Three things to know about the 2023 ICD-10 code updates
The new updates to the ICD-10-CM code system for 2023 include 1176 new billable healthcare codes for areas such as social determinants of health (SDoH), dementia, maternal care, and pregnancy.
As we navigate this post-pandemic way of life, the only constant is change. The face of healthcare is evolving and the way we access and receive our medical information is transitioning - even the way we interact with our providers looks monumentally different than it did just two years ago.
More recently, one of the most significant changes is the rate and volume of code and content updates released by the standards bodies. There has been a steady increase in recent years, with this year’s releases hitting an all-time high as several standards bodies have changed to more frequent release schedules with significantly larger numbers of code families. The transition from a fee-for-service to a value-based care healthcare model has driven many of these changes, therefore requiring a more complete documentation process with greater focus on ensuring code specificity that fully captures the acuity of the patient and the care provided, as the new reimbursement model is contingent upon the quality of care provided. While this is a significant shift, the goal is to ideally improve patient outcomes.
Let's take a look at the latest changes in the ICD-10-CM code system.
Highlights from the new 2023 ICD-10-CM codes
Dementia, endometriosis, maternal care for fetal disorders, head injuries, and motorcycles/electric bike accidents are among the major changes in the staggering 1176 new billable codes for 2023 (last year’s numbers only topping out at 159 new billable codes). 251 codes have also been deleted, several terms and inclusion terms have been modified, and 36 codes are being converted to parent codes.
Social determinants of health ICD-10 codes
New social determinants of health codes have been introduced in Chapter 21: Factors influencing health status and contact with health services (Z00-Z99) adding several new codes including ‘Z59.82 Transportation insecurity,’ and ‘Z59.87 Material hardship’.
Health Language Physician Informaticist, Dr. Michael Stearns commented, "Some in the RA industry are expecting some or all of the roughly 111 SDoH codes to be included in the determination of Medicare Advantage risk adjustment factor scores (RAF scores) as early as 2023".
Dementia ICD-10 codes
With dementia becoming a growing health concern due to an aging baby boomer generation, Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders expands dementia families 3-fold with the addition of 87 new codes. It appears that CMS wants more detailed information on dementia severity and associated behavioral disorders, likely to support improvements in clinical care and to identify levels of expenditure. The 2023 ICD-10-CM official guidelines (page 43) read:
“The ICD-10-CM classifies dementia (categories F01, F02, and F03) on the basis of the etiology and severity (unspecified, mild, moderate or severe). Selection of the appropriate severity level requires the provider’s clinical judgment and codes should be assigned only on the basis of provider documentation (as defined in the Official Guidelines for Coding and Reporting), unless otherwise instructed by the classification. If the documentation does not provide information about the severity of the dementia, assign the appropriate code for unspecified severity.If a patient is admitted to an inpatient acute care hospital or other inpatient facility setting with dementia at one severity level and it progresses to a higher severity level, assign one code for the highest severity level reported during the stay.”
These new dementia codes were discussed during the ‘ICD-10-CM Coordination and Maintenance Committee’ 2021 meetings in both March and September. The proposal stated: “Although codes exist for dementia without and with behavioral disturbances, there is a need for additional detail on other key associated disorders, particularly psychotic disorders, mood disorders, and anxiety.”
Sample of 2023 ICD-10-CM Updates for "Mental, Behavioral and Neurodevelopmental Disorders"
|Vascular dementia, mild, with mood disturbance
|Vascular dementia, mild, with anxiety
|Vascular dementia, moderate
|Vascular dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
|Unspecified dementia, unspecified severity, with agitation
|Unspecified dementia, unspecified severity, with other behavioral disturbance
Endometriosis and Maternal Care ICD-10 codes
Additional areas with numerous code updates were found in Chapter 14 & 15. Chapter 14: Diseases of Genitourinary System (N00-N99) added 168 new endometriosis codes, which gives further granularity to the limited legacy codes to include anatomic locations, depth, and laterality.
Sample of 2023 ICD-10-CM Updates for "Diseases of the Genitourinary System"
|Endometriosis of the uterus, unspecified
|Superficial endometriosis of the uterus
|Deep endometriosis of the uterus
|Adenomyosis of the uterus
|Endometriosis of ovary, unspecified depth
|Superficial endometriosis of the ovary
|Deep endometriosis of ovary, unspecified ovary
|Endometriosis of fallopian tube, unspecified depth
Chapter 15: Pregnancy, Childbirth and the Puerperium (O00-O9A) added 200 new codes needed to more accurately represent a large number of specific fetal conditions that were not represented adequately in prior versions of ICD-10-CM.
Sample of 2023 ICD-10-CM Updates for "Pregnancy, Childbirth and Puerperium"
|Maternal care for (suspected) central nervous system malformation or damage in fetus, choroid plexus cysts, fetus 5
|Maternal care for (suspected) central nervous system malformation or damage in fetus, encephalocele, not applicable or unspecified
|Maternal care for (suspected) central nervous system malformation or damage in fetus, holoprosencephaly, fetus 2
|Maternal care for (suspected) central nervous system malformation or damage in fetus, hydrocephaly, fetus 1
Additional ICD-10 code updates in April 2023
CMS announced in 2022 that the ICD-10-CM and ICD-10-PCS codes sets will now update twice a year, in April and October.
The updates going into effect on April 1, 2023, have been released and include 42 new ICD-10-CM codes, seven code deletions, and one revised code. The new ICD-10 codes are in Chapters 19, 20, and 21.
Supporting the collection of health-related social needs (HRSN)
As defined by CMS, HRSN are “individual-level adverse social conditions that negatively impact a person’s health.” The new codes that will go into effect in April reflect the importance of collecting this information to improve health equity.
S00-T88 are 12 new codes regarding confirmed or suspected financial abuse problems for an adult or child. All codes come with initial, subsequent, or sequela designation. V00-Y99 are 15 new codes that are used for neglect and maltreatment. They provide codes for the perpetrator of the abuse as the partner, husband, wife, child, grandparent, sibling, or acquaintance/friend.
The classification of Factors Influencing Health Status codes (Z00-Z99) includes social determinants of health (SDOH) codes, with one especially exciting code that covers health literacy. As more patients have access to and use their health records, it is important from a clinical standpoint to document if the patient understands their own conditions and treatment processes. We suspect the codes specifically around that subject will expand over the next few years.
Other newly added codes will help capture important information such as housing issues, abuse, and noncompliance with medication or treatment (whether due to financial hardship or other reasons).
Tracking new technologies and therapies
An interesting addition to the new codes is in the new technology section. A code has been added for the introduction of regn-cov2, a monoclonal antibody. Adding these codes allows for more efficient tracking of this therapy when used for the treatment of COVID-19.
There are three new codes that cover sabizabulin an antiviral/anti-inflammatory used to treat patients with severe COVID-19. As with regn-cov2, having a designated code will allow for more efficient therapy tracking.
Additionally, two new codes cover exagamglogene autoemcel, a cell therapy used to treat sickle cell disease and beta-thalassemia. Exa-cel (CTX001) is a new therapy under investigation and used via stem cell transplant.
Streamlining workflows for updating code sets
Several other chapters reflected significant changes, but as noted in the Tabular List addenda, only a few chapters in this edition of ICD-10-CM escaped revision to some extent. As always, October will be here in the blink of an eye, so hopefully you are ready for change, because it’s here to stay, and ready for you.
If your team needs guidance or support with these updates, please reach out to our Health Language team, terminology management is our specialty. We not only have teams of experienced coders who can help augment your team’s workload, but even better, we have the terminology software solution to ensure you don’t have to do this update (or future updates) manually. Contact us today! Happy updating!