Chapterwise 2023 ICD-10 codes changes in codebook

Exactly 1,468 new codes will be added to the ICD- 10-CM code set for fiscal year (FY) 2023. Moreover, 251 diagnosis codes will be deleted, 35 code descriptors will be revised, and 36 codes will be converted to parent codes to many of the new child codes. The changes go into effect Oct. 1, 2022.

The FY 2023 ICD-10-CM code files and guidelines are available on the Centers for Medicare & Medicaid Services’ (CMS’) 2023 ICD-10-CM web page. Downloads are:

• 2023 Conversion Table
• 2023 Code Descriptions in Tabular Order
• 2023 Addendum
• 2023 Code Tables, Tabular and Index
• FY 2023 ICD-10-CM Coding Guidelines

These are ZIP folders containing multiple files; many of the files contain the same information in multiple formats.

In the 2023 Conversion Table folder, for example, there are two files that contain the same information, but one is an Excel worksheet and the other is comma-separated per Section 508 accessibility standards. The conversion table includes the new codes, effective dates, and previously assigned code equivalents. For example, the spreadsheet shows us that, beginning Oct. 1, instead of reporting D59.3 Plication of urethrovesical junction, you will have three more specific codes from which to choose (D59.30-D59.32), as appropriate, but only if your providers document the information necessary to support this more granular coding.

A review of the files in the 2023 Addendum folder reveals exactly what is changing in the Table of Drugs and Chemicals, Index, Table of

Neoplasms, and Tabular List. In the Tabular List addenda, you can see that every chapter except Chapter 7: Diseases of the Eye and Adnexa (H00-H59) and Chapter 8: Diseases of the Ear and Mastoid Process (H60-H95) has revisions and to what extent. For example, Chapter 12: Diseases of the Skin and Subcutaneous Tissue (L00-L99) has only one change to an Excludes1 note for L81 Other disorders of pigmentation. Here is a quick review of changes in the remaining chapters of ICD-10-CM for FY 2023.

Chapter 1: Certain infectious and parasitic diseases (A00-B99)

There are minimal changes in the chapter: Just a few revisions to the inclusion terms for A81 Atypical virus infections of central nervous system; an Excludes1 note change for A85 Other viral encephalitis, not elsewhere classified; and two new codes under B37.3 Candidiasis of vulva and vagina.

Chapter 2: Neoplasms (C00-D49)

There are no changes in this chapter to speak of — mainly just descriptor revisions to codes in category C84 Mature T/NK-cell lymphomas to change “not classified” to “not elsewhere classified.”

Chapter 3: Diseases of blood/blood-forming organs & disorders involving immune mechanism (D50-D89)

Under D59.3- Hemolytic-uremic syndrome, you’ll find new codes that delineate unspecified hemolytic-uremic syndrome (HUS) from atypical hemolytic-uremic syndrome (aHUS), and a note instructing you to use an additional code to identify an associated infection, if known. 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.

Under D75.82 Heparin induced thrombocytopenia (HIT), you’re instructed to use an additional code to report an adverse effect of heparin, if applicable, and you’ll find 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, you’ll use D75.84 Other platelet-activating anti-PF4 disorders.

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

Chapter 4: Endocrine, nutritional and metabolic diseases (E00-E89)

There is a lot of expansion under categories E34 Other endocrine disorders and E87 Other disorders of fluid, electrolyte and acid-base balance for FY 2023. 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. Beginning Oct. 1, you will 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.

Chapter 5: Mental, behavioral and neurodevelopmental disorders (F01-F99)

This is an area in medicine that is experiencing a lot of attention lately, and it shows in all the changes in this chapter. You will find 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. Plan on spending a significant amount of time reviewing this chapter.

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 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, you’ll be able to use an additional code to report the specific type of dementia, rather than just with or without behavioral disturbance.

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.

Categories G90 Disorders of the nervous system, G93 Other disorders of brain, and G96 Other disorders of central nervous system didn’t go untouched either.

Chapter 9: Diseases of the circulatory system (I00-I99)

You’ll find plenty of new codes added in this chapter for improved specificity. There are new codes for reporting chronic ischemic heart disease, pulmonary heart disease, and other types of heart disease

Expansion of existing codes enables you to specify the effected anatomical area more succinctly 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)

Chapter 10: Diseases of the respiratory system (J00-J99)

There’s only one new code, J95.87 Transfusion-associated dyspnea (TAD), in this chapter, and some added instructional notes for a few other categories.

Chapter 11: Diseases of the digestive system (K00-K95)

You’ll be able to 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 you 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)

If you report pain management services, several new codes for re- porting intervertebral annulus fibrosus defects (M51.A0-M51.A5) and other muscle disorders (M62.5A-) will interest you. 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.

Chapter 14: Diseases of the genitourinary system (N00-N99)

There are almost 200 diagnoses related to endometriosis. New diagnosis codes provide details in terms of laterality, location, depth of invasion, volume of disease, and specific organs involved.

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. Contrast induced nephropathy is the third leading cause of hospital-acquired acute kidney injury, according to Cone Health.

Chapter 15: Pregnancy, childbirth and the puerperium (O00-O9A)

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.

Chapter 16: Certain conditions originating in the perinatal period (P00-P96)

When reporting respiratory and cardiovascular disorders specific to the perinatal period (P19-P29), you will have 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.

Chapter 17: Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)

Here, too, you will find inclusion terms 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, you will report Q21.13 Coronary sinus atrial septal defect, which includes coronary sinus defect and unroofed coronary sinus.

According to requestor Cheryl Bullock, Q21.1 was 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.

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

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)

ICD-10-CM 2023 also introduces new codes for concussion, traumatic brain injury, cerebral edema, and hemorrhage when it isn’t known whether the patient lost consciousness. Under category T43 Poisoning by, adverse effect of and underdosing of psychostimulants, take note of several new codes that specify whether a patient’s poisoning by methamphetamines was unintentional, an act of self-harm, an assault, or undetermined.

Chapter 20: External Causes of Morbidity

Beginning Oct. 1, you 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.”

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

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.

You’ll find more 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).