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’.
Wolters Kluwer, 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.”