2023 ICD-10-CM Coding Updates

Vatsala Muthukumaraswamy, COC, AAPC Fellow

 Disclaimer

This presentation is designed to offer basic information for coding and

billing. The information presented here is based on the experience,
training and interpretation of the author. Although the information has
been carefully researched and checked for accuracy and
completeness, the instructor does not accept any responsibility or
liability with regard to errors, omissions, misuse or misinterpretation.
This material is intended as an Educational guide and should not be
considered a legal/consulting opinion.
 Learning Objectives
Important Changes to be Noted
Summary of 2023 ICD-10- CM coding updates
(New, Revised & Deleted)
General Coding Guidelines Updates
Chapter wise ICD-10-CM code changes
Case Studies
 Summary: Important Changes to be noted
 1176 additions, 287 deletions, and 28 revisions
 Hemolytic-uremic syndrome
 Dementia
 Neurocognitive disorder
 Postural orthostatic tachycardia syndrome [POTS]
 Post viral fatigue syndrome Financial Year Number Additions
 Refractory angina pectoris FY2020 72,184 252
 Ventricular tachycardia
FY2021 72,621 437
FY2022 72,748 127
 Dissection and aneurysm of the aorta
FY2023 73,639 891
 Endometriosis
 Atrial septal defect
 PTEN tumor syndrome
 Poisoning by, adverse effect of and underdosing of methamphetamines
 New Z codes and External cause of morbidity and mortality codes
 Summary: Important Changes to be noted
Chapters Additions Revisions Deletions Total
1 2 0 1 3
2 0 11 0 11
3 20 0 3 23
4 11 0 2 13
5 83 3 4 90
6 14 3 1 18
7 0 0 0 0
8 0 0 0 0
9 43 0 10 53
10 1 0 0 1
11 1 2 0 3
12 0 0 0 0
13 35 9 0 44
14 139 0 7 146
15 175 0 14 189
16 10 0 2 12
17 16 0 3 19
18 0 0 0 0
19 104 0 0 104
20 477 0 237 714
21 45 0 3 48
22 0 0 0 0
Total 1176 28 287 1491
 Basics
• Each year the ICD-10 code system sees new, revised and deleted codes. How does this happen? There is a federal inter-
departmental committee that reviews proposals submitted. This ICD-10 Coordination and Maintenance Committee then
passes their recommendations along to the Department of Health and Human Services who makes final decisions. Co-
Chairs of the Committee are one representative from the National Center for Health Statistics (NCHS) and one from
Centers for Medicare and Medicaid Services (CMS). NCHS has lead responsibility for ICD-10-CM for diagnoses and CMS
for ICD-10-PCS for inpatient acute care procedures.
• 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.
 General Coding Guidelines Updates
1.A.19
Code assignment and Clinical Criteria
The assignment of a diagnosis code is based on the
provider’s diagnostic statement that the condition exists.
The provider’s statement that the patient has a particular
condition is sufficient. Code assignment is not based on
clinical criteria used by the provider to establish the
diagnosis. If there is conflicting medical record
documentation, query the provider.
1.B.14
Documentation by Clinicians Other than the Patient's
Provider
Underimmunization status joins Body Mass Index (BMI),
pressure ulcer staging, coma and stroke scales, social
determinants of health, laterality, and blood alcohol level,
as elements of documentation which can be coded from
non-provider documentation.
Underimmunization status was added to the listing of
documentation elements that can be coded from non-
provider documentation. Specifically, unvaccinated and
partially vaccinated (i.e., underimmunized) for COVID-19
can be documented by others and picked up by the coder.
 General Coding Guidelines Updates

1.B.16
Documentation of Complications of Care
This guideline is trying to unravel the mess that Coding Clinic wrought in 2021, in the second quarter , when they advised use
of a complication code of accidental puncture and laceration despite the clinician deeming it unavoidable and inherent to the
procedure.
In this section, the addition to the guideline states that the documentation must support that the condition is clinically
significant, but the provider does not have to be explicit in calling it “a complication.”
Specifically, the guideline reads, “There must be a cause-and-effect relationship between the care provided and the condition,
and the documentation must support that the condition is clinically significant. It is not necessary for the provider to
explicitly document the term “complication.”
For example, if the condition alters the course of the surgery as documented in the operative report, then it would be
appropriate to report a complication code.
It goes on to stipulate, “Query the provider for clarification if the documentation is not clear as to the relationship between
the condition and the care or procedure.”
The sole responsibility doesn’t rest on the coder; when in doubt, have a discussion with the provider.
If the documentation is not clear, a query is necessary.
 Chapter-1 :Certain Infectious and Parasitic diseases (A00 – B99)
Coding Updates
1.C.1.a.2
Selection and sequencing of HIV codes
Usually, HIV-related conditions are normally sequenced with B20, Human immunodeficiency virus [HIV] disease, followed by
additional diagnosis code(s) or all HIV-related conditions.
Hemolytic-uremic syndrome (HUS) is getting a new specific condition – D59.31, Infection-associated hemolytic-uremic
syndrome
This is a condition which is brought on by an infection, but the mechanism is thrombotic microangiopathy (TMA)
TMA is a clinical syndrome defined by hemolytic anemia, low platelets, and organ damage by tiny blood clots, specifically
renal failure in HUS.
The guideline now reads, “An exception to this guideline is if the reason for admission is hemolytic-uremic syndrome
associated with HIV disease., assign code D59.31, Infection-associated hemolytic-uremic syndrome, followed by
code B20, Human immunodeficiency virus [HIV] disease.”
This sequencing makes more sense because the patient is being admitted because they have HUS, but there is an HIV
backdrop.
 Chapter-1 :Certain Infectious and Parasitic diseases (A00 – B99)
Coding Updates
1.C.1.d.9
Hemolytic-uremic syndrome associated with sepsis:
If the reason for admission is hemolytic-uremic syndrome that is
associated with sepsis, assign code D59.31, Infection-associated
hemolytic-uremic syndrome, as the principal diagnosis
Codes for the underlying systemic infection and any other
conditions (such as severe sepsis) should be assigned as
secondary diagnoses.
 Chapter-2 :Neoplasms (C00 – D499) Coding Updates

1.C.2.a
Admission/Encounter for treatment of primary site:
The guidelines clarify that the primary malignancy is sequenced as
principal first-listed diagnosis if it is “chiefly responsible for
occasioning the patient admission/encounter and treatment is
directed at the primary site.”
The only exception to this guideline is that, if treatment for a malignancy
such as chemotherapy, immunotherapy, or radiation therapy is chiefly
responsible for occasioning the admission/encounter. In that case,
assign the appropriate Z51.- code would be principal/first-listed and the
underlying malignancy would be a secondary diagnosis.
 Chapter-2 :Neoplasms (C00 – D499) Coding Updates

1.C.2.t
Secondary malignant neoplasm of lymphoid tissue
“When a malignant neoplasm of lymphoid tissue metastasizes beyond the lymph nodes, a
code from categories C81-C85 with a final character “9” should be assigned identifying
“extranodal and solid organ sites” rather than a code for the secondary neoplasm of the
affected solid organ
For example, for metastasis of B-cell lymphoma to the lung, brain and left adrenal gland,
assign code C83.39, Diffuse large B-cell lymphoma, extranodal and solid organ sites.”
• Normally, a malignancy that spreads to a secondary site is found in C76-C80, Malignant
neoplasms of ill-defined, other secondary and unspecified sites, subcategorized by site, such as
lung or bone. If it is carcinoid, there is a separate subcategory of secondary neuroendocrine
tumors. However, if a lymphoid cancer (e.g., lymphoma) spreads to a solid organ, the proper code
to select has the final character of 9 which indicates extranodal and solid organ sites.
Chapter-4 :Endocrine, nutritional and metabolic diseases (E00 – E89)
Coding Updates

1.C.4.a
Diabetes mellitus
All the diabetes sections (general and gestational) had a
revision clarifying that Z79.84, Long term use of oral
hypoglycemic drugs is for use of oral hypoglycemic drugs, not
just oral medications as previously indicated
The guidelines are introducing the new code of Z79.85, Long
term (current) use of injectable non-insulin antidiabetic
drugs to replace the generic other long term drug therapy in
appropriate instances.
Chapter-5 :Mental, Behavioral and Neurodevelopmental Disorders(F01
– F99) Coding Updates
1.C.5.d
Dementia
Dementia is undergoing a significant expansion indicating severity. The guideline reads, “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.
 Chapter-15 :Pregnancy, Childbirth and Puerperium
(O00 – O9A) Coding Updates
1.C.15.a.7
Completed weeks of gestation
In ICD-10-CM, “completed” weeks of gestation refers to full weeks.
For example, if the provider documents gestation at 39 weeks and 6 days, the
code for 39 weeks of gestation should be assigned, as the patient has not yet
reached 40 completed weeks.

39 0/7 to 39 6/7=39 completed weeks

Chapter-15 :Pregnancy, Childbirth and Puerperium(O00 – O9A) Coding
Updates
I.C.15.q.4
Hemorrhage following elective abortion
This guideline gives us insight into how to approach complications after an elective abortion
(conditions which are not going to be legislated away – in fact, they will likely increase).
With the recent Supreme Court ruling regarding abortions, it is more than likely that hemorrhage (and
other complications) following an abortion will increase, so this could be an important instruction. It
reads,
“For hemorrhage post elective abortion, assign code O04.6, Delayed or excessive
hemorrhage following (induced) termination of pregnancy.
Do not assign code O72.1, Other immediate postpartum hemorrhage, as this code should not
be assigned for post abortion conditions.
Do not assign code Z33.2, Encounter for elective termination of pregnancy, when the patient
experiences a complication post elective abortion.”.
Chapter-19 :Injury, Poisoning, and Certain Other Consequences of
External Causes(S00 – T88) Coding Updates
1.C.19.e.5.c
Underdosing
Underdosing refers to taking less of a medication than is prescribed by a provider or
a manufacturer’s instruction. Discontinuing the use of a prescribed medication on
the patient's own initiative (not directed by the patient's provider) is also classified
as an underdosing. For underdosing, assign the code from categories T36-T50 (fifth
or sixth character “6”).
Documentation of a change in the patient’s condition is not required in order
to assign an underdosing code.
Documentation that the patient is taking less of a medication than is
prescribed or discontinued the prescribed medication is sufficient for code
assignment.
Chapter-21 :Factors Influencing Health Status and Contact With Health
Services(Z00 – Z99) Coding Updates
I.C.21.c.10
Counseling
Code Z71.87, Encounter for pediatric-to-adult transition
counseling, should be assigned when pediatric-to-adult transition
counseling is the sole reason for the encounter or when this
counseling is provided in addition to other services, such as
treatment of a chronic condition.
If both transition counseling and treatment of a medical condition
are provided during the same encounter, the code(s) for the
medical condition(s) treated and code Z71.87 should be assigned,
with sequencing depending on the circumstances of the
encounter.
Chapter-21 :Factors Influencing Health Status and Contact With Health
Services(Z00 – Z99) Coding Updates
• I.C.21.c.17
• Social Determinants of Health
• Codes describing problems or risk factors related to social determinants of
health (SDOH) should be assigned when this information is documented.
• Assign as many SDOH codes as are necessary to describe all of the
problems or risk factors.
• These codes should be assigned only when the documentation specifies
that the patient has an associated problem or risk factor.
• For example, not every individual living alone would be assigned code
Z60.2, Problems related to living alone
Chapter – Specific Coding Guidelines
 Chapter - 1 Certain Infectious and Parasitic Diseases (A00-B99)
Inclusion terms for A81 Atypical virus infections of central nervous system
Excludes1 note change for A85 Other viral encephalitis, not elsewhere classified
2 new codes under B37.3 Candidiasis of vulva and vagina

Candidiasis of vulva and vagina

A yeast infection of the vagina and tissues at the opening of the vagina (vulva)
Other terms-Vaginal yeast infection, Candidal vulvovaginitis

• B37.31-Acute Candidiasis of Vulva and Vagina

• B37.32-Chronic Candidiasis of Vulva and Vagina
 Chapter - 2 Neoplasms (C00-D49)

Descriptor revisions to codes in category C84 Mature T/NK-cell lymphomas to change “not classified” to “not elsewhere
classified.”
 Chapter - 3 Diseases of the Blood and Blood-Forming Organs and
Certain Disorders Involving the Immune Mechanism (D50-D89)
Hemolytic-uremic syndrome
Under D59.3- Hemolytic-uremic syndrome, new codes that delineate unspecified hemolytic-uremic syndrome (HUS) from atypical
hemolytic-uremic syndrome (aHUS), and a note instructing to use an additional code to identify an associated infection, if known.
Condition that can occur when the small blood vessels in kidneys become damaged and inflamed
This damage can cause clots to form in the vessels
The clots clog the filtering system in the kidneys and lead to kidney failure, which could be life-threatening

D59.30 Hemolytic-uremic syndrome, unspecified

D59.31 Infection-associated hemolytic-uremic syndrome
D59.32 Hereditary hemolytic-uremic syndrome
D59.39 Other hemolytic-uremic syndrome
 Chapter - 3 Diseases of the Blood and Blood-Forming Organs and
Certain Disorders Involving the Immune Mechanism (D50-D89)
Von Willebrand disease
Code D68.0 Von Willebrand disease (code is revised to remove the apostrophe ‘s’) is expanded to add new codes for the
various types of this disease
Von Willebrand disease (VWD) is a blood disorder in which the blood does not clot properly
Blood contains many proteins that help the blood clot when needed
One of these proteins is called von Willebrand factor (VWF)

D68.00 Von Willebrand disease, unspecified

D68.01 Von Willebrand disease, type 1
D68.020 Von Willebrand disease, type 2A
D68.021 Von Willebrand disease, type 2B
D68.022 Von Willebrand disease, type 2M
D68.023 Von Willebrand disease, type 2N
D680.29 Von Willebrand disease, type 2, unspecified
D68.03 Von Willebrand disease, type 3
D68.04 Acquired von Willebrand disease
D68.09 Other von Willebrand disease
Chapter - 3 Diseases of the Blood and Blood-Forming Organs and
Certain Disorders Involving the Immune Mechanism (D50-D89)
Non-immune heparin-induced thrombocytopenia
Under D75.82 Heparin induced thrombocytopenia (HIT), instructed to use an additional code to report an adverse effect of
heparin, if applicable
New codes for reporting non-immune HIT (D75.821-D75.822), other HIT (D75.828), and unspecified HIT (D75.829)
For disorders that do not involve exposure to heparin, use D75.84 Other platelet-activating anti-PF4 disorders
A non‐immunologic response to heparin treatment, mediated by a direct interaction between heparin and circulating platelets
causing platelet clumping or sequestration

D75.821 Non-immune heparin-induced thrombocytopenia

D75.822 Immune-mediated heparin-induced thrombocytopenia
D75.828 Other heparin-induced thrombocytopenia syndrome
D75.829 Heparin-induced thrombocytopenia, unspecified
D75.84 Other platelet-activating anti-PF4 disorders
Chapter - 3 Diseases of the Blood and Blood-Forming Organs and
Certain Disorders Involving the Immune Mechanism (D50-D89)

Activated Phosphoinositide 3-kinase Delta Syndrome [APDS]

This new code identifies a primary immune regulatory disorder (PIRD)
and includes p110k-activating mutation causing senescent T cells,
lymphadenopathy, and immunodeficiency [PASLI] disease.
Code also any associated manifestations

D81.82 Activated Phosphoinositide 3-kinase Delta Syndrome [APDS]

Chapter- 4 Endocrine, Nutritional and Metabolic Diseases (E00-E89)

Short stature due to endocrine disorder

There is a lot of expansion under categories E34 Other endocrine disorders
For example, conditions such as Laron-type short stature and constitutional short stature are no longer inclusion terms under
E34.3 Short stature due to endocrine disorder
Report constitutional short stature with new code E34.31, and Laron type short stature is an inclusion term under new code
E34.321 Primary insulin-like growth factor-1 (IGF-1) deficiency.

E34.30 Short stature due to endocrine disorder, unspecified

E34.31 Constitutional short stature
E34.321 Primary insulin-like growth factor-1 (IGF-1) deficiency
E34.322 Insulin-like growth factor-1 (IGF-1) resistance
E34.328 Other genetic causes of short stature
E34.329 Unspecified genetic causes of short stature
E34.39 Other short stature due to endocrine disorder
Chapter- 4 Endocrine, Nutritional and Metabolic Diseases (E00-E89)

Acidosis
There is a lot of expansion under categories E87 Other disorders of fluid, electrolyte and acid-base balance
A condition in which there is too much acid in the body fluids
The level of bicarbonate in the blood (HCO3−) determines the severity of acidosis. Bicarbonate measurements are part of
routine metabolic panels.
Acute metabolic acidosis-Excessive amounts of organic acids
Chronic metabolic acidosis-Impaired kidney function

E87.20 Acidosis, unspecified

E87.21 Acute metabolic acidosis
E87.22 Chronic metabolic acidosis
E87.29 Other acidosis
Chapter - 5 Mental, Behavioral and Neurodevelopmental Disorders
(F01-F99)
Dementia
With dementia becoming a growing health concern due to an aging baby boomer generation, this chapter expands
dementia families 3-fold with the addition of new codes.
Baby boomers got their name from a phenomenon known as the baby boom. This boom was a spike in birth rates after World
War II. In the United States, around 3.4 million babies were born in 1946, more than ever before in United States history. The
sudden increase in U.S. births occurring between 1946 and 1964.
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 National Minority Quality Forum requested these new codes during the Sept. 2021 ICD-10 Coordination and Maintenance
Committee Meeting.
The organization noted that the existing dementia codes “do not identify the stage of severity and also do not fully identify
behavioral and psychological symptoms of dementia (BPSD). Both of these clinical elements are major factors in patient
management strategies.”
 Chapter - 5 Mental, Behavioral and Neurodevelopmental Disorders
(F01-F99)
83 new codes were added to Chapter 5 (Mental, Behavioral and Neurodevelopmental disorders [F01-F99]) of ICD-10-CM,
including 69 new codes for dementia with and without psychological symptoms.
“The ICD-10-CM classifies dementia (categories F01, F02, and F03) on the basis of the etiology and severity (unspecified,
mild, moderate or severe)
Updates to category F01 Vascular dementia include a few code revisions and 29 new codes
Code F01.5- Vascular dementia, unspecified severity and the codes that fall under it are all revised to include the verbiage
“unspecified severity.”
Revised code F01.51- Vascular dementia, unspecified severity, with behavioral disturbance is converted to a parent code to
two new codes that specify with “agitation” or “other behavioral disturbance.”
Also added are codes to identify the presence of psychotic disturbance, mood disturbance, or anxiety
Other expansions allow clinicians to identify the stage of severity for vascular dementia: mild (F01.A-), moderate (F01.B-), and
severe (F01.C-).

Codes F02.- Dementia in other diseases classified elsewhere and F03.- Unspecified dementia are also revised to include
severity and type of disturbance.
Chapter - 5 Mental, Behavioral and Neurodevelopmental Disorders
(F01-F99)
Stages of Dementia
• Mild dementia: “Clearly evident functional impact on daily life, affecting mainly instrumental activities. No longer fully
independent/requires occasional assistance with daily life activities.”
• Moderate dementia: “Extensive functional impact on daily life with impairment in basic activities. No longer independent
and requires frequent assistance with daily life activities.”
• Severe dementia: “Clinical interview may not be possible. Complete dependency due to severe functional impact on daily
life with impairment in basic activities, including basic self-care.”
• Knowing these stages will be imperative to choosing the right code and collecting accurate reimbursement, because each
new dementia code is reported based on the stage
• For instance, mild unspecified dementia will be coded to F03.A, whereas severe unspecified dementia should be reported
with F03.C.
• New guidelines for reporting dementia emphasize that providers must clearly document the severity of the patient’s
condition. If the documentation is incomplete, the coder should default to the appropriate unspecified code
• In addition, the updated guidelines stipulate that if a patient with dementia is admitted to an inpatient facility and gets worse
during their stay, the coder should assign the highest severity level reported during the stay.
Chapter - 5 Mental, Behavioral and Neurodevelopmental Disorders
(F01-F99)
New codes describing use of alcohol, opioids, cannabis, cocaine, and other substances

F10.90 Alcohol use, unspecified, uncomplicated

F10.91 Alcohol use, unspecified, in remission
F11.91 Opioid use, unspecified, in remission
F12.91 Cannabis use, unspecified, in remission
Sedative, hypnotic or anxiolytic use, unspecified, in
F13.91 remission
F14.91 Cocaine use, unspecified, in remission
F15.91 Other stimulant use, unspecified, in remission
F16.91 Hallucinogen use, unspecified, in remission
F18.91 Inhalant use, unspecified, in remission
Other psychoactive substance use, unspecified, in
F19.91 remission

A multitude of convention changes, code descriptor revisions, and new codes that allow for more coding specificity if that
specificity is given in the provider’s note.
 Chapter 6: Diseases of the nervous system (G00-G99)
There are many inclusion changes in this chapter to account for expansion of dementia codes in the preceding chapter. For
example, under categories G10 Huntington’s disease, G20 Parkinson’s disease, and G30 Alzheimer’s disease, use an additional
code to report the specific type of dementia, rather than just with or without behavioral disturbance.
Limb girdle muscular dystrophies
A group of diseases that cause weakness and wasting of the muscles in the arms and legs
The muscles most affected are those closest to the body (proximal muscles), specifically the muscles of the shoulders, upper
arms, pelvic area, and thighs.
There is also a lot of activity under category G71 Primary disorders of muscles. Code G71.03 Limb girdle muscular dystrophies
is added, along with several six- and seven-character codes that more clearly identify the type of dystrophy and associated
disfunction.
G71.031 Autosomal dominant limb girdle muscular dystrophy
G71.032 Autosomal recessive limb girdle muscular dystrophy due to calpain-3 dysfunction
G71.033 Limb girdle muscular dystrophy due to dysferlin dysfunction
G71.0340 Limb girdle muscular dystrophy due to sarcoglycan dysfunction, unspecified
G71.0341 Limb girdle muscular dystrophy due to alpha sarcoglycan dysfunction
G71.0342 Limb girdle muscular dystrophy due to beta sarcoglycan dysfunction
G71.0349 Limb girdle muscular dystrophy due to other sarcoglycan dysfunction
G71.035 Limb girdle muscular dystrophy due to anoctamin-5 dysfunction
G71.038 Other limb girdle muscular dystrophy
G71.039 Limb girdle muscular dystrophy, unspecified
 Chapter 6: Diseases of the nervous system (G00-G99)

Postural orthostatic tachycardia syndrome [POTS]

An abnormal increase in heart rate that occurs after sitting up or standing. Some typical symptoms include dizziness and
fainting.

• Categories G90 Disorders of the nervous system, G93 Other disorders of brain, and G96 Other disorders of central
nervous system

G90.A Postural orthostatic tachycardia syndrome [POTS]

G93.31 Postviral fatigue syndrome
G93.32 Myalgic encephalomyelitis/chronic fatigue syndrome
G93.39 Other post infection and related fatigue syndromes
 Chapter - 9 Diseases of the Circulatory System (I00-I99)
A plenty of new codes added in this chapter for improved specificity
Refractory angina pectoris(RAP)
Occurrence of frequent angina attacks uncontrolled by optimal drug therapy, significantly limiting the patients' daily activities, and
with the presence of coronary artery disease rendering percutaneous coronary intervention or bypass surgery unsuitable (CABG)

I20.2 Refractory angina pectoris

I25.112 Atherosclerosis heart disease of native coronary artery with refractory angina pectoris
I25.702 Atherosclerosis of coronary artery bypass graft(s), unspecified, with refractory angina pectoris
I25.712 Atherosclerosis of autologous vein coronary artery bypass graft(s) with refractory angina pectoris
I25.722 Atherosclerosis of autologous artery coronary artery bypass graft(s) with refractory angina pectoris
I25.732 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with refractory angina pectoris
I25.752 Atherosclerosis of native coronary artery of transplanted heart with refractory angina pectoris
I25.762 Atherosclerosis of bypass graft of coronary artery of transplanted heart with refractory angina pectoris
I25.792 Atherosclerosis of other coronary artery bypass graft(s) with refractory angina pectoris
 Chapter - 9 Diseases of the Circulatory System (I00-I99)
Malignant pericardial effusion in diseases classified elsewhere
A condition in which cancer causes extra fluid to collect inside the sac around the heart.
The extra fluid causes pressure on the heart, which keeps it from pumping blood normally
Lymph vessels may be blocked, which can cause infection.
I31.31 Malignant pericardial effusion in diseases classified elsewhere

Nonrheumatic mitral (valve) annulus calcification

Degenerative calcific process of mitral valve (MV) support ring
I34.81 Nonrheumatic mitral (valve) annulus calcification

There are new codes for reporting chronic ischemic heart disease, pulmonary heart disease, and other types of heart disease
Expansion of existing codes enables us to specify the effected anatomical area more brief if provider documentation allows. For
example, I71.1 Thoracic aortic aneurysm, ruptured, is expanded to include I71.10-I71.13 to report which part of the thoracic aorta
ruptured (unspecified, ascending, arch, or descending).
Dissection of thoracic aorta
Thoracic aortic aneurysm
 Chapter 10: Diseases of the respiratory system (J00 - J99)

There’s only one new code in this chapter, and some added instructional notes for a few other categories.
Transfusion-associated dyspnea (TAD)
Acute respiratory distress occurring within 24 hours of blood transfusion
J95.87 Transfusion-associated dyspnea (TAD)
 Chapter 11: Diseases of the digestive system (K00-K95)

Report diseases of the liver with more specificity with the addition of K76.82 Hepatic encephalopathy (HE), which includes
HE not otherwise specified, HE without coma, hepatocerebral intoxication, and portal-system encephalopathy
An instructional note lets us know to code also the underlying liver disease, but pay attention to the new Excludes1 note.
Chapter 13: Diseases of the musculoskeletal system and connective
tissue (M00-M99)
For pain management services, several new codes are added for reporting intervertebral annulus fibrosus defects
(M51.A0-M51.A5) and other muscle disorders (M62.5A-).
There are also some code revisions under category M93 Other osteocondropathies to indicate stability
several new codes for issues pertaining to hip epiphyses (bone endings), and
new codes for reporting rib, sternum, and thorax fractures associated with compression of the chest and cardiopulmonary
resuscitation.

Lumbar and lumbosacral annulus fibrosis disc defects

Chapter 13: Diseases of the musculoskeletal system and connective
tissue (M00-M99)
Muscle wasting and atrophy
Decrease in size and wasting of muscle tissue. Muscles that lose their nerve supply can atrophy and simply waste away. People
may lose 20 to 40 percent of their muscle and, along with it, their strength as they age.

Slipped upper femoral epiphysis (nontraumatic)

When the head (“ball” part) of the top of the thigh bone (femur) slips backward and downward at the point of growth plate.
Normal hip with femur head and neck fully intact.
Chapter 13: Diseases of the musculoskeletal system and connective
tissue (M00-M99)

Fracture of ribs, sternum associated with chest compression and cardiopulmonary resuscitation
According to the statistics, about 30% of those who survive CPR for cardiac arrest, wake up with a cracked sternum and/or
broken rib.
60% of cases with rib fractures are found a fracture of the 2nd rib.
 Chapter 14: Diseases of the genitourinary system (N00-N99)
Contrast-induced nephropathy

On an entirely different topic, new codes N14.11 Contrast induced nephropathy and N14.19 Nephropathy induced
by other drugs, medicaments and biological substances identify disorders associated with contrast dyes and the
kidneys.

A serious complication of angiographic procedures resulting from the administration of contrast media (CM). It is
the third most common cause of hospital acquired acute renal injury and represents about 12% of the cases.

N14.11 Contrast-induced nephropathy

Nephropathy induced by other drugs, medicaments and biological
N14.19 substances
 Chapter 14: Diseases of the genitourinary system (N00-N99)
Fournier disease of vagina and vulva
An acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or
perianal regions
N76.82 Fournier disease of vagina and vulva

Expansion of Endometriosis codes

A disease in which the endometrium (the tissue that lines the inside of the uterus or womb) is present outside of the uterus.
Added 135 new codes related to endometriosis which further provides details in terms of laterality, anatomical location, depth of
invasion, volume of disease, and specific organs involved
The American College of Obstetricians and Gynecologists (ACOG) has been proposing expansion to the endometriosis section
of the ICD-10-CM code set since 2020, and those requests finally appear to be taking effect.
Essentially, many of the new endometriosis codes provide further specificity to specify whether the condition is superficial or
deep.
• Superficial endometriosis:
• Ectopic growth of endometrial-like tissue that extends 5mm or less below the peritoneal surface
• Lesions can vary in number (singular or in multiple locations)
 Chapter 14: Diseases of the genitourinary system (N00-N99)
• Deeply infiltrating endometriosis:
• Ectopic growth of endometrial-like tissue that extends greater than 5mm below the peritoneal surface
• Lesions can vary in number (singular or in multiple locations)
• These lesions are commonly associated with deep fibrosis and adhesions.
• If either “deep” or “superficial” is not documented, then look for any indication of how far below the peritoneal surface the tissue
extended. This will be essential in selecting the right code under the new 2023 ICD-10-CM codes.

Uterus
Ovary
Fallopian tubes
Pelvic Peritoneum
Uterosacral ligament
Rectovaginal Septum
Rectum
Sigmoid Colon
Cecum
Appendix
Bladder
Ureter
Pleura
Lung
Diaphragm
Pelvic Nerves
 Chapter 15: Pregnancy, childbirth and the puerperium (O00-O9A)

The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine requested new
codes for fetal anomalies
These physicians currently document these conditions during patient assessments but have no method of capturing the data with
any reasonable specificity using the current code set
Added 88 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.
Under category O35 Maternal care for known or suspected fetal abnormality and damage several new codes are added for
various types of abnormalities and damage in the fetus.
There are also several new codes to report chromosomal abnormality in the fetus beyond O35.1- Maternal care for (suspected)
chromosomal abnormality in fetus
New codes that will help practices gain specificity in this area when the provider sees a pregnant woman whose baby is
suspected of having conditions like Trisomy 21 (O35.13), facial anomalies (O35.A), Turner Syndrome (O35.14), and many other
conditions.
Chapter 15: Pregnancy, childbirth and the puerperium (O00-O9A)
Unspecified
agenesis of the corpus callosum
anencephaly
central nervous choroid plexus cysts
system
encephalocele
malformation not applicable or unspecified
or damage in holoprosencephaly
fetus hydrocephaly fetus 1
microcephaly fetus 2
spina bifida fetus 3
Other specified fetus 4
Unspecified fetus 5
Trisomy 13 Other fetus
chromosomal Trisomy 18
abnormality in Trisomy 21
fetus
Turner Syndrome
sex chromosome abnormality
other chromosomal abnormality
fetal facial anomalies
fetal cardiac anomalies
fetal pulmonary anomalies
fetal
fetal gastrointestinal anomalies
abnormality
and damage fetal genitourinary anomalies
fetal musculoskeletal anomalies of trunk
fetal upper extremities anomalies
fetal lower extremities anomalies
 Chapter 16: Certain conditions originating in the perinatal period
(P00-P96)
Primary sleep apnea of newborn
A state of lack of breathing suffered by infants most common in pre-term babies.
When reporting respiratory and cardiovascular disorders specific to the perinatal period (P19-P29), there are several more
options for reporting sleep apnea in newborns.
Inclusion terms under existing codes in this category are deleted and assigned to codes such as P28.31 Primary central sleep
apnea of newborn and P28.42, Obstructive apnea of newborn
The American Academy of Pediatrics requested these additions to the ICD-10-CM code set to identify the specific types of sleep
apnea and non-sleep apnea of prematurity.

P28.30 Primary sleep apnea of newborn, unspecified

P28.31 Primary central sleep apnea of newborn
P28.32 Primary obstructive sleep apnea of newborn
P28.33 Primary mixed sleep apnea of newborn
P28.39 Other primary sleep apnea of newborn
P28.40 Unspecified apnea of newborn
P28.41 Central neonatal apnea of newborn
P28.42 Obstructive apnea of newborn
P28.43 Mixed neonatal apnea of newborn
P28.49 Other apnea of newborn
 Chapter 17: Congenital malformations, deformations and
chromosomal abnormalities (Q00-Q99)
Atrial and atrioventricular septal defect
Inclusion terms are deleted and assigned to new codes with their own inclusion terms, particularly under category Q21
Congenital malformations of cardiac septa. For example, instead of reporting Q21.1 Atrial septal defect for coronary sinus
defect, we have to report Q21.13 Coronary sinus atrial septal defect, which includes coronary sinus defect and unroofed
coronary sinus.
According to requestor Cheryl Bullock, Currently, Q21.1 is being used to report both the presence of a secundum atrial
septal defect and a patent foramen ovale, as well as acting as a rule-out code for congenital heart disease. “Adding
granularity to Q21.1 will drastically improve the data quality and accuracy of the component defects, allowing researchers
and surveillance staff to analyze and understand the defects more efficiently,” Bullock attested at the ICD-10 Coordination
and Maintenance Committee Meeting, Sept. 21, 2021.
Q21.10 Atrial septal defect, unspecified
Q21.11 Secundum atrial septal defect
Q21.12 Patent foramen ovale
Q21.13 Coronary sinus atrial septal defect
Q21.14 Superior sinus venosus atrial septal defect
Q21.15 Inferior sinus venosus atrial septal defect
Q21.16 Sinus venosus atrial septal defect, unspecified
Q21.19 Other specified atrial septal defect
Q21.20 Atrioventricular septal defect, unspecified as to partial or complete
Q21.21 Partial atrioventricular septal defect
Q21.22 Transitional atrioventricular septal defect
Q21.23 Complete atrioventricular septal defect
 Chapter 17: Congenital malformations, deformations and
chromosomal abnormalities (Q00-Q99)
Phakomatoses

Also known as neurocutaneous syndromes

Broad group of congenital disorders that are characterized by hamartomatous lesions of the skin and the central and
peripheral nervous systems.

Also new codes are added under category Q85 Phakomatoses, not elsewhere classified. Phakomatoses identifies a broad
group of congenital disorders that affect the integumentary and nervous systems.

Q85.81 PTEN tumor syndrome

Q85.82 Other Cowden syndrome
Q85.83 Von Hippel-Lindau syndrome
Q85.89 Other phakomatoses, not elsewhere classified
Chapter 18: Symptoms, signs and abnormal
clinical and laboratory findings, not elsewhere
classified (R00-R99)
• There are minimal changes in this chapter that are a result of the
code expansions seen in other chapters.
 Chapter 19: Injury, Poisoning, and Certain other Consequences of
External Causes (S00-T88)
New Concussion, Brain Injury Codes
 There are 35 new 2023 ICD-10-CM codes in the S06 (Intracranial injury) range, describing such conditions as concussions,
contusions, traumatic brain injuries, blast injuries, cerebral edema, and hemorrhages when it is not known (status unknown)
whether the patient lost consciousness
 Several of the new head injury codes were requested by the American Academy of Pediatrics in September 2021 to reflect
whether or not patients experienced a loss of consciousness during their injuries. Therefore, it will be imperative to know
whether a patient lost consciousness
 For instance, if a patient had a loss of consciousness with a concussion, we have to report a code from the S06.0XA series,
whereas a primary blast injury of the brain with loss of consciousness of 30 minutes or less will code out to the S06.8A1 range
of codes
 The blast injury codes were requested by the Department of Defense and the Department of Veterans Affairs in March 2021,
and these injuries often affect service members.
Chapter 19: Injury, Poisoning, and Certain other Consequences of
External Causes (S00-T88)
Poisoning by methamphetamines
Emergency department coders will find a whole new code category describing poisoning by methamphetamines, as well as
codes for adverse effects relating to meth use.
In the past, coders reporting meth overdoses had to report these services from the general “amphetamines” category, but use
of that code made it challenging for public health authorities to track meth overdoses.
Under category T43 Poisoning by, adverse effect of and underdosing of psychostimulants, 18 new codes are added that
specify whether a patient’s poisoning by methamphetamines was unintentional, an act of self-harm, an assault, or
undetermined.
New codes are added in this category under the new T43.65 (Poisoning by, adverse effect of and underdosing of
methamphetamines performed due to self-harm or assault) range.
To report them accurately, we should find in the record whether the overdose was accidental, was, or if the status is
undetermined. These factors will be essential in allowing us to select the correct code

Initial encounter

Subsequent encounter

Sequela
 Chapter 20: External Causes of Morbidity

Electric (assisted) bicycle injury codes in categories V20-V29

474 codes are added
Beginning Oct. 1, we can go one step beyond the term “motorcycle” and choose from new V codes that specify whether the
patient was hurt in a collision while riding an “electric (assisted) bicycle” or “other motorcycle.”
If we see a patient injured in an electric bicycle accident, we currently need to report the “external cause of injury” with a
motorcycle code
Several organizations, including the American College of Surgeons, requested new ICD-10-CM codes to describe injuries
sustained on e-bicycles, and they are very detailed in allowing us to show more detail about what happened.
For instance, if a patient presents following an accident when their e-bike collided with a pedal cycle in a park, we have to
report a code from the V21.21 category (Unspecified electric [assisted] bicycle rider injured in collision with pedal cycle in
nontraffic accident)

Initial encounter

Subsequent encounter

Sequela
 Chapter 21: Factors Influencing Health Status and Contact With
Health Services (Z00-Z99)

Various Z codes, including additional long-term use of drug codes, personal

history of corrected conditions, and additional noncompliance codes
Lastly, we have the Z codes, and there are even more of them for 2023 to report
various social determinants of health such as transportation insecurity (Z59.82),
financial insecurity (Z59.86), and material hardship (Z59.87), which includes the
inability to obtain adequate clothing and other basic needs.
There are many new codes and inclusion revisions to existing codes in categories
Z71, Z72, Z79, Z87, and Z91 to provide added granularity for factors preventing
quality care such as a patient’s noncompliance with dietary regimen due to
financial hardship (Z91.110).
 Crack the codes
1. The nurse documented that the patient
underwent 1st dose of COVID-19 vaccination.
What is the code assignment?
• U07.1, COVID-19
• Z28.311, Partially vaccinated for COVID-19
• Z28.310, Unvaccinated for COVID-19
• U09.9, Post COVID-19 condition
 Crack the codes
2. The patient had a coronary artery disease and
underwent Coronary artery bypass graft(CABG).
Postoperatively, he had bradycardia and was given
medications for that. What is the responsibility of the
coder?
• Query the provider
• Code as complication of care
• No code
• None of the above
 Crack the codes
3. The patient had prostate cancer and presented
to the hospital for chemotherapy. What is the
principal diagnosis for this case?
• Prostate cancer
• Encounter for chemotherapy
• Bone cancer
• Anemia
 Crack the codes
4. A patient with 11-completed weeks of gestation was admitted for elective
abortion on 9/1/2022 based on her provider’s advice that her severe heart disease
indicated that an abortion might be advisable to prevent cardiac complications. On
9/2/2022 the patient presented to the hospital again due to hemorrhage post
elective abortion. What is the code assignment for 9/2/2022?
• O72.1, Other immediate postpartum hemorrhage
• Z33.2, Encounter for elective termination of pregnancy
• O04.6, Delayed or excessive hemorrhage following (induced) termination of
pregnancy
• O03.5 -Genital tract and pelvic infection following complete or unspecified
spontaneous abortion
 Crack the codes
5. The patient discontinued the medication because of
headache. What is the code assignment for this case?
• Poisoning
• Adverse effect
• Underdosing
• Overdose
 Summary
New codes for candidiasis of the vulva and vagina (B37.- series)
Revisions to over a dozen T-cell lymphoma codes (C84.4 series)
More specificity to new codes for hemolytic-uremic syndrome (D59.3 series)
Expansion of the codes for Von Willebrand disease (D68.0 series)
Several new codes describing short stature (E34.3 series)
Expansion of the acidosis codes (E87.2 series)
New codes describing use of alcohol, opioids, cannabis, cocaine, and other
substances (F10.9 series)
Expansion to Dementia coding options
Codes added that describe limb girdle muscular dystrophy (G71.03 series)
An expansion of the atherosclerosis category (I25.- series)
 Summary
New codes describing muscle wasting of the back (M62.5A series)
More than 20 additional codes describing slipped upper femoral epiphysis (M93.0 series)
O35.0- Expansion of O35. Maternal Care
New codes for newborn sleep disorders (P28.- series)
New codes for Intracranial Injury with Unknown Loss of Consciousness to all applicable codes in
category S06, add new codes in subcategory S06.8A Primary blast injury of brain, not elsewhere
classified
Poisoning by methamphetamines
Electric (assisted) bicycle injury codes in categories V20-V29
Various Z codes, including additional long-term use of drug codes, personal history of corrected
conditions, and additional noncompliance codes with provider’s orders(Z91.1 series)
 Reference
https://www.cms.gov/medicare/icd-10/2023-icd-10-cm

https://www.medicaleconomics.com/view/new-icd-10-codes-to-know-before-
october

https://icd10monitor.com/updates-to-the-icd-10-cm-official-guidelines-for-coding-
and-reporting-fy-2023/

https://yes-himconsulting.com/review-summary-fy-2023-icd-10-cm-codes-
guidelines-updates/
THANK YOU