Summary of 2021 ICD-10 changes
Make sure your practice is prepared to navigate the ICD-10 updates that took effect Oct. 1, 2021.
The AOA provides the following information and resources to assist osteopathic physicians in navigating the latest revisions to the ICD-10 code set, the World Health Organization’s medical classification list of diagnosis codes for diseases, signs and symptoms, complaints, abnormal findings and external causes of injury or disease.
View the AOA’s on-demand webinar for additional information on recent ICD-10 updates.
New codes for 2021
The following summary is provided by Stanley Nachimson, principal of Nachimson Advisors, a health IT consulting firm dedicated to finding innovative uses for health information technology and encouraging its adoption.
CMS has issued the latest updates to the ICD-10-CM code set, which take effect for services provided on Oct 1, 2021, and after. The latest update includes a smaller number of changes than last year, with 159 new codes as compared to 2020’s 485 new codes, 27 revised codes, and 25 deleted codes.
The full list of changes can be viewed in tables 6A, 6C, ad 6E of the final rule available at the following location on the CMS website: https://www.cms.gov/medicare/acute-inpatient-pps/fy-2022-ipps-final-rule-home-page#Tables.
Several new codes were introduced this year, with the biggest concentration in the chapter on injuries and poisonings.
New codes include:
- Codes to report COVID-19 sequela.
- Six additional codes related to COVID-19.
- 45 codes in the chapter on injuries and poisonings, six of which relate to traumatic brain compression.
- 25 codes in the chapter on musculoskeletal system and connective tissue.
- 22 codes in the chapter on factors influencing health status and contact with health services, reflecting the increased interest in social determinants of health.
- 14 codes in symptoms, signs, and abnormal laboratory findings.
- 13 codes in diseases of the digestive system, most having to do with gastric intestinal metaplasia.
- 10 codes in diseases of the nervous system.
Details by chapter
Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99)
Number of new codes: 1
- A79.82 Anaplasmosis [A. phagocytophilum], with some updates to the “exclude” notes.
Chapter 2: Neoplasms (C00-D49)
Number of new codes: 3
- Two codes to for bilateral ovarian malignancies
- 3 Malignant neoplasm of bilateral ovaries
- 63 Secondary malignant neoplasm of bilateral ovaries
- 7A – Anaplastic large cell lymphoma, ALK-negative, breast
Chapter 3: Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism (D50-D89)
Number of new codes: 5 (with two which provide greater specificity in the diagnosis of anemia)
- 21 Anemia due to pyruvate kinase deficiency
- 29 Anemia due to other disorders of glycolytic enzymes
- 838 Other thrombocytosis
- 839 Thrombocytosis, unspecified
- 44 Hereditary alpha tryptasemia
Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E00-E89)
Number of new codes: 1
- E75.244 Niemann-Pick disease type A/B.
Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01-F99)
Number of new codes: Several, including one in the Depression category
- F32.A Depression, unspecified, as well as a new subcategory F78.A- Other genetic related intellectual disabilities with codes:
- F78.A1 SYNGAP1-related intellectual disability
- F78.A9 Other genetic related intellectual disability
Chapter 6: Diseases of the Nervous System (G00-G99)
Number of new codes: 10
- G04.82 Acute flaccid myelitis
- G44.86 Cervicogenic headache.
- G92 Toxic encephalopathy contains additional specificity in subcategory G92.0 Immune effector cell-associated neurotoxicity syndrome. New codes are:
- G92.00 Immune effector cell-associated neurotoxicity syndrome, grade unspecified
- G92.01 Immune effector cell-associated neurotoxicity syndrome, grade 1
- G92.02 Immune effector cell-associated neurotoxicity syndrome, grade 2
- G92.03 Immune effector cell-associated neurotoxicity syndrome, grade 3
- G92.04 Immune effector cell-associated neurotoxicity syndrome, grade 4
- G92.05 Immune effector cell-associated neurotoxicity syndrome, grade 5
- G92.8 Other toxic encephalopathy
- G92.9 Unspecified toxic encephalopathy
Chapter 7: Diseases of the Eye and Adnexa
Number of new codes: 0
Chapter 8: Diseases of the Ear and Mastoid Process
Number of new codes: 0
Chapter 9: Diseases of the Circulatory System (I00-I99)
Number of new codes: 1
- I5A Non-ischemic myocardial injury (non-traumatic) as well as additions and modifications to Excludes 1/2 and Code first notes.
Chapter 10: Diseases of the respiratory system
Number of new codes: 0
Chapter 11: Diseases of the digestive system (K00-K95)
Number of new codes: 3
- K22.1 Esophageal polyp
- K22.82 Esophagogastric junction polyp
- K22.89 Other specified disease of esophagus (hemorrhage of the esophagus NOS)
New subcategory K31.A- Gastric intestinal metaplasia, containing 10 new codes which designate location involved and the presence of dysplasia:
- K31.A0 Gastric intestinal metaplasia, unspecified
- K31.A1 Gastric intestinal metaplasia without dysplasia
- K31.A11 Gastric intestinal metaplasia without dysplasia, involving the antrum
- K31.A12 Gastric intestinal metaplasia without dysplasia, involving the body (corpus)
- K31.A13 Gastric intestinal metaplasia without dysplasia, involving the fundus
- K31.A14 Gastric intestinal metaplasia without dysplasia, involving the cardia
- K31.A15 Gastric intestinal metaplasia without dysplasia, involving multiple sites
- K31.A19 Gastric intestinal metaplasia without dysplasia, unspecified site
- K31.A2 Gastric intestinal metaplasia with dysplasia
- K31.A21 Gastric intestinal metaplasia with low grade dysplasia
- K31.A22 Gastric intestinal metaplasia with high grade dysplasia
- K31.A29 Gastric intestinal metaplasia with dysplasia, unspecified
Chapter 12: Diseases of the Skin and Subcutaneous Tissue (L00-L99)
Number of new codes: 8, plus 2 new subcategories for irritant contact dermatitis
- L24.A Irritant contact dermatitis due to friction or contact with body fluids
- L24.A0 Irritant contact dermatitis due to friction or contact with body fluids, unspecified
- L24.A1 Irritant contact dermatitis due to saliva
- L24.A2 Irritant contact dermatitis due to fecal, urinary or dual incontinence
- L24.A9 Irritant contact dermatitis due friction or contact with other specified body fluids
- L24.B Irritant contact dermatitis related to stoma or fistula
- L24.B0 Irritant contact dermatitis related to unspecified stoma or fistula
- L24.B1 Irritant contact dermatitis related to digestive stoma or fistula
- L24.B2 Irritant contact dermatitis related to respiratory stoma or fistula
- L24.B3 Irritant contact dermatitis related to fecal or urinary stoma or fistula
Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)
Number of new codes: Several, with additional specificity around Sjögren syndrome and a category for Non-radiographic axial spondyloarthritis:
- Subcategory M31.1- for reporting hematopoietic stem cell transplant-associated thrombotic microangiopathy
- The code set adds a “Use Additional” note after code M31.11, instructing coding for the specific organ dysfunction
- M31.1 Thrombotic microangiopathy
- M31.10 Thrombotic microangiopathy, unspecified
- M31.11 Hematopoietic stem cell transplantation-associated thrombotic microangiopathy [HSCT-TMA]
- M31.19 Other thrombotic microangiopathy
Several codes under revised subcategory M35.0 Sjögren syndrome are also revised, and seven codes are added for identification of associated diseases or conditions.
- M35.05 Sjögren syndrome with inflammatory arthritis
- M35.06 Sjögren syndrome with peripheral nervous system involvement
- M35.07 Sjögren syndrome with central nervous system involvement
- M35.08 Sjögren syndrome with gastrointestinal involvement
- M35.0A Sjögren syndrome with glomerular disease
- M35.0B Sjögren syndrome with vasculitis
- M35.0C Sjögren syndrome with dental involvement
There is a new subcategory M45.A Non-radiographic axial spondyloarthritis and ten codes for non-radiographic axial spondyloarthritis, which allow for classification based on the affected region of the spine.
- M45.A Non-radiographic axial spondyloarthritis
- M45.A0 Non-radiographic axial spondyloarthritis of unspecified sites in spine
- M45.A1 Non-radiographic axial spondyloarthritis of occipito-atlanto-axial region
- M45.A2 Non-radiographic axial spondyloarthritis of cervical region
- M45.A3 Non-radiographic axial spondyloarthritis of cervicothoracic region
- M45.A4 Non-radiographic axial spondyloarthritis of thoracic region
- M45.A5 Non-radiographic axial spondyloarthritis of thoracolumbar region
- M45.A6 Non-radiographic axial spondyloarthritis of lumbar region
- M45.A7 Non-radiographic axial spondyloarthritis of lumbosacral region
- M45.A8 Non-radiographic axial spondyloarthritis of sacral and sacrococcygeal region
- M45.AB Non-radiographic axial spondyloarthritis of multiple sites in spine
There is also greater specificity in the category M54.5 Low back pain. Remember that category and subcategory codes are not used for billing. Use the specific codes under the category or subcategory.
- M54.50 Low back pain, unspecified
- M54.51 Vertebrogenic low back pain
- M54.59 Other low back pain
Chapter 14: Diseases of the genitourinary system (N00-N99)
Number of new codes: 0
Chapter 15: Pregnancy, childbirth and the puerperium (O00-O9A)
Number of new codes: 0
Chapter 16: Certain Conditions Originating in the Perinatal Period (P00-P96)
Number of new codes: 9
- P00.82 Newborn affected by (positive) maternal group B streptococcus (GBS) colonization; and under category P09 Abnormal findings on neonatal screening:
- P09.1 Abnormal findings on neonatal screening for inborn errors of metabolism
- P09.2 Abnormal findings on neonatal screening for congenital endocrine disease
- P09.3 Abnormal findings on neonatal screening for congenital hematologic disorders
- P09.4 Abnormal findings on neonatal screening for cystic fibrosis
- P09.5 Abnormal findings on neonatal screening for critical congenital heart disease
- P09.6 Abnormal findings on neonatal screening for neonatal hearing loss
- P09.8 Other abnormal findings on neonatal screening
- P09.9 Abnormal findings on neonatal screening, unspecified
Chapter 17: Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00-Q99)
Number of new codes: 0 (only minor language revisions)
Chapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99)
Number of new codes: Several
Please note: R05 is now a category code.
- R05.1 Acute cough
- R05.2 Subacute cough
- R05.3 Chronic cough
- R05.4 Cough syncope
- R05.8 Other specified cough
- R05.9 Cough, unspecified
Number of new codes: 2 (codes differentiate between nocturnal polyuria and polyuria not otherwise specified)
- R35.81 Nocturnal polyuria
- R35.89 Other polyuria
Other new codes in this chapter include:
- R45.88 Nonsuicidal self-harm
- R79.83 Abnormal findings of blood amino-acid level
- R63.30 Feeding difficulties, unspecified
- R63.31 Pediatric feeding disorder, acute
- R63.32 Pediatric feeding disorder, chronic
- R63.39 Other feeding difficulties (feeding problem (elderly) (infant) NOS, picky eater)
Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88)
Number of changes: Several
There are 6 new codes for traumatic brain compression:
- S06.A0XA Traumatic brain compression without herniation, initial encounter
- S06.A0XD Traumatic brain compression without herniation, subsequent encounter
- S06.A0XS Traumatic brain compression without herniation, sequela
- S06.A1XA Traumatic brain compression with herniation, initial encounter
- S06.A1XD Traumatic brain compression with herniation, subsequent encounter
- S06.A1XS Traumatic brain compression with herniation, sequela
Reporting for cannabis has a number of new subcategories and codes. There are two new subcategories T40.71 Cannabis (derivatives) and T40.72 Synthetic cannabinoids and 36 new codes to classify poisoning, adverse effect, and underdosing of cannabis and synthetic cannabinoids, replacing deleted subcategory T40.7X- Cannabis (derivatives) and it’s codes.
Examples of the new codes:
- T40.711A Poisoning by cannabis, accidental (unintentional), initial encounter
- T40.711D Poisoning by cannabis, accidental (unintentional), subsequent encounter
- T40.711S Poisoning by cannabis, accidental (unintentional), sequela
New codes for complication of immune effector cellular therapy:
- T80.82XA Complication of immune effector cellular therapy, initial encounter
- T80.82XD Complication of immune effector cellular therapy, subsequent encounter
- T80.82XS Complication of immune effector cellular therapy, sequela
Chapter 20: External Causes of Morbidity (V00-Y99)
Number of new codes: Several, mostly focusing on the increased interest in collecting information on the social determinants of health. These codes will enable providers to record specific social factors in the patient’s record and make decisions based on these factors.
There are three new codes for legal interventions:
- Y35.899 Legal intervention involving other specified means, unspecified person injured
- Y35.899A Legal intervention involving other specified means, unspecified person injured, initial encounter
- Y35.899D Legal intervention involving other specified means, unspecified person injured, subsequent encounter
- Y35.899S Legal intervention involving other specified means, unspecified person injured, sequela
The codes involving social determinants are:
- Z55.5 Less than High School Diploma
- Z58.6 Inadequate drinking-water supply
- Z59.00 Homelessness unspecified
- Z59.01 Sheltered homelessness
- Z59.02 Unsheltered homelessness
- Z59.4 Lack of food
- Z59.41 Food insecurity
- Z59.48 Other specified lack of adequate food.
- Z59.8- Other Problems Related to Housing and Economic Circumstances
- Z59.81 Housing instability, housed
- Z59.811 Housing instability, housed, with risk of homelessness
- Z59.812 Housing instability, housed, homelessness in past 12 months
- Z59.819 Housing instability, housed unspecified
- Z59.89 Other problems related to housing and economic circumstances
Chapter 21: Factors Influencing Health Status and Contact With Health Services (Z00-Z99)
Number of new codes: Several
- Z71.85 Encounter for immunization safety counseling
- Z91.014 Allergy to mammalian meats.
- Z91.51 Personal history of suicidal behavior
- Z91.52 Personal history of nonsuicidal self-harm
- Z92.850 Personal history of Chimeric Antigen Receptor T-cell therapy
- Z92.858 Personal history of other cellular therapy
- Z92.859 Personal history of cellular therapy, unspecified
- Z92.86 Personal history of gene therapy
Chapter 22: Codes for Special Purposes (U00-U85)
This contains a new code for post Covid-19 conditions as well as instructions for its use.
- U09.9 Post COVID-19 condition, unspecified. The instructions call for the provider to list the code for the specific condition related to COVID-19, if known, first.
Key 2022 guideline changes
There are a number of updates to the ICD-10-CM coding guidelines which also must be followed by providers. These include:
- Section I.B.14 – Documentation by Clinicians Other Than the Patient’s Provider
- Specific items which can be obtained from other clinicians records
- Section I.C.1.g.1.m, clarifies coding for post-COVID-19 conditions
- New Section Section I.C.2.s – Breast Implant Associated Anaplastic Large Cell Lymphoma
- Section I.C.4.a – Diabetes Mellitus
- Section I.C.4.a.3 – Diabetes mellitus and the use of insulin, oral hypoglycemics, and injectable non-insulin drugs
- Section I.C.4.a.6.a – Secondary diabetes mellitus and the use of insulin, oral hypoglycemic drugs, or injectable non-insulin drugs
- Section I.C.15.a – General Rules for Obstetric Cases
- Section I.C.21 – Factors Influencing Health Status and Contact With Health Services (Z00-Z99), especially new section:
- Section I.C.21.c.17 – Social Determinants of Health
Official sources of information
CMS provides access to the official ICD-10-CM code set and guidelines. The Medicare/CMS ICD-10 Code Set is available at: https://www.cms.gov/medicare/icd-10/2022-icd-10-cm.
The ICD-10 Guidelines can be accessed at: https://www.cms.gov/files/document/fy-2022-icd-10-cm-coding-guidelines.pdf.
These changes are now in effect and must be used on claims for all services delivered Oct 1, 2021 and after.
What are the key actions that provider practices should take?
- Review changes in codes and guidelines for your range of practice
Focus first on the codes you use most in your practice, then review changes for the others.
- Adjust documentation as necessary
Your documentation processes may need to be changed so that you have the information needed to use the new codes. Review how you document and revise as necessary.
- Train staff
Make sure all staff involved in documentation, coding, and billing are aware of these changes and adjust as necessary. Review the changes with them and note any processes that need to be updated.
- Assure that software is up to date for these changes
Check with your software vendors to ensure they have incorporated the new 2022 ICD-10-CM codes in your products. Test the products by entering the new codes and see if they work. If your software has not been updated, contact your vendor immediately to get the updates.
- Review any instructions from health plans
Individual health plans may have updated their coverage and billing guidelines to take these new codes into account.
- Monitor for future changes
Remember that there are coding changes every year, so keep up to date. There may be new codes issued during the year, as well as the major change each Oct 1.
About the author: Stanley Nachimson is principal of Nachimson Advisors, a health IT consulting firm dedicated to finding innovative uses for health information technology and encouraging its adoption. Nachimson focuses on assisting health care providers, vendors, and plans with regulatory interpretation and implementation, influencing HIT policy, and providing advice on HIT industry status and trends. He is the author of the authoritative paper on the cost of ICD-10 for physician practices. He served at CMS for over 30 years, with a focus on HIPAA and other HIT regulations.