Starting Oct. 1, 2017, you’ll be able to capture the severity of non-pressure chronic ulcers that have penetrated muscle and bone tissue but haven’t caused necrosis, thanks to the addition of 72 new codes in the L97.- (Non-pressure chronic ulcer of lower limb, not elsewhere classified) and L98.- categories (Other disorders of skin and subcutaneous tissue, not elsewhere classified).
 
These 72 new codes are among 360 new, 142 deleted and 226 revised diagnosis codes in the final FY2018 update posted to CMS’ website June 13.
 
The final FY2018 ICD-10-CM codes include a total of 322 more changes than what was proposed in the Hospital Inpatient Prospective Payment Systems (IPPS) rule in April.
 
More specifically, a non-pressure chronic ulcer of the left calf in which muscle tissue is evident but not necrotic will be able to be more accurately captured with the upcoming addition of L97.225 (Non-pressure chronic ulcer of left calf with muscle involvement without evidence of necrosis).
 
Currently, this wound could not be captured with L97.223 (Non-pressure chronic ulcer of left calf with necrosis of muscle), leaving L97.222 (Non-pressure chronic ulcer of left calf with fat layer exposed) as the next best option, according to Coding Clinic guidance.
 
Also, a new subcategory (I50.8, Other heart failure), new sub-subcategory (I50.81, Right heart failure) and nine new codes for heart failure, including I50.84 (End stage heart failure) will make their way into the code set on Oct. 1.
 
More specifically, new codes for various types of right heart failure include acute (I50.811), chronic (I50.812), acute on chronic (I50.813) and unspecified (I50.810). You’ll also have new codes to report for right heart failure due to left heart failure (I50.814), biventricular heart failure (I50.82), high output heart failure (I50.83) and end stage heart failure (I50.84) for patients with an advanced form of the disease that no longer responds to medication.
 
Also, new inclusion terms on heart failure codes, including “Heart failure with preserved ejection fraction [HFpEF]” on subcategory I50.3- (Diastolic (congestive) heart failure), will help guide code choices based on diagnostic statements. — Megan Batty (mbatty@decisionhealth.com) and Julia Kyles (jkyles@decisionhealth.com)
 
Editor's note: Read this upcoming week's issue of Home Health Line for more detail. View the changes at http://go.cms.gov/2sAkzcS