News: FY 2019 ICD-10-CM Guidelines released

CMS and the National Center for Health Statistics recently released the 2019 ICD-10-CM Official Guidelines for Coding and Reporting. Changes include clarification on the usage of “with,” updated sepsis guidance, and added guidelines for subsequent myocardial infarction (MI), according to JustCoding.

The guideline detailing “with” guidance, found in Section I.A.15, has been updated with bold text to state that “the word ‘with’ or ‘in’ should be interpreted to mean ‘associated with’ or ‘due to’ when it appears in a code title, the Alphabetic Index (either under a main term or subterm), or an instructional note in the Tabular List.”

The “with” guideline frequently sees changes and, in the past, has directly contradicted previous guidance from sources such as Coding Clinic, which has led to confusion for coders, JustCoding reported.

Guidelines for reporting sepsis due to a postprocedural infection, located in Section I.C.1.d.5.b-c, now state that a code from 2019 ICD-10-CM subcategories T81.40- to T81.43- (infection following a procedure) or a 2019 code from subcategories O86.00 to O86.03 (infection of obstetric surgical wound) that identifies the site of the infection should be coded first, if known.

The 2019 Guidelines also state that coders should assign an additional code for sepsis following a procedure (2019 code T81.44-) or sepsis following an obstetrical procedure (2019 code O86.04). “Use an additional code to identify the infectious agent. If the patient has severe sepsis, the appropriate code from subcategory R65.2.- (severe sepsis) should also be assigned with the additional code(s) for any acute organ dysfunction,” the Guidelines state.

The 2019 Guidelines also added the following language for sepsis due to a postprocedural infection:

For infections following infusion, transfusion, therapeutic injection, or immunization, a code from subcategory T80.2-, or code T88.0-, should be coded first, followed by the code for the specific infection. If the patient has severe sepsis, the appropriate code from subcategory R65.2- should also be assigned, with the additional codes(s) for any acute organ dysfunction.

When reporting postprocedural infection and postprocedural septic shock, the 2019 Guidelines say to assign the codes indicated, followed by one from category T81.12- (postprocedural septic shock) and not  to assign code R65.21 (severe sepsis with septic shock), and that additional code(s) should be assigned for any acute organ dysfunction, according to JustCoding.

The 2019 Guidelines also added direction for reporting subsequent MI, which comes on the heels of details regarding  the upcoming release of the fourth edition of the universal definition of MI published in the American Journal of Medicine.

Under Section I.C.9.e.4, the Guidelines now state that if a subsequent MI of one type occurs within four weeks of an MI of a different type, assign the appropriate codes from category I21.- (acute myocardial infarction) to identify each type. In this instance, coders should not assign a code from category I22.- (subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction). Codes from category I22.- should only be assigned if both the initial and subsequent MIs are Type 1 or unspecified.

Additional updates to the 2019 Guidelines include, but are not limited to, the following topics and conditions:

• Body mass index
• Burns of the same anatomic site
• Documentation by clinicians other than the patient's provider
• Drug use during pregnancy, childbirth, and the puerperium
• Factitious disorders
• Healthcare encounters in hurricane aftermath
• Underdosing

Editor’s note: This article originally appeared in JustCoding. To read about the 2019 IPPS Final Rule that was also released last week, click here.