ICD-10-CM Code Updates, April 2024

As you know, CMS and the CDC release the majority of code changes for the fiscal year on October 1 each year. However, they are now making a second release of updates, as well as an update to the grouper, that become effective on April 1 of each year. This Coding Tip presents the ICD-10-CM code changes that will go into effect on April 1, 2024.

To ensure you are current on all ICD-10 code updates, read ICD-10-PCS CODE CHANGES EFFECTIVE APRIL 1, 2024.

Where can I find the updates?

To download the updated files, use this link to the CMS website: https://www.cms.gov/medicare/coding-billing/icd-10-codes/2024-icd-10-cm. The files include an updated version of the guidelines, the index and the tabular as well as an addendum with files that include only the specific changes being made to the classification. Reviewing the addendum makes it easy to see exactly what is being changed/updated.

ICD-10-CM Code Updates

There are no new diagnosis codes being implemented in the April 1, 2024, release of ICD-10-CM updates, but there are additions, deletions, and revisions to some index entries, tabular entries and instructional notes that have implications for the coding process. In addition to the updates to the Index to Diseases and Injuries and the Tabular List, there were updates made to the Official Guidelines for Coding and Reporting.

Index to Diseases and Injuries

The are 5 alphabetic sections of the ICD-10-CM Index to Diseases and Injuries that have updates for April 1, 2024.

B

• The term “obliterative” was removed as a nonessential modifier for the subterm chronic, under the main term Bronchiolitis.

C

• Seven new subterms were added under the main term Calculus, calculi, calculous.
  • The subterm with bile duct involvement – see also Calculus, bile duct was added under the subterm biliary.
  • Six subterm entries were added that lead to codes for reporting:
    • calculus of the ureter
      • with hydronephrosis (new)
        • with infection (new)
    • calculus of the kidney and ureter
      • with hydronephrosis (new)
        • with infection (new)
    • congenital calculus of the kidney
      • with hydronephrosis (new)
        • with infection (new)

D

• The code directed by a search of the index under the terms Depression (acute)(mental) and central nervous system was changed from R09.2 Respiratory Arrest to G98.8 Other Disorders of Central Nervous System.

Note: This is a significant update as code R09.2 is an MCC. The change to G98.8 for reporting depression of central nervous system rather than R09.2 will result in the loss of an MCC.

• Under the main term Disease, diseased corrections were made to the spelling of subterm entries of priaprism. The second “r” was removed, and the spelling changed to priapism.

F

• The code directed by a search of the index under the terms Feeling (of) and foreign body in throat was changed from R09.89 Other specified symptoms and signs involving the circulatory and respiratory systems to R09.A2 Foreign body sensation, throat.

This change in the index is based on the expansion of category R09 to include codes that are specific for reporting Foreign body sensation of the circulatory and respiratory system in the October release of the ICD-10-CM 2024 updates.

M

• Mpox was added as new main term.

Tabular List of Diseases and Injuries

The are 11 chapters in the ICD-10-CM Tabular List that have updates for April 1, 2024.

Chapter 1 Certain infectious and parasitic diseases (A00-B99)

• Mpox was added as an inclusion term under code B04 Monkeypox 

Chapter 4 Endocrine, nutritional and metabolic diseases (E00-E89)

• The instructional note under code E89.1 Postprocedural hypoinsulinemia was changed from a “Use Additional Code” for diabetes mellitus (E13.-) note to a “Code first”, if applicable, diabetes mellitus (E13.-) note.

Note that this change effects sequencing and the decision of whether a code from category E13 Other specified diabetes mellitus, which reports post pancreatectomy and postprocedural diabetes, should be assigned. Refer to the updated guideline I.C.4.a.6.b.i for official sequencing direction.

Chapter 6 Diseases of the nervous system (G00-G99)

• In the Excludes1 note under code G20.c Parkinsonism, unspecified, a period was added to the excluded code (G21.-)

Chapter 9 Diseases of the circulatory system (I00-I99)

• The Excludes1 note under code category I49 Other cardiac arrhythmias was changed to an Excludes2 note for these conditions.
  • neonatal dysrhythmia (P29.1-)
  • sinoatrial bradycardia (R00.1)
  • sinus bradycardia (R00.1)
  • vagal bradycardia (R00.1)

Chapter 10 Diseases of the respiratory system (J00-J99)

• The Excludes1 note under code category J12 Viral pneumonia, not elsewhere classified was changed to an Excludes2 note for these conditions.
  • aspiration pneumonia due to anesthesia during labor and delivery (O74.0)
  • aspiration pneumonia due to anesthesia during pregnancy (O29)
  • aspiration pneumonia due to anesthesia during puerperium (O89.0)
  • aspiration pneumonia due to solids and liquids (J69.-)
  • aspiration pneumonia NOS (J69.0)
  • congenital pneumonia (P23.0)
  • congenital rubella pneumonitis (P35.0)
  • interstitial pneumonia NOS (J84.9)
  • lipid pneumonia (J69.1)
  • neonatal aspiration pneumonia (P24.-)

• In the Excludes2 note under code J18.0 Pneumonia, unspecified organism, the code reference for excluded diagnosis chronic bronchiolitis was changed from (J44.9) to (J44.89). Additionally, Other specified chronic obstructive pulmonary disease (J44.89) was added to the list of diagnoses in the Excludes2 note for this code.

• In the Excludes2 note under code category J45 Asthma, the code reference for these excluded diagnoses was changed from (J44.9) to (J44.89).
  • Asthma with chronic obstructive pulmonary disease
  • Chronic asthmatic (obstructive) bronchitis
  • Chronic obstructive asthma

Additionally, Other specified chronic obstructive pulmonary disease (J44.89) was added to the list of diagnoses in the Excludes2 note for category J45.

Chapter 11 Diseases of the digestive system (K00-K95)

• The Excludes1 note that excluded code N73.6 Female pelvic adhesions from being reported with code K66.0 Peritoneal adhesions (postprocedural) (postinfection) was changed to an Excludes2 note and code N99.4 Female pelvic postprocedural adhesions was added to the new Excludes2 note.

Chapter 15 Pregnancy, childbirth and the puerperium (O00-O9A)

• The Excludes1 note that excluded codes O86.1- Genital tract infection following delivery and O86.2- Urinary tract infection following delivery from being reported with codes from category O85 Puerperal sepsis was changed to an Excludes2 note.

Chapter 16 Certain conditions originating in the perinatal period (P00-P96)

• In the Excludes2 note under code P28.5 Respiratory failure of newborn, the dash was removed to the excluded code (P22.0).

Chapter 17 Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)

• In the Code also note under code Q87.85 MED13L syndrome, a period was added to the excluded code (Q21.-).

Chapter 18 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)

• The Excludes1 note that excluded code K11.7 Salivary gland hyposecretion from being reported with code R68.2 Dry mouth, unspecified was changed to an Excludes2 note.

Chapter 21 Factors influencing health status and contact with health services (Z00-Z99)

• The Excludes1 note that excluded code Z77.1 Problems related to the natural and physical environment from being reported with code Z59.1 Inadequate housing was changed to an Excludes2 note.

In the cases where an Excludes1 note was changed to an Excludes2 note, if the patient has both the condition listed in the code with the note and the excluded code, it is now appropriate to report codes for both conditions if they are not integral to one another and meet the criteria for reporting.

For example, to report both K11.7 Salivary gland hyposecretion and R68.2 Dry mouth, unspecified the documentation should support the symptom of dry mouth as secondary to something other than salivary gland hyposecretion, such medication use, for both conditions to be reportable. 

Official Guidelines for Coding and Reporting
The are 2 ICD-10-CM coding guidelines that have updates for April 1, 2024.

I.C.4.a.6.b.i Secondary diabetes mellitus due to pancreatectomy
This is the guideline as it stood in the October 2024 release of ICD-10-CM.

FY2024 October

This is the guideline as it has been updated for April 1, 2024, by adding the content in bold text.

The update to this guideline changes the direction for sequencing of diagnosis codes when a patient has diabetes secondary to surgical removal of the pancreas. Previously this guideline directed the assignment of code E89.1 Postprocedural hypoinsulinemia as the principal or first-listed diagnosis with the appropriate code from category E13 Other specified diabetes mellitus and code Z90.41 Acquired absence of pancreas assigned as additional codes. The April 1, 2024, update reverses the sequencing of the principal/first-listed diagnosis making a code from category E13 the principal/first-listed diagnosis and code E89.1 a secondary diagnosis. Code Z90.41 is still assigned as an additional code. The corresponding instructional notes in the Tabular List have been updated as well as discussed above.

This is a significant update because the change in principal diagnosis sequencing changes the MS-DRG the case is assigned to from 641 Miscellaneous disorder of nutrition, metabolism, fluid and electrolytes to 639 Diabetes without CC/MCC, which has a lower relative weight.

I.C.21.c.7 Categories of Z codes, Aftercare

This guideline has been updated to replace the specification of “solely” with the specification of “chiefly” in the following sentence: “These codes are to be first listed, followed by the diagnosis code when a patient’s encounter is chiefly solely to receive radiation therapy, chemotherapy, or immunotherapy for the treatment of a neoplasm.”

This change has implications for correct selection of the first-listed diagnosis for encounters when patients are admitted for radiation therapy, chemotherapy, or immunotherapy as well as treatment of another condition. 

To review the impact of this change in more depth, read the Coding Tip Admission Solely vs Chiefly for Chemotherapy, Immunotherapy and Radiation Therapy FY2024.

Note that coders should download all the files from the CMS.gov website listed below to have a complete copy of the changes/updates going into effect on April 1, 2024, to use as a reference when coding.

References

https://www.cms.gov/medicare/coding-billing/icd-10-codes/2024-icd-10-cm

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