On June 24, 2016, the Centers for Disease Control and Prevention (CDC) released the new 2017 ICD-10-CM codes that went into effect on October 1, 2016. According to Laurie Johnson, MS, RHIA, CPC-H, FAHIMA—the director of health information management (HIM) consulting services for Panacea Health Solutions, Inc. and author of this ICD10 Monitor article—there are “1,974 additions, 311 deletions, and 425 revisions,” resulting in a total of 71,486 codes. Now, not all of these changes are relevant to rehab therapists—thank goodness—but many are, which is why we’re going to use this post to:

  • summarize the new changes for the three chapters most relevant to therapists;
  • provide you with some examples of deleted, added, and updated codes that may impact your daily practice; and
  • offer you with a helpful reminder about coding now that Medicare’s ICD-10 grace period has ended.

Ready? Let’s dive in.

ICD-10 Changes by Chapter

Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue

Johnson said CMS added “bunion, bunionette, pain in joints of the hand, more specificity to temporomandibular joints, cervical disc disorders at specific levels, atypical femoral fractures, and periprosthetic fractures.”

Chapter 19: Injuries, Poisoning, and Certain Other Consequences of External Causes

As noted in the above-cited article, CMS also made a “significant number of additions [to] the specific fractures to bones of the skull”—as well as “various fracture types of the foot.” There also are “title revisions to complications involving prosthetic devices; new stenosis of cardiac stent codes, and additions to complication types, including breakdown, displacement, infection, erosion, exposure, pain, fibrosis, thrombosis, and leakage.”

Chapter 20: External Causes of Morbidity

The CDC also updated several vehicular accident codes and “added contact with paper or sharp objects, overexertion, and…the choking game.” (Let’s hope you never need to use the code for that last one.)

Deleted, Added, and Updated Codes

Deleted Codes

As Johnson mentioned, this update removed more than 300 ICD-10 codes from the code set. If you’ve used any of these codes in your documentation for existing patients—and then continued to see those patients on or after October 1, 2016—then you would need to select new diagnosis codes for any dates of service falling after the new code set went into effect.

Now, let’s look at some examples. Here are six codes that have been removed from Chapter 19: Injuries, Poisoning, and Certain Other Consequences of External Causes:

  1. T84.040  Periprosthetic fracture around internal prosthetic right hip joint
  2. T84.041  Periprosthetic fracture around internal prosthetic left hip joint
  3. T84.042  Periprosthetic fracture around internal prosthetic right knee joint
  4. T84.043  Periprosthetic fracture around internal prosthetic left knee joint
  5. T84.048  Periprosthetic fracture around other internal prosthetic joint
  6. T84.049  Periprosthetic fracture around unspecified internal prosthetic joint

Added Codes

Based on Johnson’s assessment, we know that the CDC added more codes than it deleted, which means you should have no problem finding a satisfactory replacement for any code you can no longer use. Let’s continue our previous example of deleted codes: if you used one of the above-listed codes for periprosthetic fracture for an existing patient—and that patient returned to your clinic on or after October 1, 2016—then you would need to enter a new code. Luckily, as part of the update, a new family of codes for this injury is available: M97, Periprosthetic fracture around internal prosthetic joint. If one of the below-listed replacement codes accurately reflects the patient’s condition, you could use it as a replacement for the deleted code:

  • M97.0 Periprosthetic fracture around internal prosthetic hip joint
  • M97.01 Periprosthetic fracture around internal prosthetic right hip joint
  • M97.02 Periprosthetic fracture around internal prosthetic left hip joint
  • M97.3 Periprosthetic fracture around internal prosthetic shoulder joint
  • M97.2 Periprosthetic fracture around internal prosthetic ankle joint

Updated Code Descriptions

With more than 400 updated code descriptions, there’s a good chance you’ll run into one of these revisions sooner rather than later—but they shouldn’t cause too much confusion, because the ICD-10 code is the same; only the description is different. Still, you should double-check the descriptions for codes on any active cases to ensure they still accurately reflect your patient’s condition. Here are three examples of updates from Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue:

M96.83
  • Original description: Postprocedural hemorrhage and hematoma of a musculoskeletal structure following a procedure
  • Revised description: Postprocedural hemorrhage of a musculoskeletal structure following a procedure
M96.830
  • Original description: Postprocedural hemorrhage and hematoma of a musculoskeletal structure following a musculoskeletal system procedure
  • Revised description: Postprocedural hemorrhage of a musculoskeletal structure following a musculoskeletal system procedure
M96.831
  • Original description: Postprocedural hemorrhage and hematoma of a musculoskeletal structure following other procedure
  • Revised description: Postprocedural hemorrhage of a musculoskeletal structure following other procedure

The End of the Grace Period

When ICD-10 first went into effect on October 1, 2015, Medicare implemented a one-year “grace period” that culminated with dates of service falling on or after September 30, 2016. During this period, as long as the provider selected a code from the correct family of codes, CMS would accept that code—regardless of whether it was the most specific code available.

As you well know, the first three characters of any ICD-10 code typically denote the code family. Providers must then use the remaining characters to account for additional clinical details relevant to that patient’s condition. Before October 1, 2016, submitting a code with the correct first three digits was enough to receive payment. However, that’s no longer the case. Codes on claims with dates of service falling on or after October 1, 2016, will be subject to more intense scrutiny, which could lead to more ICD-10-related denials.

Example

Consider the following table of codes:

Code

Description

M54.0

Panniculitis affecting regions of neck and back

M54.01

Panniculitis affecting regions of neck and back, site unspecified

M54.03

Panniculitis affecting regions of neck and back, cervical region

M54.04

Panniculitis affecting regions of neck and back, cervicothoracic region

M54.3

Sciatica

M54.30

Sciatica, unspecified side

M54.31

Sciatica, right side

M54.41

Lumbago with sciatica, right side

All the codes above fall within the M54 family of Dorsalgia. The additional characters that come after “M54” convey more specific information about the patient’s condition. During the grace period, if a patient presented with a condition falling under the M54 umbrella, the provider could use any of the codes beginning with “M54” to receive reimbursement. Today, providers could receive a claim denial for using a code that is either incorrect or lacking specificity. That’s why it’s imperative that providers—and billers—use the most accurate, specific codes available to describe their patients’ conditions.

Using an EMR? Be sure your software vendor has updated the system to account for all of the coding changes mentioned in this post. Otherwise, you might not receive accurate payment for your services. (If you’re a WebPT Member, don’t worry—you’re covered.) For a complete explanation of these ICD-10 changes, check out Johnson’s blog post in full here or refer to the CMS 2017 ICD-10-CM files here.


How is your practice handling the new codes and the end of the grace period? Have you noticed an increase in denial rates, or is it still too soon to tell? Share your experiences in the comments section below.