Get Prepared for More Diagnosis Codes

The tentative list includes 1,176 new diagnosis codes.

The Proposed Rule for the Inpatient Prospective Payment System (IPPS) was released on April 18. The tentative list of new diagnosis codes was also released, including three diagnosis codes that were effective for discharges and visits occurring on and after April 1. The tentative list includes 1,176 new diagnosis codes, with the chapter breakdown listed in the table below:

The final list is expected to be published in mid-June.

The most significant changes appear in chapters 3, 5, 9, 13, 14, 15, 19, 20, and 21. In Chapter 3 (Diseases of the Blood and Blood Forming Organs and Certain Disorders Involving the Immune Mechanism), the code set has expanded von Willebrand disease and hemolytic-uremic syndrome. Chapter 5 (Mental, Behavioral, and Neurodevelopmental Disorders) has additions to various forms of drug use, in remission, and expansion of several types of dementia with manifestations.

The Diseases of the Circulatory System (Chapter 9) has more codes regarding aortic aneurysms, as well as additions including refractory angina and changes to ventricular tachycardia. Chapter 13 (Diseases of the Musculoskeletal System and Connective Tissue) has added codes for acute, chronic, or acute-on-chronic slipped femoral epiphysis.

The changes in Chapter 14 (Diseases of the Genitourinary System) include expanding the sites of endometriosis. Pregnancy, Childbirth, and Puerperium (Chapter 15) have added codes for central nervous system malformations, chromosomal abnormalities, and facial, cardiac, gastrointestinal, genitourinary, and extremity anomalies.

Chapter 19 (Injury, Poisoning, and Certain Other Consequences of External Cause) has expanded codes for several types of brain injuries and added codes for poisoning by methamphetamines. The additions in Chapter 20 (External Causes of Morbidity) include the electric bicycle (driver and passenger) and caught, crushed, or pinched between moving and stationary objects. This chapter has also expanded on accidents of the motorcycle driver and passengers. Chapter 21 (Factors Influencing Healthcare Status and Contact with Health Services) has expanded codes for non-compliance, to include patients and caregivers.

I had a specific interest in the new diagnosis codes in Chapter 17 (Congenital Malformations, Deformations, and Chromosomal Abnormalities), as I had assisted in writing a proposal for the Coordination and Maintenance Committee meeting held in September 2021. The code of interest was PTEN Hamartoma Tumor Syndrome, which appears in the tentative list – Q85.81.

Action is required with the publication of the tentative new codes. It is important to review this list and note if the code is a CC, MCC, or no complication/comorbidity status. Run frequency reports for diagnosis codes that are related to the new codes to understand the potential frequency of use.

Spend time educating your coding staff on these new codes. By beginning early, your education can be done slowly over the coming months. Refer to the materials that are available on the Coordination and Maintenance Committee website. Also, update any effect that the new codes may have on your facility-specific coding guidelines. Remember that education is the key to consistent and accurate coding.

Resources:

New Diagnosis Codes (Table 6A)

Coordination and Maintenance Committee Materials