2022 ICD-10-CM Coding Updates

Vatsala Muthukumaraswamy, COC

 DISCLAIMER

This presentation is intended for Educational

purpose only.
The information shared here has been reviewed
completely for accuracy, the instructor does not
accept any responsibility or liability with regards to
errors or misinterpretation and it should not be
considered as legal advice.

2
Agenda of the Presentation

Summary of 2022 ICD-10- CM coding updates

(New, Revised & Deleted)
 General Coding Guidelines Updates
 Chapter wise ICD-10-CM code changes
 Case Studies
 Important Changes to be Noted

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Summary of 2022 ICD-10- CM coding updates -
Additions

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Summary of 2022 ICD-10- CM coding updates - Deletions
S# ICD-10-CM Description
1 D55.2 Anemia due to disorders of glycolytic enzymes
2 F78 Other intellectual disabilities
3 G92 Toxic encephalopathy
4 K22.8 Other specified diseases of esophagus
5 M31.1 Thrombotic microangiopathy
6 M54.5 Low back pain
7 P09 Abnormal findings on neonatal screening
8 R05 Cough
9 R35.8 Other polyuria
10 R63.3 Feeding difficulties
11 T40.7X1A Poisoning by cannabis (derivatives), accidental (unintentional), initial encounter
12 T40.7X1D Poisoning by cannabis (derivatives), accidental (unintentional), subsequent encounter
13 T40.7X1S Poisoning by cannabis (derivatives), accidental (unintentional), sequela
14 T40.7X2A Poisoning by cannabis (derivatives), intentional self-harm, initial encounter
15 T40.7X2D Poisoning by cannabis (derivatives), intentional self-harm, subsequent encounter
16 T40.7X2S Poisoning by cannabis (derivatives), intentional self-harm, sequela

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Summary of 2022 ICD-10- CM coding updates - Deletions
S# ICD-10-CM Description
17 T40.7X3A Poisoning by cannabis (derivatives), assault, initial encounter
18 T40.7X3D Poisoning by cannabis (derivatives), assault, subsequent encounter
19 T40.7X3S Poisoning by cannabis (derivatives), assault, sequela
20 T40.7X4A Poisoning by cannabis (derivatives), undetermined, initial encounter
21 T40.7X4D Poisoning by cannabis (derivatives), undetermined, subsequent encounter
22 T40.7X4S Poisoning by cannabis (derivatives), undetermined, sequela
23 T40.7X5A Adverse effect of cannabis (derivatives), initial encounter
24 T40.7X5D Adverse effect of cannabis (derivatives), subsequent encounter
25 T40.7X5S Adverse effect of cannabis (derivatives), sequela
26 T40.7X6A Underdosing of cannabis (derivatives), initial encounter
27 T40.7X6D Underdosing of cannabis (derivatives), subsequent encounter
28 T40.7X6S Under dosing of cannabis (derivatives), sequela
29 Z59.0 Homelessness
30 Z59.4 Lack of adequate food and safe drinking water
31 Z59.8 Other problems related to housing and economic circumstances
32 Z91.5 Personal history of self-harm

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Summary of 2022 ICD-10- CM coding updates - Revisions
S# ICD-10-CM Revise From Revise to
1 G71.20 Congenital myopathy, unspecifed Congenital myopathy, unspecified
2 M35.00 Sicca syndrome, unspecified Sjogren syndrome, unspecified

3 M35.01 Sicca syndrome with keratoconjunctivitis Sjogren syndrome with keratoconjunctivitis

4 M35.02 Sicca syndrome with lung involvement Sjogren syndrome with lung involvement
5 M35.03 Sicca syndrome with myopathy Sjogren syndrome with myopathy
Sicca syndrome with tubulo-interstitial
6 M35.04 nephropathy Sjogren syndrome with tubulo-interstitial nephropathy
Sicca syndrome with other organ
7 M35.09 involvement Sjogren syndrome with other organ involvement
Toxic effect of contact with Portugese Man-o-
war, accidental (unintentional), initial Toxic effect of contact with Portuguese Man-o-war, accidental
8 T63.611A encounter (unintentional), initial encounter
Toxic effect of contact with Portugese Man-o-
war, accidental (unintentional), subsequent Toxic effect of contact with Portuguese Man-o-war, accidental
9 T63.611D encounter (unintentional), subsequent encounter
Toxic effect of contact with Portugese Man-o- Toxic effect of contact with Portuguese Man-o-war, accidental
10 T63.611S war, accidental (unintentional), sequela (unintentional), sequela

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Summary of 2022 ICD-10- CM coding updates - Revisions
S# ICD-10-CM Revise From Revise to
Toxic effect of contact with Portugese Man-o-war, Toxic effect of contact with Portuguese Man-o-war, intentional self-harm,
11 T63.612A intentional self-harm, initial encounter initial encounter
Toxic effect of contact with Portugese Man-o-war, Toxic effect of contact with Portuguese Man-o-war, intentional self-harm,
12 T63.612D intentional self-harm, subsequent encounter subsequent encounter
Toxic effect of contact with Portugese Man-o-war, Toxic effect of contact with Portuguese Man-o-war, intentional self-harm,
13 T63.612S intentional self-harm, sequela sequela
Toxic effect of contact with Portugese Man-o-war, Toxic effect of contact with Portuguese Man-o-war, assault, initial
14 T63.613A assault, initial encounter encounter
Toxic effect of contact with Portugese Man-o-war, Toxic effect of contact with Portuguese Man-o-war, assault, subsequent
15 T63.613D assault, subsequent encounter encounter
Toxic effect of contact with Portugese Man-o-war,
16 T63.613S assault, sequela Toxic effect of contact with Portuguese Man-o-war, assault, sequela
Toxic effect of contact with Portugese Man-o-war, Toxic effect of contact with Portuguese Man-o-war, undetermined, initial
17 T63.614A undetermined, initial encounter encounter
Toxic effect of contact with Portugese Man-o-war, Toxic effect of contact with Portuguese Man-o-war, undetermined,
18 T63.614D undetermined, subsequent encounter subsequent encounter
Toxic effect of contact with Portugese Man-o-war,
19 T63.614S undetermined, sequela Toxic effect of contact with Portuguese Man-o-war, undetermined, sequela
20 Z92.25 Personal history of immunosupression therapy Personal history of immunosupression therapy

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General Coding Guidelines Updates

Diagnosis codes are to be used

and reported at their highest
number of characters available
1.B.2 Level of detail in coding
and to the highest level of
specificity documented in the
medical record

The appropriate code or codes

from A00.0 through T88.9, Z00-
Code or codes from A00.0 Z99.8, and U00-U85 must be
through T88.9, Z00-Z99.8, used to identify diagnoses,
1.B.3
symptoms, conditions,
U00-U85 problems, complaints or other
reason(s) for the
encounter/visit

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General Coding Guidelines Updates

1.B.13 Laterality

When laterality is not documented by the patient’s provider, code

assignment for the affected side may be based on medical record
documentation from other clinicians. If there is conflicting medical
record documentation regarding the affected side, the patient’s
attending provider should be queried for clarification. Codes for
“unspecified” side should rarely be used, such as when the
documentation in the record is insufficient to determine the affected
side and it is not possible to obtain clarification

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 General Coding Guidelines Updates
1.B.14
Documentation by Clinicians Other than the Patient's Provider
 In this context, “clinicians” other than the patient’s provider refer to healthcare professionals permitted, based on regulatory or
accreditation requirements or internal hospital policies, to document in a patient’s official medical record.
 These exceptions include codes for:
o Body Mass Index (BMI)
o Depth of non-pressure chronic ulcers
o Pressure ulcer stage
o Coma scale
o NIH stroke scale (NIHSS)
o Social determinants of health (SDOH)
o Laterality
o Blood alcohol level
• This information is typically, or may be, documented by other clinicians involved in the care of the patient (e.g., a dietitian often documents
the BMI, a nurse often documents the pressure ulcer stages, and an emergency medical technician often documents the coma scale).
However, the associated diagnosis (such as overweight, obesity, acute stroke, pressure ulcer, or a condition classifiable to category F10,
Alcohol related disorders) must be documented by the patient’s provider. If there is conflicting medical record documentation, either from
the same clinician or different clinicians, the patient’s attending provider should be queried for clarification. The BMI, coma scale, NIHSS,
blood alcohol level codes and codes for social determinants of health should only be reported as secondary diagnoses.

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General Coding Guidelines Updates

As stated in the introductory section of these official

coding guidelines, a joint effort between the healthcare
provider and the coder is essential to achieve complete
Use of and accurate documentation, code assignment, and
Sign/Symptom/ reporting of diagnoses and procedures. The importance of
1.B.18 consistent, complete documentation in the medical record
Unspecified Codes cannot be overemphasized. Without such documentation
accurate coding cannot be achieved. The entire record
should be reviewed to determine the specific reason for
the encounter and the conditions treated

Z codes (other reasons for healthcare encounters)

may be assigned as appropriate to further explain the
Use of Z reasons for presenting for healthcare services,
1.B.19.d including transfers between healthcare facilities, or
codes
provide additional information relevant to a
patient encounter

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 Chapter-1 :Certain Infectious and Parasitic diseases
(A00 – B99) Coding Updates
1.C.1.a.2 d
Encounters for testing for HIV
If a patient is being seen to determine his/her HIV
status, use code Z11.4, Encounter for screening for
human immunodeficiency virus [HIV]. Use
additional codes for any associated high-risk
behavior, if applicable.
Asymptomatic human immunodeficiency virus
Z21, Asymptomatic human immunodeficiency virus
[HIV] infection status, is to be applied when the
patient without any documentation of symptoms is
listed as being “HIV positive, ”known HIV,” “HIV test
positive,” or similar terminology. Do not use this 1.C.1.a.2.h
code if the term “AIDS” or “HIV disease” is used or
if the patient is treated for any HIV-related illness or
is described as having any condition(s) resulting
from his/her HIV positive status; use B20 in these
cases.
History of HIV managed by medication
If a patient with documented history of HIV
disease is currently managed on antiretroviral
medications, assign code B20, Human
1.C.1.a. 2.i immunodeficiency virus [HIV] disease. Code
Z79.899, Other long term (current) drug therapy,
may be assigned as an additional code to
identify the long-term (current) use of
antiretroviral medications.
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Chapter-1 :Certain Infectious and Parasitic diseases
(A00 – B99) Coding Updates
Signs and symptoms without
1.C.1.g.1.g definitive diagnosis of
COVID-19
Follow-up visits after COVID-19
1.C.1.g.1.j
infection has resolved
For patients presenting with any
signs/symptoms associated with
COVID-19 (such as fever, etc.) but a
definitive diagnosis has not been
established, assign the appropriate
code(s) for each of the presenting
signs and symptoms such as:
• R05.1, Acute cough, or R05.9,
Cough, unspecified
• R06.02 Shortness of breath
• R50.9 Fever, unspecified
For individuals who previously had
COVID-19, without residual symptom(s)
or condition(s), and are being seen for
follow-up evaluation, and COVID-19 test
results are negative, assign codes Z09,
Encounter for follow-up examination
after completed treatment for conditions
other than malignant neoplasm, and
Z86.16, Personal history of COVID-19.
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Chapter-1 :Certain Infectious and Parasitic diseases
(A00 – B99) Coding Updates
1.C.1.g.1. l
Multisystem Inflammatory
Syndrome
If an individual with a history of
COVID-19 develops MIS, assign
codes M35.81, Multisystem
inflammatory syndrome, and
U09.9, Post COVID-19
condition, unspecified
1..C.1.g.1.m
Post COVID-19 Condition
For follow-up visits for individuals with symptom(s) or
condition(s) related to a previous COVID-19 infection
For sequela of COVID-19, or associated symptoms or
conditions that develop following a previous COVID-19
infection, assign a code(s) for the specific symptom(s) or
condition(s) related to the previous COVID-19 infection, if
known, and code U09.9, Post COVID-19 condition, unspecified
Code U09.9 should not be assigned for manifestations of an
active (current) COVID-19 infection
If a patient has a condition(s) associated with a previous
COVID-19 infection and develops a new active (current) COVID-
19 infection, code U09.9 may be assigned in conjunction with
code U07.1, COVID-19, to identify that the patient also has a
condition(s) associated with a previous COVID-19 infection.
Code(s) for the specific condition(s) associated with the
previous COVID-19 infection and code(s) for manifestation(s)
of the new active (current) COVID-19 infection should also be
assigned.
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Chapter- 2 Neoplasms (C00 – D49)

1.C.2.s

Breast Implant Associated Anaplastic Large Cell Lymphoma

Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is a type of lymphoma that can develop
around breast implants. Assign code C84.7A, Anaplastic large cell lymphoma, ALK-negative, breast, for
BIAALCL

Do not assign a complication code from chapter 19

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 Chapter-4 Endocrine, nutritional and metabolic diseases
(E00 –E90)
1.C.4.a.3

Diabetes mellitus and the use of insulin, oral hypoglycemics, and injectable non-insulin drugs

If the documentation in a medical record does not indicate the type of diabetes but does indicate that the patient uses insulin, code E11-, Type 2 diabetes mellitus,
should be assigned. Additional code(s) should be assigned from category Z79 to identify the long-term (current) use of insulin, oral hypoglycemic drugs, or injectable
non-insulin antidiabetic, as follows: If the patient is treated with both oral medications and insulin, both code Z79.4, Long term (current) use of insulin, and code
Z79.84, Long term (current) use of oral hypoglycemic drugs, should be assigned.

1.C.4.a.6.a

Secondary diabetes mellitus and the use of insulin, oral hypoglycemic drugs, or injectable non-insulin drugs

For patients with secondary diabetes mellitus who routinely use insulin, oral hypoglycemic drugs, or injectable non-insulin drugs, additional code(s) from category Z79
should be assigned to identify the long-term (current) use of insulin, oral hypoglycemic drugs, or non-injectable non-insulin drugs as follows: If the patient is treated
with both oral medications and insulin, both code Z79.4, Long term (current) use of insulin, and code Z79.84, Long term (current) use of oral hypoglycemic
drugs, should be assigned.

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Chapter-5 Mental and behavioural disorders (F00 –F49):
1.C.5.b.3 Psychoactive Substance
Use, Unspecified
Medical Conditions Due to
1.C.5.b.4 Psychoactive Substance Use,
Abuse and Dependence
As with all other unspecified diagnoses, the codes for
unspecified psychoactive substance use (F10.9-, F11.9-,
F12.9-, F13.9-, F14.9-, F15.9-, F16.9-, F18.9-, F19.9-) should
only be assigned based on provider documentation and when
they meet the definition of a reportable diagnosis (see Section
III, Reporting Additional Diagnoses). These codes are to be
used only when the psychoactive substance use is associated
with a substance related disorder (chapter 5 disorders such
as sexual dysfunction, sleep disorder, or a mental or
behavioral disorder) or medical condition, and such a
relationship is documented by the provider.
Medical conditions due to substance use, abuse, and
dependence are not classified as substance-induced
disorders. Assign the diagnosis code for the medical
condition as directed by the Alphabetical Index along
with the appropriate psychoactive substance use, abuse
or dependence code. For example, for alcoholic
pancreatitis due to alcohol dependence, assign the
appropriate code from subcategory K85.2, Alcohol
induced acute pancreatitis, and the appropriate code
from subcategory F10.2, such as code F10.20, Alcohol
dependence, uncomplicated. It would not be appropriate
to assign code F10.288, Alcohol dependence with other
alcohol-induced disorder.
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Chapter-5 Mental and behavioural disorders (F00 –F49):

1.C.5.b.5

Blood Alcohol Level

A code from category Y90, Evidence of alcohol involvement determined by blood alcohol level, may be assigned
when this information is documented and the patient’s provider has documented a condition classifiable to category
F10, Alcohol related disorders. The blood alcohol level does not need to be documented by the patient’s provider in
order for it to be coded.

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Chapter-12 Diseases of the skin and subcutaneous
tissue ( L00-L99)
1.C.12.a.2

Unstageable pressure ulcers

Assignment of the code for unstageable pressure ulcer (L89.--0) should be based on the clinical documentation. These
codes are used for pressure ulcers whose stage cannot be clinically determined (e.g., the ulcer is covered by eschar or has
been treated with a skin or muscle graft). This code should not be confused with the codes for unspecified stage (L89.--9).
When there is no documentation regarding the stage of the pressure ulcer, assign the appropriate code for unspecified
stage (L89.-- 9).
If during an encounter, the stage of an unstageable pressure ulcer is revealed after debridement, assign only the
code for the stage revealed following debridement.

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 Chapter-15 Pregnancy, childbirth and the puerperium
(O00 –O99) :
1.C.15.a.3
Final character for trimester
When the classification does not provide an
obstetric code with an “in childbirth” option, it
is appropriate to assign a code describing the
current trimester
1. C. 15. l. 1
Alcohol use during pregnancy, childbirth and
the puerperium
Codes under subcategory O99.31, Alcohol use
complicating pregnancy, childbirth, and the
puerperium, should be assigned for any
pregnancy case when a patient uses alcohol
during the pregnancy or postpartum. A
secondary code from category F10, Alcohol
related disorders, should also be assigned to
identify manifestations of the alcohol use
1. C. 15. I
Gestational (pregnancy induced) diabetes
Gestational (pregnancy induced) diabetes can
occur during the second and third trimester of
pregnancy in patients who were not diabetic
prior to pregnancy. Gestational diabetes can
cause complications in the pregnancy similar to
those of pre-existing diabetes mellitus. It also
puts the patient at greater risk of developing
diabetes after the pregnancy
1.C.15.n.1
Drug use during pregnancy, childbirth and the
puerperium
Codes under subcategory O99.32, Drug use
complicating pregnancy, childbirth, and the
puerperium, should be assigned for any pregnancy
case when a patient uses drugs during the
pregnancy or postpartum. This can involve illegal
drugs, or inappropriate use or abuse of prescription
drugs. Secondary code(s) from categories F11-F16
and F18-F19 should also be assigned to identify
manifestations of the drug use
Gestational (pregnancy induced) diabetes
Gestational (pregnancy induced) diabetes can occur
during the second and third trimester of pregnancy
in patients who were not diabetic prior to pregnancy.
Gestational diabetes can cause complications in the
pregnancy similar to those of pre-existing diabetes
mellitus. It also puts the patient at greater risk of
developing diabetes after the pregnancy.
1. C. 15. n. 1
Encounter for full term uncomplicated delivery
Code O80 should be assigned when a patient is
admitted for a full-term normal delivery and delivers
a single, healthy infant without any complications
antepartum, during the delivery, or postpartum
during the delivery episode. Code O80 is always a
principal diagnosis. It is not to be used if any other
code from chapter 15 is needed to describe a current
complication of the antenatal, delivery, or postnatal
period. Additional codes from other chapters may be
used with code O80 if they are not related to or are
in any way complicating the pregnancy
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Chapter-15 Pregnancy, childbirth and the puerperium
(O00 –O99) :
1.C.15.o.5

Pregnancy associated cardiomyopathy

Pregnancy associated cardiomyopathy, code O90.3, is unique in that it may be diagnosed in the third trimester of pregnancy but may continue to
progress months after delivery. For this reason, it is referred to as peripartum cardiomyopathy. Code O90.3 is only for use when the
cardiomyopathy develops as a result of pregnancy in a patient who did not have pre-existing heart disease.

1.C.15.p.1

Code O94

Code O94, Sequelae of complication of pregnancy, childbirth, and the puerperium, is for use in those cases when an initial complication of a
pregnancy develops a sequela or sequelae requiring care or treatment at a future date.

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Chapter-18 Symptoms, signs and abnormal clinical and
laboratory findings, not elsewhere classified ( R00-R99)
1.C.18.e.1

Coma

Code R40.20, Unspecified coma, may be assigned in conjunction with codes for any medical condition.

Do not report codes for unspecified coma, individual or total Glasgow coma scale scores for a patient with a medically
induced coma or a sedated patient.

1) Coma Scale The coma scale codes (R40.21- to R40.24-) can be used in conjunction with traumatic brain injury codes. These
codes are primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma
scale codes should be sequenced after the diagnosis code(s). If multiple coma scores are captured within the first 24 hours after
hospital admission, assign only the code for the score at the time of admission. ICD-10-CM does not classify coma scores that are
reported after admission but less than 24 hours later.

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Chapter-19 Injury, poisoning and certain other
consequences of external causes (S00-T98)

1.C.19.d.6

Burns and corrosions classified according to extent of body surface involved

Assign codes from category T31, Burns classified according to extent of body surface involved, or T32, Corrosions classified according to
extent of body surface involved, for acute burns or corrosions when the site of the burn or corrosion is not specified or when there is a need
for additional data. It is advisable to use category T31 as additional coding when needed to provide data for evaluating burn mortality, such as
that needed by burn units. It is also advisable to use category T31 as an additional code for reporting purposes when there is mention of a third
degree burn involving 20 percent or more of the body surface. Codes from categories T31 and T32 should not be used for sequelae of
burns or corrosions.

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

Z Codes Indicate a Reason for an Z codes are not procedure codes. A

Encounter or Provide Additional corresponding procedure code must
1.C.21.b Information about a Patient accompany a Z code to describe any
Encounter procedure performed

The reason for the encounter (for

example, screening or counseling)
should be sequenced first and the
1.C.21.c.4 History (of)
appropriate personal and/or family
history code(s) should be assigned
as additional diagnos(es)

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Chapter-21 Factors influencing health status and
contact with health services

Codes in category Z52, Donors of organs

and tissues, are used for living individuals
who are donating blood or other body
1.C.21.c.9 Donor tissue. These codes are for individuals
donating for others, as well as for self-
donations. They are not used to identify
cadaveric donations

Code Z71.85, Encounter for

immunization safety counseling, is to be
used for counseling of the patient or
caregiver regarding the safety of a
1. C.21.c.10 Counselling vaccine. This code should not be used
for the provision of general information
regarding risks and potential side effects
during routine encounters for the
administration of vaccines

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Chapter-21 Factors influencing health status and
contact with health services
1.C.21.c.17
Social Determinants of Health
Codes describing social determinants of health (SDOH) should be assigned when this information is documented. For social
determinants of health, such as information found in categories Z55-Z65, Persons with potential health hazards related to socioeconomic and
psychosocial circumstances, code assignment may be based on medical record documentation from clinicians involved in the care of the patient
who are not the patient’s provider since this information represents social information, rather than medical diagnoses. For example, coding
professionals may utilize documentation of social information from social workers, community health workers, case managers, or
nurses, if their documentation is included in the official medical record.
Patient self-reported documentation may be used to assign codes for social determinants of health, as long as the patient self-reported
information is signed-off by and incorporated into the medical record by either a clinician or provider.
Social determinants of health codes are located primarily in these Z code categories:
• Z55 Problems related to education and literacy
• Z56 Problems related to employment and unemployment
• Z57 Occupational exposure to risk factors
• Z58 Problems related to physical environment
• Z59 Problems related to housing and economic circumstances
• Z60 Problems related to social environment
• Z62 Problems related to upbringing
• Z63 Other problems related to primary support group, including family circumstances
• Z64 Problems related to certain psychosocial circumstances
• Z65 Problems related to other psychosocial circumstances

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Chapter-22 Codes for Special Purposes (U00 - U99)

1.C.22

U07.0 Vaping-related disorder (see Section I.C.10.e., Vaping-related disorders)

U07.1 COVID-19 (see Section I.C.1.g.1., COVID-19 infection)

U09.9 Post COVID-19 condition, unspecified (see Section I.C.1.g.1.m)

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COVID -19 Coding Guidelines
This year includes a new code to report sequela related to COVID-19, U09.9 (Post COVID-19 condition,
unspecified)
 In addition, there were six codes introduced on January 1, 2021, related to COVID-19 that are
included in this final list for FY 2022:
 J12.82 Pneumonia due to coronavirus disease 2019 (MCC)
 M35.81 Multisystem inflammatory syndrome (CC)
 M35.89 Other specified system involvement of connective tissue (CC)
 Z11.52 Encounter for screening for COVID-19
 Z20.822 Contact with and (suspected) exposure to COVID-19
 Z86.16 Personal history of COVID-19

29
No Changes in some chapters

Chapter 7: Diseases of the Eye and Adnexa

Chapter 8: Diseases of the Ear and Mastoid Process (H60-H95)

Chapter 10: Diseases of the respiratory system

Chapter 14: Diseases of the genitourinary system

Chapter 15: Pregnancy, childbirth and the puerperium

30
Chapter – Specific Coding Guidelines

31
Chapter - 1 Certain Infectious and Parasitic Diseases (A00-B99)

Anaplasmosis or Human Granulocytic Anaplasmosis (HGA)

o Tick-borne infectious disease caused by the bacterium Anaplasma phagocytophilum
o Transmitted human-to-human via a blood transfusion-Transfusion-Transmitted Anaplasmosis (TTA)
o Fever, Headache, chills and muscle aches
o Most commonly reported in the Northeastern and upper Midwestern states.

A79.82 Anaplasmosis [A. phagocytophilum]

32
Chapter– 2 Neoplasms (C00-D49)

Neoplasm of Ovary
Currently, the codes for both the malignant and secondary neoplasm of ovaries are limited to only right and left
laterality. There is no code to represent the bilateral neoplasm condition.
• C56.3 Malignant neoplasm of bilateral ovaries
• C79.63 – Secondary malignant neoplasm of bilateral ovaries.

33
Chapter - 2 Neoplasms (C00-D49)

Anaplastic large cell lymphoma, ALK-negative

• Anaplastic large cell lymphoma (ALCL) refers to a group of non-Hodgkin lymphomas
• Breast implant-associated anaplastic large cell lymphoma
• Complication of silicon-filled and saline-filled breast implants which develops 9-10 years after surgical
implantation
• 0.25 cases per 100,000 people in the United States of America

C84.7A Anaplastic large cell lymphoma, ALK-negative, breast

34
Chapter - 3 Diseases of the Blood and Blood-Forming Organs and
Certain Disorders Involving the Immune Mechanism (D50-D89)
D55.2 Anemia due to disorders of glycolytic enzymes
• D55.21 Anemia due to pyruvate kinase deficiency
PK deficiency anemia
Pyruvate kinase deficiency anemia
This is a genetic blood disorder characterized by low levels of pyruvate kinase(enzyme used by red
blood cells) which could lead to hemolytic anemia
• D55.29 Anemia due to other disorders of glycolytic enzymes

35
Chapter- 3 Diseases of the Blood and Blood-Forming Organs and
Certain Disorders Involving the Immune Mechanism (D50-D89)

D75.83- Thrombocytosis
D75.838 Other thrombocytosis
Reactive thrombocytosis
Secondary thrombocytosis
D75.839 Thrombocytosis, unspecified
Thrombocythemia NOS
Thrombocytosis NOS

D89.44 Hereditary alpha tryptasemia

Patient has inherited extra copies of the alpha tryptase gene and causes increased blood levels of
trypase
Abdominal pain, diarrhea, reflux and difficulty in swallowing

36
Chapter- 4 Endocrine, Nutritional and Metabolic Diseases (E00-E89)

Niemann-Pick disease

Asphingomyelinase(ASM) deficiency are classified into type A and B

Niemann–Pick disease type A: classic infantile
Niemann–Pick disease type B: visceral
Type A patients exhibit hepatosplenomegaly in infancy and profound central nervous system
involvement and unable to survive beyond two years of age
Type B patients also show hepatosplenomegaly and pathologic alterations of their lungs but usually
without the involvement of their central nervous system.

E75.24- Niemann-Pick disease

E75.244 Niemann-Pick disease type A/B

37
Chapter - 5 Mental, Behavioral and Neurodevelopmental
Disorders (F01-F99)

Depression
 F32 Depressive episode
 F32.A Depression, unspecified
 Depression NOS
 Depressive disorder NOS

38
Chapter - 5 Mental, Behavioral and Neurodevelopmental
Disorders (F01-F99)

Genetic related intellectual disabilities (ID, formerly mental retardation)

Caused by genetic abnormalities
The two most common genetic causes of intellectual disabilities are Down syndrome and Fragile X
syndrome

F78.A Other genetic related intellectual disabilities

F78.A1 SYNGAP1-related intellectual disability
F78.A9 Other genetic related intellectual disability

39
Chapter - 6 Diseases of the Nervous System (G00 - G99)

• Acute Flaccid Myelitis(AFM)

• G04.82 Acute flaccid myelitis

40
Chapter - 6 Diseases of the Nervous System (G00-G99)

Cervicogenic headache
Cervicogenic headaches are secondary headaches. Secondary headaches are those caused by an
underlying condition, such as neck injuries, infections, or severe high blood pressure. This sets them apart
from primary headaches, such as migraines and cluster headaches.
The pain caused by a cervicogenic headache begins in the neck and the back of the head and radiates
towards the front of the head.

• G44.86 Cervicogenic headache

41
CHAPTER - 6 Diseases of the Nervous System (G00-G99)

Immune effector cell-associated neurotoxicity syndrome( ICANS)

 G92.0 Immune effector cell-associated neurotoxicity syndrome

 Code first underlying cause such as
 complications of immune effector cellular therapy(T80.82)
 Code also associated signs and symptoms, such as seizures and cerebral edema

 G92.00 Immune effector cell-associated neurotoxicity syndrome, grade unspecified

 G92.01 Immune effector cell-associated neurotoxicity syndrome, grade 1
 G92.02 Immune effector cell-associated neurotoxicity syndrome, grade 2
 G92.03 Immune effector cell-associated neurotoxicity syndrome, grade 3
 G92.04 Immune effector cell-associated neurotoxicity syndrome, grade 4
 G92.05 Immune effector cell-associated neurotoxicity syndrome, grade 5

 Neuropsychiatric syndrome which is an adverse effect of CAR T-cell therapy

 G92.8 Other toxic encephalopathy

 G92.9 Unspecified toxic encephalopathy

42
Chapter - 9 Diseases of the Circulatory System (I00-I99)

I5A Non-ischemic myocardial injury (non-traumatic)

Acute (non-ischemic) myocardial injury
Chronic (non-ischemic) myocardial injury
Unspecified (non-ischemic) myocardial injury
Code first the underlying cause, if known and applicable
Excludes 1: acute myocardial infarction(I21.-)
Excludes 2: other acute ischemic heart diseases(I24.-)

43
Chapter - 11 Diseases of the Digestive System (K00-K95)

K31.A0 Gastric intestinal metaplasia, unspecified

K31.A1 Gastric intestinal metaplasia without dysplasia
K31.A11 Gastric intestinal metaplasia without dysplasia, involving the antrum
K31.A12 Gastric intestinal metaplasia without dysplasia, involving the body (corpus)
K31.A13 Gastric intestinal metaplasia without dysplasia, involving the fundus
K31.A14 Gastric intestinal metaplasia without dysplasia, involving the cardia
K31.A15 Gastric intestinal metaplasia without dysplasia, involving multiple sites
K31.A19 Gastric intestinal metaplasia without dysplasia, unspecified site

K31.A2 Gastric intestinal metaplasia with dysplasia

K31.A21 Gastric intestinal metaplasia with low grade dysplasia
K31.A22 Gastric intestinal metaplasia with high grade dysplasia
K31.A29 Gastric intestinal metaplasia with dysplasia, unspecified

44
Chapter - 11 Diseases of the Digestive System (K00-K95)

Esophageal polyps are a kind of rare benign tumor of the esophagus, consisting of material such
as fibrous tissue, blood vessels, and adipose tissue

K22.81 Esophageal polyp

Excludes 1: benign neoplasm of esophagus(D13.0)
K22.82 Esophagogastric junction polyp
Excludes 1: benign neoplasm of stomach(D13.1)
K22.89 Other specified disease of esophagus
Hemorrhage of the esophagus NOS

45
Chapter - 12 Diseases of the Skin and Subcutaneous Tissue
(L00-L99)
Irritant contact dermatitis
L24.A Irritant contact dermatitis due to friction or contact with body fluids
L24.A0 Irritant contact dermatitis due to friction or contact with body fluids, unspecified
L24.A1 Irritant contact dermatitis due to saliva
L24.A2 Irritant contact dermatitis due to fecal, urinary or dual incontinence
L24.A9 Irritant contact dermatitis due to friction or contact with other specified body fluids
Irritant contact dermatitis related to endotracheal tube
Wound fluids, exudate
L24.B Irritant contact dermatitis related to stoma or fistula
L24.B0 Irritant contact dermatitis related to unspecified stoma or fistula
L24.B1 Irritant contact dermatitis related to digestive stoma or fistula
L24,B2 Irritant contact dermatitis related to respiratory stoma or fistula
L24.B3 Irritant contact dermatitis related to fecal or urinary stoma or fistula

46
Chapter - 13 Diseases of the Musculoskeletal System
and Connective Tissue (M00-M99)
Thrombotic microangiopathy
Rare, yet life-threatening, disorders that encompass microangiopathic hemolytic anemia, thrombocytopenia,
and microthrombi, which, in turn, leads to ischemic tissue injuries. These conditions require urgent treatment.

M31.1 Hematopoietic stem cell transplant-associated thrombotic microangiopathy

M31.10 Thrombotic microangiopathy, unspecified
M31.11 Hematopoietic stem cell transplantation-associated thrombotic microangiopathy
M31.19 Other thrombotic microangiopathy
Thrombotic thrombocytopenic purpura

47
Chapter - 13 Diseases of the Musculoskeletal System and
Connective Tissue (M00-M99)
Sjogren syndrome
M35.0 Sjogren syndrome
 Sicca syndrome
M35.00 Sjogren syndrome, unspecified
M35.01 Sjogren syndrome with keratoconjunctivitis
M35.02 Sjogren syndrome with lung involvement
M35.03 Sjogren syndrome with myopathy
M35.04 Sjogren syndrome with tubulo-interstitial nephropathy
M35.05 Sjogren syndrome with inflammatory arthritis
M35.06 Sjogren syndrome with peripheral nervous system involvement
M35.07 Sjogren syndrome with central nervous system involvement
M35.08 Sjogren syndrome with gastrointestinal involvement
M35.09 Sjogren syndrome with organ involvement
M35.0A Sjogren syndrome with glomerular disease
M35.0B Sjogren syndrome with vasculitis
M35.0C Sjogren syndrome with dental involvement

48
Chapter - 13 Diseases of the Musculoskeletal System and
Connective Tissue (M00-M99)
Non-radiographic axial spondyloarthritis

 M45.A Non-radiographic axial spondyloarthritis

 M45.A0 Non-radiographic axial spondyloarthritis of unspecified sites in spine

 M45.A1 Non-radiographic axial spondyloarthritis of occipito-atlanto -axial region

 M45.A2 Non-radiographic axial spondyloarthritis of cervical region

 M45.A3 Non-radiographic axial spondyloarthritis of cervicothoracic region

 M45.A4 Non-radiographic axial spondyloarthritis of thoracic region

 M45.A5 Non-radiographic axial spondyloarthritis of thoracolumbar region

 M45.A6 Non-radiographic axial spondyloarthritis of lumbar region

 M45.A7 Non-radiographic axial spondyloarthritis of lumbosacral region

 M45.A8 Non-radiographic axial spondyloarthritis of sacral and sacrococcygeal region

 M45.AB Non-radiographic axial spondyloarthritis of multiple spines in spine

49
Chapter - 13 Diseases of the Musculoskeletal System and
Connective Tissue (M00-M99)
Vertebrogenic low back pain
 M54.5 Low back pain
• M54.50 Low back pain, unspecified
Loin pain
Lumbago NOS
• M54.51 Vertebrogenic low back pain
Low back vertebral endplate pain
• M54.59 Other low back pain

50
Chapter - 16 Certain Conditions Originating in the Perinatal
Period (P00-P96)
Neonatal Screening
P09 Abnormal findings on neonatal screening
P09.1 Abnormal findings on neonatal screening for inborn errors of metabolism
P09.2 Abnormal findings on neonatal screening for congenital endocrine disease
P09.3 Abnormal findings on neonatal screening for congenital hematologic disorders
P09.4 Abnormal findings on neonatal screening for cystic fibrosis
P09.5 Abnormal findings on neonatal screening for critical congenital heart disease
P09.6 Abnormal findings on neonatal screening for neonatal hearing loss
P09.8 Other abnormal findings on neonatal screening
P09.9 Abnormal findings on neonatal screening, unspecified

 Group B Streptococcus(GBS)
 P00.82 Newborn affected by (positive) maternal group B streptococcus (GBS) colonization
 Contact with positive maternal group B streptococcus

51
Chapter - 18 Symptoms, Signs and Abnormal Clinical and
Laboratory Findings, Not Elsewhere Classified (R00-R99)
R05 Cough R35 Polyuria

R05.1 Acute cough R35.81 Nocturnal polyuria

Excludes 2: nocturnal enuresis(N39.44)
R05.2 Subacute cough
R35.89 Other polyuria
R05.3 Chronic cough Polyuria NOS
 Persistent cough
 Refractory cough
 Unexplained cough
R05.4 Cough syncope
Code first syncope and collapse(R55)
R05.8 Other specified cough
R05.9 Cough, unspecified

52
Chapter - 18 Symptoms, Signs and Abnormal Clinical and
Laboratory Findings, Not Elsewhere Classified (R00-R99)

R45.8 Other symptoms and signs involving emotional state

R45.88 Nonsuicidal self-harm
Nonsuicidal self-injury
Nonsuicidal self-mutilation
Self-inflicted injury without suicidal intent
Code also injury, if known

53
Chapter - 18 Symptoms, Signs and Abnormal Clinical and
Laboratory Findings, Not Elsewhere Classified (R00-R99)
Feeding difficulty
The term feeding difficulties is a broad term used to describe a variety of feeding or mealtime
behaviours perceived as problematic for a child or family. This may include behaviors such as: Picky
eating. Food fussiness. Food refusal.
R63.30 Feeding difficulties, unspecified
R63.31 Pediatric feeding disorder, acute
R63.32 Pediatric feeding disorder, chronic
R63.39 Other feeding difficulties
Feeding problem (elderly) (infant) NOS
Picky eater

Abnormal findings of blood amino-acid level

 R79.83 Abnormal findings of blood amino-acid level
Homocyteinemia

54
Chapter - 19 Injury, Poisoning, and Certain Other Consequences of
External Causes (S00-T88)
Traumatic brain compression with and without herniation
S06.A Traumatic brain compression and herniation
Traumatic cerebral compression
Code first the underlying traumatic brain injury, such as:
diffuse traumatic brain injury (S06.2-)
focal traumatic brain injury (S06.3-)
traumatic subdural hemorrhage (S06.5-)
traumatic subarachnoid hemorrhage (S06.6-)

S06.A0 Traumatic brain compression without herniation

S06.A1 Traumatic brain compression with herniation
Assign 7th character for initial encounter, subsequent encounter and sequela

55
Chapter - 19 Injury, Poisoning, and Certain Other
Consequences of External Causes (S00-T88)
Cannabis and Synthetic Cannabinoids – codes expanded to allow the differentiation and reporting
of poisoning, adverse effect and underdosing of cannabis and synthetic cannabinoids with two new
subcategories:

T40.71 Poisoning by, adverse effect of and underdosing of cannabis (derivatives)

T40.72 Poisoning by, adverse affect of and underdosing of synthetic cannabinoids
Corresponding codes created at each subcategory for:
◦ poisoning accidental (unintentional)
◦ poisoning intentional self-harm
◦ poisoning assault
◦ poisoning undetermined
7th character applies to all T40.7- codes (initial encounter, subsequent encounter, sequela)

56
Chapter - 19 Injury, Poisoning, and Certain Other Consequences
of External Causes (S00-T88)
Complication of Immune Effector Cellular Therapy

T80.82XA Complication of immune effector cellular therapy, initial

encounter
T80.82XD Complication of immune effector cellular therapy, subsequent
encounter
T80.82XS Complication of immune effector cellular therapy, sequela
Use Additional code to identify the specific complication, such as:
Cytokine release syndrome (D89.83-)
immune effector cell-associated neurotoxicity syndrome (G92.0-)

57
Chapter - 20 External Causes of Morbidity
(V00-Y99)

Chapter 20 includes three new codes for legal

interventions involving other specified means to
include an unspecified injured person.
The codes in Y35.899- also require a 7th character
(A, D, or S), so the six-character addition in the
addenda translates to three new seven-character
codes.

58
Chapter - 21 Factors Influencing Health Status and Contact
With Health Services (Z00 - Z99)
Social determinants of Health

 Z55 Problems related to education and literacy

Z55.5 Less than a high school diploma
No general equivalence degree(GED)
 Z58 Problems related to physical environment
Z58.6 Inadequate drinking-water supply
Lack of safe drinking water
 Z59.0 Homelessness
Z59.00 Homelessness, unspecified
Z59.01 Sheltered homelessness
Living in a shelter such as: motel, scattered site housing, temporary or transitional living situation
Z59.02 Unsheltered homelessness
Residing in place not meant for human habitation such as: abandoned buildings, cars, parks,
sidewalk
Residing on the street

59
Chapter -21 Factors Influencing Health Status and Contact With
Health Services (Z00-Z99)
 Z59.41 Food insecurity
 Z59.48 Other specified lack of adequate food
Inadequate food
Lack of food
 Z59.81 Housing instability, housed

•Z59.811 Housing instability, housed, with risk of homelessness

•Z59.812 Housing instability, housed, homelessness in past 12 months
•Z59.819 Housing instability, housed unspecified
 Z59.89 Other problems related to housing and economic circumstances

60
Chapter - 21 Factors Influencing Health Status and Contact
With Health Services (Z00-Z99)
 Z71.85 Encounter for immunization safety counseling
oCode also, if applicable, encounter for immunization (Z23)
oCode also, if applicable, immunization not carried out (Z28.-)
 Z91.014, Allergy to mammalian meats
 Z91.51, Personal history of suicidal behavior
 Z91.52, Personal history of nonsuicidal self-harm
 Z92.850, Personal history of Chimeric Antigen Receptor T-cell therapy
 Z92.858, Personal history of other cellular therapy
 Z92.859, Personal history of cellular therapy, unspecified
 Z92.86, Personal history of gene therapy

61
Chapter - 22 Codes for Special Purposes (U00-U85)

Post COVID-19 Condition

U09.9, Post COVID-19 condition, unspecified
Note: This code enables establishment of a link with COVID-19
This code is not to be used in cases that are still presenting with active COVID-19. However, an exception
is made in cases of re-infection with COVID-19, occurring with a condition related to prior COVID-19
Code first the specific condition related to COVID-19 if known, such as:
chronic respiratory failure (J96.1-)
loss of smell (R43.8)
loss of taste (R43.8)
multisystem inflammatory syndrome (M35.81)
pulmonary embolism (I26.-)
pulmonary fibrosis (J84.10)
Code Z86.16, Personal history of COVID-19, should not be assigned if the patient still has any COVID-19-
related manifestation or residual symptoms.

62
Knowledge Check 1:

Patient was seen in hospital with COVID-19 related multisystem inflammatory

syndrome. Patient had a history of COVID-19 infection two months ago and now is
not infected.

 M35.81, Multisystem inflammatory syndrome

 U09.9, Post COVID-19 condition, unspecified

63
Knowledge Check 2:

Patient was seen in hospital with re-infection with COVID-19 and COVID
Pneumonia. The patient also had COVID-19 multisystem inflammatory syndrome
from previous infection.

 U07.1, COVID-19
 J12.82, pneumonia due to COVID-19
 M35.81, Multisystem inflammatory syndrome
 U09.9, Post COVID-19 condition, unspecified

64
Knowledge Check 3:

Patient presented to the Emergency Department with complaint of malaise

following administration of the COVID-19 vaccine. The provider documented
adverse effect of COVID Pneumonia. The patient also had COVID-19 multisystem
inflammatory syndrome from previous infection.

 R53.81, Other malaise

 T50.B95A, Adverse effect of other viral vaccines, initial encounter

65
Knowledge Check 5:

Patient presented with both aspiration pneumonia and pneumonia due to

COVID-19.
Rationale :
 J69.0, Pneumonitis due to inhalation of food and vomit
 J12.82, Pneumonia due to coronavirus disease 2019

66
Knowledge Check 6:

Patient who previously had COVID-19 was seen for a follow-up exam and the
CVID-19 test was negative.
Rationale :
 Z01, Encounter for follow-up examination
 Z86.16, Personal history of COVID-19

67
 Summary : Important Changes to be Noted
 159 additions, 32 deletions, and 20 revisions for 2022
 Personal history codes added to the code category
 Addition of codes for anemia due to other disorders
 Replacement codes for toxic encephalopathy
 Specific code assignments for diseases of the esophagus
 More codes to further identify Sjogren syndrome
Financial Number
 Expansion of low back pain Year of codes Additions
 Neonatal screenings FY2020 72,184 252
 Deletion of R05 for cough and new codes to use FY2021 72,621 437
FY2022 72,748 127
 Drug table changes to include cannabinoids

68
Resources / References

ICD-10-CM Official Guidelines for Coding and Reporting FY 2022

https://www.cms.gov/medicare/icd-10/2022-icd-10-cm

69
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