labour Organization (ILO) estimates that 20.9 million people are trafficked worldwide. These new codes will help track clinical interactions of victims within the healthcare system. Although the codes are limited in nature, these codes are a starting point for data collection.

FY 2019 ICD-10-PCS Updates

For FY 2019, there will be a total of 78,881 ICD-10-PCS codes, which includes 392 new codes and 216 deleted codes. Optimizing ICD-10-PCS code assignment is a considerable challenge so understanding new procedure codes is critical to using them effectively.

Among the changes are new ICD-10-PCS codes that provide greater specificity in areas including unicondylar knee replacements and coding of ECMO (extracorporeal membrane oxygenation), as well as code deletions that include ICD-10-PCS codes with a root operation that always involves a device that had a device character of “no device.”

FY 2019 IPPS Updates

Annual IPPS changes affect more than just codes – there are changes affecting DRG methodology, DRG weight, new technology add-on payment (NTAP), as well as changes integral to the HAC/PSI initiative. Additional highlights include:

  • A reclassification of the antepartum, vaginal delivery, cesarean delivery MS-DRGs
  • Some exciting changes for non-OR (operating room) procedures that will now be classified as OR procedures, including thoracoscopic pericardium and pleura involving drainage and extirpation and percutaneous excision procedures involving transcranial brain and cerebral ventricle such as burr hole biopsies
  • The demotion of  2 encephalopathy codes from MCC to CC

Tips for Successful Implementation of Changes

  1. Don’t just learn the new codes. Understand the rationale behind the changes to be sure you can recognize documentation needs, apply the coding updates, and identify potential MCC and CC changes.
  2. Use all the resources available to you. It’s always good practice, for example, to use both the codebook Index and Tabular.
  3. Be sure not only your coders but your clinical staff and CDI team are educated on the new codes and guidelines so your HIM team can all navigate new codes and concepts.

While the volume of changes has decreased, the FY 2019 updates still require coding stakeholders to understand more than 670 new codes, in addition to the non-coding changes to methodologies and guidelines. Taking the time to understand the changes will allow your organization to ensure the ongoing accuracy and compliance of your coding.

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