Comments Due Friday on Proposed New ICD-10 Codes

The Coordination and Maintenance Committee Meeting was held March 7-8 at the Centers for Medicare & Medicaid Services (CMS) headquarters for the purposes of reviewing proposals for new ICD-10-CM (diagnosis) and ICD-10-PCS (procedures) codes for the 2018 and 2019 fiscal years.

Comments on the proposals for 2018 are due April 7, 2017. This article provides more detail on two subjects – types of myocardial infarctions (MI) and heart failure classifications.

The types of myocardial infarctions are based on the American College of Cardiology (ACC) categorization.

• Type 1 indicates that the patient has evidence of spontaneous plaque rupture or erosion in an epicardial coronary vessel.
• Type 2 indicates that the MI is due to either increased oxygen demand or decreased supply (e.g. coronary artery spasm, coronary embolism, anemia, arrhythmia, hypertension, hypotension, etc.).
• Type 3 indicates that the MI resulted in sudden death.
• Type 4a indicates that the MI is associated with percutaneous coronary intervention (PCI) within 48 hours of the procedure.
• Type 4b indicates that the MI is associated with in-stent thrombosis.
• Type 4c indicates that the MI is associated with restenosis of a PCI.
• Type 5 is an MI associated with a coronary artery bypass graft (CABG) within 48 hours of the procedure.

In the code proposals, type 1 would be included in I21.0-I21.4, which are the ST elevation myocardial infarctions (STEMI) with the specificity of the involved wall and non-ST elevation myocardial infarction (NSTEMI). A new code would be added for MI NOS (I21.9). Type 2 would be assigned a new code of I21.A1. MI types 3-5 would be assigned to the proposed new code of I21.A9. Please note that demand ischemia will remain at I24.8 unless specified as “with myocardial infarction.” If that documentation is provided, the new code of I21.A1 would be assigned, as it is now a type 2 MI.

The proposal for heart failure classifications is based on those used by the ACC as well as the American Heart Association. The entities use stages of A, B, C, and D. The New York Hospital Association classifications have not been included in this proposal.

The heart failure stages are defined as:

• Stage A – the patient has a presence of risk factors, but is asymptomatic. The code assigned should be Z91.89, other specified personal risk factors, not elsewhere classified.
• Stage B – heart disease is present, but there are no symptoms. There are structural changes to the heart present.
• Stage C – structural heart disease is present with symptoms.
• Stage D – the patient is in end-stage heart failure with advanced structural heart disease and pronounced symptoms of heart failure at rest or upon minimal exertion.

A new subcategory is proposed for right heart failure (I50.84). New codes have been proposed for biventricular failure (I50.82), high-output heart failure (I50.83), end-stage heart failure (I50.84), and other heart failure (I50.89). These new codes will provide more information regarding the patient’s severity of illness.

Comments regarding the proposed diagnosis and procedure codes are due on April 7 for the codes for which expedited action has been requested. Comments regarding ICD-10-CM can be emailed to the Centers for Disease Control and Prevention (CDC) at nchsicd10CM@cdc.gov. The comments for ICD-10-PCS can be emailed to CMS at ICDProcedureCodeRequest@cms.hhs.gov. Here is your opportunity to participate in the code development process! I look forward to seeing the results in June 2017.