ICD-10-CM FY

2019 Code

Update

Chapter 1 Infectious Diseases

Zika Virus

Spread by mosquito and no vaccine or medication for Zika

New code P35.4 Congenital Zika Virus Disease

New code Z20.81 Contact with and (suspected) exposure to Zika virus

New note “use additional code to identify the manifestation such as Q02Microcephaly

Ch 4:Endocrine, Nutritional &

Metabolic Disease (E00-E89)

Metabolic Disorders

New code E78.4 Other hyperlipidemia

E78.41 elevated lipoprotein (a) or Lp(a)

E78.49 other hyperlipidemia

This is a genetic lipid disorder and a risk factor

for CVD disorder including heart attack,

stroke, PAD and aortic valve disease

Metabolic Disorders

Family history of elevated lipoprotein (a)

Z83.430 family history of elevated

lipoprotein (a)

Ch 5: Mental Health &

Behavioral Disorders

Cannabis Withdrawl

New code F12.23 Cannabis dependence

(on their own) with withdrawal (when they

stop)

F12.93 Cannabis use, unspecified (under

medical supervision such as treatment for

pain from chemo or seizures)

Mental Disorders Associated

with the Puerperium

Category F53 has been renamed from F53

Puerperal psychosis to F53 Mental and

behavioral disorders associated with the

puerperium, NEC

Postpartum Depression F53.0- Happens immediately after delivery up to 1 year

or more post delivery

less severe condition

related to hormone from pregnancy delivery

Puerperal psychosis F.31 Very severe condition

Happens within days up to 2-6 weeks post delivery

Psychotic thoughts of mom about the baby, lack of bonding or fear mom will hurt baby

Ch 6 Diseases of the Nervous

System (G00-G99)

Hemifacial Spasms (HFS)

Involuntary irregular movements of the

muscles innervated by the 7th cranial

(facial) nerve

New code for HFS

G51.3 Clonic hemifacial spasm

G51.31 right

G51.32 left

G51.33 bilateral

G51.39 unspecified

Muscular Dystrophy (MD)

Expanded G71.0 to the most common

types of MD

G71.00 Unspecfied

G71.01 Becker and Duchenne

G71.02 Facioscapulohumeral

G71.09 Other specified

Ch7: Diseases of the Eye &

Adnexa (H00-H59)

Rosacea Conjunctivitis

Inflammation of midface and eyes-also

called ocular rosacea

New subcategory for it

H10.82 Rosacea conjunctivitis

H10.821 right eye

H10.822 left eye

H10.823 bilateral

H10.829 unspecified

Brow Ptosis

Drooping of eyelid

New code H57.81 Brow ptosis

H57.811 right

H57.812 left

H57.813 bilateral

H5.819 unspecified

Ch 9 Diseases Circulatory

System

Lacunar Infarcts

Lacunar infarcts are cerebral infarcts of small

penetrating branch arteries in the deep portion

of the brain. “Lacune” are the spaces left

behind after the infarct heals

Caused by occlusion or stenosis of a small

cerebral artery----I63.81

I63.81 other cerebral infarction due to occlusion or stenosis of small artery

Lacunar infarction

Ch 11 Diseases of the

Digestive System (K00-K95)

Appendicitis

Abscesses can form with appendicitis

K35.2 has been expanded

K53.20 acute appendicitis with peritonitis

without abscess

K53.21 acute appendicitis with peritonitis

with abscess

K35.3 acute appendicitis has been expanded to include gangrene, perforation and abscess

K35.30 acute appendicitis with localized peritonitis without perforation or gangrene

K35.31 acute appendicitis with localized peritonitis and gangrene without perforation

K35.32 acute appendicitis with perforation and localized peritonitis, without abscess

K35.33 acute appendicitis with perforation and localized peritonitis, with abscess

K358 acute appendicitis has expanded to

include without perforation, with or

without gangrene:

K35.890 without perforation or gangrene

K35.891without perforation with gangrene

Diverticular Disease

Often cause peritonitis

Just added “code also” peritonitis if

applicable K65

Anal and Rectal Abscess

Regions

Category K61 has been expanded to

include the 4 different regions

K61.0 Perianal

K61.3x Ischiorectal

K61.4 Intersphincteric

K61.5 Supralevator

Gallbladder, Gangrene,

Perforation

2 new (use in addition to)codes

Must code the cholelithiasis or cholecystitis first

K82.A1 gangrene of gallbladder in cholecystitis

K82.A2 perforation of gallbladder in cholecystitis

“code first the type of cholecystitis or

cholelithiasis with cholecystitis

Cholangitis Expanded for specific code Primary sclerosing

cholangitis for tracking purposes

Progressive (chronic) and can damage the entire

biliary system and lead to liver transplant

K83.01 Primary sclerosing cholangitis

K83.09 Other cholangitis

Ch 13 Disease of the

Musculoskeletal &

Connective Tissue systems

New codes for myalgia of the mastication and

auxiliary muscles of head and neck

Help differentiate muscle pain in head and neck

from temporomandibular (TMJ) pain

M79.10 myalgia unspecified site

M79.11 myalgia of mastication muscle

M79.12 myalgia of auxiliary muscles head and

neck

M79.18 myalgia other site

Ch 14 Genitourinary System

(N00-N99)

Urethral stricture codes expanded to

show specific anatomical sites

N35.811 other urethral stricture, male

meatal

N35.812 bulbous

N35.813 other memranous

N35.814 other anterior

N35.816 overlapping

Ch 15 Pregnancy, Childbirth

and Puerperium (O00-O9A)

Infection of Obstetrical

Surgical Wound

Expanded O86.0 Infection of OB surgical wound to

identify sites of the wound

O86.00 infection OB surgical wound, unspecified

O86.01 superficial incisional site

O86.02 deep incisional site

O86.02 organ and space site

O86.04 sepsis following an OB procedure

O86.09 other surgical site

Ch 16 Perinatal Period (P00-

P96)

FIRS-fetal counterpart of systemic

inflammatory response syndrome (SIRS) in

adults

Develops due to infectious organisms in

amniotic fluid during choriamnionitis

P02.70 newborn affected by FIRS

P02.78 newborn affected by other

conditions from chorioamnionitis

Newborn affected by

maternal medications Newborn affected by maternal medications P04.1 expanded to specific

medications

P04.11 newborn affected by maternal antineoplastic chemotherapy

P04.12 cytotoxic drugs P04.13 anticonvulsants

P04.14 opiates P04.15 antidepressants P04.16 amphetamines P04.17 sedative-hypnotics P04.1A anxiolytics P04.18 other P04.19 unspecified

Newborn affected by

maternal drugs

P04.4 P04.8 includes unspecified,

hallucinogens, cannabis and other drug

Newborn metabolic

disturbance

P74.2, P74.3 P74.4 expanded to include

both hyper and hypo levels of:

Sodium

Potassium

Chloride

And hyper level bicarbonate

Ch 18 Symptoms, signs and

abnormal clinical and

laboratory findings

Abnomal urine findings

Captures data on patients who form

kidney stones or low level of citrate

R82.991 Hypocitraturia (low citrate level)

R82.992 Hyperoxaluria (high oxalate level)

R82.993 Hyperuricoscuria (high uric acid)

R82.994 Hypercalciuria (high calcium)

R82.998 Other abnormal urine findings

Abnormal radiological findings

R93.8 expanded to include 6th characters to represent

“diagnostic imaging” on testicles

R93.811 abnormal radiologic findings on

diagnostic imaging of right testicle

R93.812 left testicle

R93.813 bilateral

R93.819 unspecified

Ch 19 Injury and Poisoning

Ecstasy

Ecstasy has both hallucinogenic and

stimulant effects so a new category has

been assigned

T43.64 Poisoning by Ecstasy

T43.641 accidental

T43.642 intentional self-harm

T43.643 assault

T43.644 undetermined

Infection following procedure

T81.4 infection following procedure has

expanded to identify the site of surgical

wound with infection

T81.41 superficial incision site

T81.42 deep incisional site

T81.43 organ and space site

T81.44 sepsis following procedure

T81.49 other surgical site

Adult and Child Abuse New inclusion terms and new code subcategories

Bullying and intimation suspected/confirmed through

social medial

T74.3x Psychological abuse, confirmed

Bullying and intimidation, confirmed

Intimidation through social media, confirmed

Ch 21 Factors Influencing

Health Status (Z00-Z99)

Z28.8 expanded to include the

unavailability of vaccine as a reason not

carried out

Z28.83 Immunization not carried out due to

unavailability

delay in delivery, lack of availability,

manufacturer delay

ICD-10 CM Guideline Changes

Guideline I.A.15 “With”

The word “with” or “in” should be interpreted

to mean “associated with” or “due to” when

it appears in a code title, the Alphabetic

Index (either under a main term or subterm)

Hurricane Aftermath

New coding guideline I.B.19.a-d has been

added to provide guidance on coding

the cause of injury related to hurricanes

Current Malignancy vs History

Guideline I.2m added:

Subcategories Z85.0-Z85.7 should only be assigned for the site of a primary malignancy, not the site of a secondary malignancy. Codes from Z85.8 Personal history of malignancy neoplasms of other organs and systems may be assigned for the former site (s) of either a primary or secondary malignancy included in this subcategory

Hypertension and CKD

Guideline I.C.9.a.2 updated to clarify that

CKD should not be coded as hypertensive

if the provider indicates the CKD is not

related to the hypertension

Subsequent Myocardial Infarction

Guideline I.C.9.e.4 added

If a subsequent MI of one type occurs within

4 weeks of a MI of a different type (STEMI,

NSTEMI)assign the appropriate codes from

category I2, Acute MI, to identify each

type. Do not assign a code from I22

(subsequent MI). Codes from I22 should only

be assigned if both the initial and

subsequent MI are type 1 or unspecified

Underdosing

Guideline I.C.19.e.5(c) updated to

include: discontinuing the use of

prescribed medication on the patient's

own initiative is also classified as an

underdosing

BMI Guidance

Guideline I.C.21.c.3 updated to say “BMI

codes should only be assigned when the

associated diagnosis (overweight or

obesity) meets the definition of a

reportable diagnosis. Do not assign BMI

codes during pregnancy

References

Libman education

CMS.gov