You’ll soon have 71 new codes to capture varying severities of non-pressure chronic ulcers if all the new codes proposed in the hospital inpatient PPS rule are accepted.
 
The proposed new non-pressure chronic ulcer codes will allow coders to specifically capture wounds that have penetrated into muscle or bone tissue, but that have not caused necrosis, such as with L97.515 (Non-pressure chronic ulcer of other part of right foot with muscle involvement without evidence of necrosis).
 
Of the new codes, 60 fall within the L97.- category (Non-pressure chronic ulcer of lower limb, not elsewhere classified). The other 11 are in the L98.- category (Other disorders of skin and subcutaneous tissue, not elsewhere classified).
 
These codes are part of a total of 324 new, 43 revised and 38 deleted codes listed in the FY2018 proposed code set update, released April 14. In addition to non-pressure chronic ulcer codes, the update includes several new codes for type 2 diabetes with ketoacidosis, blindness and low vision, and pulmonary hypertension.
 
Additional new codes could find their way into the code set because this list doesn’t include the codes discussed at the March 2017 ICD-10 Coordination and Maintenance Committee meeting that were proposed for early adoption on Oct. 1. These could include new codes for heart failure and the use of electronic nicotine delivery systems (HHL 4/10/17).
 
Having more choices to capture the severities of non-pressure chronic ulcers “is an excellent and much-needed change,” says Michelle Horner, assistant director of quality operations for Floral Park, N.Y.-based coding outsourcer Quality in Real Time.
 
Currently, non-pressure chronic ulcers that involve muscle or bone but in which there’s no evidence of necrosis cannot be captured with the codes that describe muscle or bone necrosis, such as L97.213 (Non-pressure chronic ulcer of right calf with necrosis of muscle), according to Coding Clinic guidance issued in letters to an individual that were received on July 28 and Sept. 18, 2015.
 
But this guidance and the expert advice to code these wounds as having only penetrated fatty tissue such as with L97.212 (Non-pressure chronic ulcer of right calf with fat layer exposed), has unintentionally resulted in less-than-accurate records, Horner says.
 
“The fat layer description was really covering a wide range of severities and not really capturing what was really going on with the patient,” she says.
 
The addition of these codes was formally requested by DecisionHealth and the Association of Home Care Coding and Compliance (AHCC) in a proposal that was discussed at the March 2016 meeting of the ICD-10 Coordination and Maintenance Committee.
 
More changes proposed for Oct. 1
 
Here’s a quick overview of other notable proposals for the FY2018 code update:
  • Codes for blindness and low vision have expanded in the H54.- category (Blindness and low vision) with the addition of 35 new codes that have seven characters and specify the degree of blindness and/or low vision in each eye based on categories ranging from 1 to 5. For example, one proposed new code is H54.1131 (Blindness right eye category 3, low vision left eye category 1). Patients with blindness and/or low vision in one or both eyes are a common occurrence for coder Maurice Frear, who works for Bon Secours Home Health and Hospice Services in Virginia Beach. But he’s never seen documentation pertaining to a category that would allow him to use these new codes, he says.
  • The subcategory currently capturing a Clostridium difficile (C.diff) infection, A04.7, is proposed to be expanded to include two new codes, one for a recurrent infection (A04.71) and one for an infection not specified as recurrent (A04.72). This diagnosis is common in home health: “We get quite a lot of recurrent C.diff,” says Lynn Collins, the clinical/financial analyst for Crozer Keystone Home Health & Hospice in Springfield, Pa. Additionally, a recurrent C.diff infection is a “much bigger issue” than an initial infection and thus the ability to capture it as recurrent helps to better communicate the patient’s acuity, Horner says. Recurrent C.diff is also an important diagnosis in the hospice setting, where it can lead to malnutrition and decline, Frear says.
  • The current code for pulmonary hypertension, I27.2 (Other secondary pulmonary hypertension), is proposed to be expanded into a subcategory containing seven new unique codes for various forms of pulmonary hypertension, including I27.22 (Pulmonary hypertension due to left heart disease), I27.24 (Chronic thromboembolic pulmonary hypertension) and an unspecified option, I27.20 (Pulmonary hypertension, unspecified). Frear says these new codes will enable him to code more specified forms of pulmonary hypertension.
  • The code for spinal stenosis in the lumbar region (M48.06) will be replaced with spinal stenosis with, and without neurogenic claudication (M48.062 and M48.061 respectively). The neurogenic claudication codes were inadvertently dropped during the ICD-10 transition. Currently, Simmons has to use two codes for a patient who has lumbar spinal stenosis and neurogenic claudication. 
Related link: View the hospital inpatient prospective payment rule, in which the codes are listed, at http://go.cms.gov/2oognqY.