Review the changes to ensure that ICD-10-CM codes are reported accurately
On July 5th, The National Center for Health Statistics released the 2024 update to the ICD-10-CM Official Guidelines for Coding and Reporting. It is recommended that medical coders and auditors review these guidelines on an annual basis to ensure accurate reporting of patient conditions and encounters. The updated guidelines, along with the ICD-10-CM code set, will take effect on October 1st, making it an ideal time to review the changes.
Chapter Specific Changes to Guidelines
The majority of changes made to the diagnosis coding guidelines for fiscal year (FY) 2024 are specific to certain chapters. These changes consist mainly of minor narrative corrections and the addition of a small number of new diagnosis codes. However, there are a few notable significant additions as well.
note: any narrative changes to the diagnosis coding guidelines are indicated in bold typeface, any text that has been moved is underlined, and any heading revisions are italicized.
A new addition has been made to the guidelines under section I.C.1.g.1, which states the following:
(f) Screening for COVID-19
Code Z11.52, Encounter for screening for COVID-19, should be assigned for COVID-19 screening, including preoperative testing.
Effective January 1, 2021, code Z11.52 was introduced to replace code Z11.59, Encounter for screening for other viral diseases. For COVID-19 screening encounters that occur on or after October 1, 2023, code Z11.52 should be assigned.
Section I.C.9.e. Acute myocardial infarction (AMI) of the guidelines has been updated to include the following addition:
Myocardial Infarction with Coronary Microvascular Dysfunction
Coronary microvascular dysfunction (CMD) is a medical condition that affects the microvasculature by impeding microvascular flow and elevating microvascular resistance. To describe myocardial infarction with coronary microvascular disease, myocardial infarction with coronary microvascular dysfunction, and myocardial infarction with non-obstructive coronary arteries (MINOCA) with microvascular disease, code I21.B, Myocardial infarction with coronary microvascular dysfunction, should be used.
For fiscal year (FY) 2024, ICD-10-CM code I21.B has been newly added and can be used to describe myocardial infarction with coronary microvascular disease and myocardial infarction with non-obstructive coronary arteries (MINOCA) with microvascular disease.
Section I.C.18.e. Coma of the guidelines has been updated to include the following addition:
The guidelines for section I.C.18.e. Coma have been modified to include the instruction that code R40.20, Unspecified coma, be assigned when the cause of the coma is unknown, or when the cause is a traumatic brain injury and the coma scale is not recorded in the medical record.
In addition to the above, the guidelines now also state that codes for unspecified coma, individual or total Glasgow coma scale scores should not be reported for a patient with a medically induced coma or a sedated patient.
Coma Scale
The coma scale codes (R40.21- to R40.24-) can be used in conjunction with traumatic brain injury codes. These codes cannot be used with code R40.2A, Nontraumatic coma due to underlying condition. They are primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma scale codes should be sequenced after the diagnosis code(s).”
Code R40.2A is newly added for FY 2024 and also describes secondary coma. A parenthetical note in the ICD-10-CM code book instructs you to code first the underlying condition.
Under section I.C.21.c, the following is added:
Follow-up
Codes Z08 and Z09 may be assigned after any type of completed treatment modality, which includes both medical and surgical treatments. Code Z08, Encounter for follow-up examination after completed treatment for malignant neoplasm, and code Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm, are used for this purpose.
Guidelines for Reporting Additional Diagnoses
Section III of the guidelines, which covers reporting additional diagnoses, has been updated to include two significant words in the definition of “other diagnoses.”
The revised definition now reads as follows: “For reporting purposes, the definition for ‘other diagnoses’ is interpreted as additional clinically significant conditions that affect patient care in terms of requiring…”
