In 2021, CMS released the fiscal year 2022 code descriptions, tables, index and addendum which went into effect October 1st. The updates included 32 deleted codes, 20 revised codes, and 159 new codes. Although key changes will be highlighted in this article, be sure to review both the guidelines and code updates in their entirety to ensure proper coding and reporting.
Breast Implant Associated Anaplastic Large Cell Lymphoma
New code C84.7A, Anaplastic large cell lymphoma, ALK-negative breast has been added to capture what is commonly called “breast implant associated anaplastic large cell lymphoma”, or “BIA-ALCL.” BIA-ALCL is rare type of non-Hodgkin’s lymphoma that can develop around breast implants. Note that although BIA-ALCL is associated with breast implants, a complication code from chapter 19 is not assigned.
A new subcategory, D75.83, Thrombocytosis has been added to Chapter 3 to separately identify “other” and “unspecified” thrombocytosis. Coding Clinic clarifies that new code D75.838, Other thrombocytosis, includes secondary and reactive thrombocytosis. In secondary or reactive thrombocytosis, another condition or outside factor causes the elevated platelet count, such as an infection, trauma or iron deficiency.
A major change for Chapter 5 is the revision of category F32. Previously, the default code for depression NOS was F32.9, Major depressive disorder, single episode, unspecified. For FY 2022, the narrative for category F32 was revised from Major depressive disorder, single episode to “depressive episode” and new code F32.A, Depression, unspecified was added. Code F32.A, Depression, unspecified should now be assigned for depression not further specified.
Code G92, Toxic encephalopathy, has been expanded to include codes that describe “other” and “unspecified” toxic encephalopathy. There are also 6 new codes added for immune effector cell-associated neurotoxicity syndrome (ICANS), including the specified grade (1-5). ICANS is a disorder involving the central nervous system that is associated with therapies such as chimeric antigen receptor (CAR) T-cell therapy. The underlying cause of ICANS is coded first, followed by the specific ICANS grade. Code also any associated signs and symptoms, such as seizures or cerebral edema.
Non-Ischemic Myocardial Injury
Code I5A, Non-ischemic myocardial injury (non-traumatic), has been created to identify a non-traumatic, non-ischemic myocardial injury. Myocardial injury in the absence of ischemia is categorized as acute or chronic non-ischemic myocardial injury. Coding Clinic explains that based on high sensitivity troponin tests, clinicians can now distinguish whether patient have suffered a non-ischemic myocardial injury versus one of the other MI subtypes. Note that when assigning code I5A, sequence the underlying cause first (such as sepsis, heart failure, acute myocarditis, etc.) if known and/or applicable.
Newborn Affected by Maternal Group B Streptococcus Colonization
We now have a specific code for a newborn affected by maternal GBS, P00.82, Newborn affected by (positive) maternal group B streptococcus (GBS) colonization. Group B streptococcus (GBS), also known as Group B strep, is a type of bacterial infection that can be passed from a mother to a baby during birth. Although not every infant who is born to a GBS positive mother will become ill, GBS can cause serious illness such as sepsis and meningitis. Because of the high risk of morbidity for infants who are born to GBS positive mothers, antibiotics are often administered prophylactically. Note that code P00.82 also includes contact with positive maternal group B streptococcus.
Code U09.9, Post COVID-19 condition, unspecified, was created to identify health problems that can last for an extended time after the initial COVID infection has resolved. This is also referred to as “long COVID” or “long-haul COVID.” Conditions can range from symptoms such as fatigue or loss of smell or taste, to more serious conditions such as chronic respiratory failure. Code U09.9 is paired with a new guideline (I.C.g.1.m. Post COVID-19 Condition), which instructs coding professionals to assign a code(s) for the specific symptoms or conditions related to the previous COVID-19 condition, followed by code U09.9. Note that code U09.9 should not be assigned for manifestations of an active (current) COVID-19 infection.
Additional information regarding ICD-10-CM Code Updates for FY 2022 can be found below:
- CMS, 2022 ICD-10-CM Updates https://www.cms.gov/medicare/icd-10/2022-icd-10-cm
- ICD-10-CM Official Coding Guidelines I.C.2.s. Breast Implant Associated Anaplastic Large Cell Lymphoma
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2021 Pages: 7-8 Thrombocytosis and essential thrombocythemia
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2021 Pages: 9-10 Depression not otherwise specified
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2021 Pages: 14-15 Non-ischemic myocardial injury
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2021 Page: 23 Newborn affected by maternal group B streptococcus colonization
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2021 Pages: 31-32 Post COVID-19 condition