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Eyes Here: FY 2022 New Coding Guidelines

    The Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2022 ICD-10-CM diagnosis code update on June 24, 2021, effective for discharges and encounters or visits on or after October 1, 2021.

    A total of 165 codes were added, along with other adjustments. The full list of diagnosis codes that have been added, deleted, and revised can be found in tables 6A, 6C, and 6E of the Inpatient Prospective Payment Systems (IPPS) Final Rule for FY 2022.

    We have summarized below the most important changes and highlights from each chapter. In addition, there were updates to the ICD-10-CM Official Guidelines for Coding and Reporting, which can be found at the end of the list.

    Chapter-by-chapter Summary of Changes Effective October 1, 2021

    Chapter 1 Certain Infectious and Parasitic Diseases (A00-B99)

    2022 ICD-10-CM code set adds one code to this chapter: A79.82 Anaplasmosis [A.phagocytophilum]. The rest of the updates to Chapter 1 are primarily updates to exclude notes. For example, for code A80 Acute poliomyelitis, the following note is added: Excludes1: acute flaccid myelitis (G04.82).

    Chapter 2 Neoplasms (C00-D49)

    Chapter 2 now includes three new codes. Added are two codes to capture bilateral ovarian malignancies, allowing classification as malignant or secondary malignant neoplasm. Another addition to the code set is C84.7A 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)

    The 2022 code set brings five new codes to this chapter. First, the novel codes under D55.2 Anemia due to disorders of glycolytic enzymes allow more specific options such as D55.21 Anemia due to pyruvate kinase deficiency and D55.29 Anemia due to other disorders of glycolytic enzymes. 

    Other changes include the addition of codes D75.838 Other thrombocytosis (including secondary and reactive) and D75.839 Thrombocytosis, unspecified under new subcategory D75.83- Thrombocytosis. Also added is code D89.44 Hereditary alpha tryptasemia.

    Chapter 4 Endocrine, Nutritional and Metabolic Diseases (E00-E89)

    The primary update to this chapter is the addition of one code under E75.24- Niemann-Pick disease: E75.244 Niemann-Pick disease type A/B.

    Chapter 5 Mental, Behavioral and Neurodevelopmental Disorders (F01-F99)

    Changes in Chapter 5 include one new code for depression F32.A Depression, unspecified under revised category F32 Depressive episode.

    The 2022 code set also adds to this chapter F78.A1 SYNGAP1-related intellectual disability and 78.A9 Other genetic related intellectual disability under new subcategory F78.A- Other genetic related intellectual disabilities.

    Chapter 6 Diseases of the Nervous System (G00-G99)

    The updates to Chapter 6 relate primarily to the 10 new codes in these areas:

    • G04.82 Acute flaccid myelitis
    • G44.86 Cervicogenic headache
    • Added under the new subcategory G92.0 Immune effector cell-associated neurotoxicity syndrome are six codes to classify immune effector cell-associated neurotoxicity syndrome by grade.
      • G92.01 Immune effector cell-associated neurotoxicity syndrome, grade 1
      • 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 (CC)
      • G92.04 Immune effector cell-associated neurotoxicity syndrome, grade 4 (CC)
      • G92.05 Immune effector cell-associated neurotoxicity syndrome, grade 5 (CC)
    • Two codes to distinguish other and unspecified toxic encephalopathy:
      • G92.8 Other toxic encephalopathy;
      • G92.9 Unspecified toxic encephalopathy

    Chapter 9 Diseases of the Circulatory System (I00-I99)

    The addenda do not show any changes for Chapter 7: Diseases of the Eye and Adnexa or Chapter 8: Diseases of the Ear and Mastoid Process (H60-H95). The 2022 code set does add one code to Chapter 9: I5A Non-ischemic myocardial injury (non-traumatic).

    The remainder of the updates to this chapter involve additions and modifications to Excludes1/2 and Code first notes. For example, under code I5A is a note instructing you to code first the underlying cause, if known and applicable.

    Chapter 11 Diseases of the Digestive System (K00-K95)

    The addenda do not show any new codes for Chapter 10: Diseases of the respiratory system, but three new codes are added to Chapter 11 to classify esophageal diseases:

    • K22.81 Esophageal polyp
    • K22.82 Esophagogastric junction polyp
    • K22.89 Other specified disease of esophagus (hemorrhage of the esophagus NOS)

    Another notable change in this chapter is new subcategory K31.A- Gastric intestinal metaplasia and ten codes to capture gastric intestinal metaplasia. To determine the correct code among the new codes, you need to check for documentation of the location involved and the presence of dysplasia.

    • K31.A0 Gastric intestinal metaplasia, unspecified
    • 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.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)

    The update brings eight new codes to Chapter 12. There are two new subcategories for irritant contact dermatitis:

    Under L24.A- Irritant contact dermatitis due to friction or contact with body fluids, the 2022 code set adds four new codes to identify the type of fluid.

    Under L24.B- Irritant contact dermatitis related to stoma or fistula, the addition of four new codes enables specification of the type of stoma or fistula. For example, digestive, respiratory, fecal/urinary.

    Chapter 13 Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)

    The numerous changes in Chapter 13 relate primarily to new codes in these areas:

    • Three codes under subcategory M31.1 are to allow reporting of hematopoietic stem cell transplant-associated thrombotic microangiopathy.
      • M31.10 Thrombotic microangiopathy, unspecified (MCC)
      • M31.11 Hematopoietic stem cell transplantation-associated thrombotic microangiopathy (MCC)
      • M31.19 Other thrombotic microangiopathy (MCC)

    The code set adds a ‘Use Additional’ note after code M31.11, instructing you to also code for the specific organ dysfunction.

    • Several codes under revised subcategory M35.0 Sjögren syndrome are also updated, and seven codes are added for identification of associated diseases or conditions. Codes M35.00-M35.03 were revised from “Sicca syndrome” to “Sjögren syndrome.” Of note, M35.07 (Sjögren syndrome with central nervous system involvement) is classified as a CC.
    • 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.A1-M45.AB)
    • Expansion of M54.5 Low back pain, with the addition of three codes:
      • M54.50 Low back pain, unspecified,
      • M54.51 Vertebrogenic low back pain, and
      • M54.59 Other low back pain.

    Chapter 16 Certain Conditions Originating in the Perinatal Period (P00-P96)

    The addenda do not show any changes for Chapter 14: Diseases of the genitourinary system and Chapter 15: Pregnancy, childbirth and the puerperium, but Chapter 16 has nine new codes: one code for newborn affected by maternal group B Streptococcus colonization and eight codes to capture specific abnormal findings on neonatal screening.

    Chapter 17 Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00-Q99)

    Two minor revisions are the only changes noted in the addenda for Chapter 17 and include revising “Nephronopthisis” to “Nephronophthisis” under code Q61.5 Medullary cystic kidney.

    Chapter 18 Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99)

    The 2022 code set adds 14 codes to Chapter 18. Many coders have probably memorized R05 Cough, but R05 is not a reportable code in the 2022 code set. Instead, use one of the six new codes, which provide added specificity to cough.

    • 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

    Updates to this chapter also include the addition of two codes to differentiate between nocturnal polyuria and polyuria not otherwise specified (NOS). Other additions include R45.88 Nonsuicidal self-harm and R79.83 Abnormal findings of blood amino-acid level. Another noteworthy change is the addition of the following four codes:

    • 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)

    You will find the longest list of changes in this chapter of ICD-10-CM 2022. The first big change is the addition of six codes to differentiate traumatic brain compression with or without herniation under new subcategory S06.A- Traumatic brain compression and herniation. (S06.A0XA-S06.A1XS): S06.A0XA (Traumatic brain compression without herniation, initial encounter) and S06.A1XA (Traumatic brain compression with herniation, initial encounter).

    The next major change in this chapter involves reporting for cannabis. Added under new subcategories T40.71 Cannabis (derivatives) and T40.72 Synthetic cannabinoids are 36 new codes to classify poisoning, adverse effect, and underdosing of cannabis and synthetic cannabinoids. (T40.711A-T40.716S and T40.721A-T40.726S). These codes replace deleted subcategory T40.7X- Cannabis (derivatives) and all of the codes classified under it.

    The final update for this chapter adds three codes — specifying initial, subsequent, sequela — for complication of immune effector cellular therapy. Keep in mind that each code in T80.82- requires a 7th character (A, D, or S), so the five-character addition in the addenda translates to three new seven-character codes.

    Chapter 20 External Causes of Morbidity (V00-Y99)

    Chapter 20 includes three new codes for legal interventions involving other specified means to include an unspecified injured person. The codes in Y35.899- also require a 7th character (A, D, or S), so the six-character addition in the addenda translates to three new seven-character codes.

    Chapter 21 Factors Influencing Health Status and Contact With Health Services (Z00-Z99)

    The 2022 code set introduces 19 new codes in Chapter 21 that relate primarily to updates focusing on these areas:

    • Social determinants of health:
      • Additions: Z55.5 Less than High School Diploma; Z58.6 Inadequate drinking-water supply
      • Expansions: Z59.0- Homelessness to allow specification of sheltered or unsheltered. Z59.4 Lack of food to include Z59.41 Food insecurity and Z59.48 Other specified lack of adequate food. Z59.8- Other Problems Related to Housing and Economic Circumstances providing three new codes under Z59.81 Housing instability, housed and Z59.89 Other problems related to housing and economic circumstances to account for foreclosure on loan, isolated dwelling, and problems with creditors.
    • Addition of Z71.85 Encounter for immunization safety counseling and Z91.014 Allergy to mammalian meats
    • Two codes to differentiate between history of suicidal behavior and non-suicidal self-harm are added under Z91.5 Personal history of self-harm.
    • Under Z92.8 Personal history of other medical treatment, the 2022 code set adds four codes: three under new subcategory Z92.85 Personal history of cellular therapy, including chimeric antigen receptor T-Cell Therapy (CAR-T), and Z92.86 Personal history of gene therapy.

    Chapter 22 Codes for Special Purposes (U00-U85)

    Updates to this chapter include one new code: U09.9 Post COVID-19 condition, unspecified. Also added is a ‘Code first’ note. It instructs you to list the code for the specific condition related to COVID-19, if known, first. For example, J96.1- Chronic respiratory failure, R43.8 Loss of smell, R43.8 Loss of taste, or M35.81 Multisystem inflammatory syndrome.

    Other CC Designations

    Additional codes that will be designated as CCs include:

    • A79.82 Anaplasmosis [A. phagocytophilum]
    • C56.3 Malignant neoplasm of bilateral ovaries
    • C79.63 Secondary malignant neoplasm of bilateral ovaries
    • C84.7A Anaplastic large cell lymphoma, ALK-negative, breast
    • I5A Non-ischemic myocardial injury (non-traumatic)

    FY 2022 ICD-10-CM Official Guidelines for Coding and Reporting Highlights

    There are a few updates to the coding guidelines that should also be highlighted.

    • Laterality – This has been updated to reflect that documentation from other clinicians may be used for laterality if the provider does not document this information. The “unspecified” side should rarely be used, and if there is conflicting documentation of the laterality in the record, then the attending provider should be queried. (I.B.13). Documentation from clinicians who are permitted based on the regulatory or accreditation requirements or internal hospital policies to document in a patient’s official medical record may be used for codes for (I.B.14.):
      • Depth of non-pressure chronic ulcers
      • Pressure ulcer stage
      • Coma scale
      • NIH stroke scale (NIHSS)
      • Social determinants of health (SDOH)
      • Laterality
      • Blood alcohol level
    • Post-COVID-19 Condition – Assign a code for sequela of COVID-19 or the associated symptom or condition that develops following a previous infection and code U09.9, Post COVID-19 condition, unspecified. If a patient who previously had a COVID-19 infection develops a new active infection, then code U09.9 may be used in conjunction with U07.1 to show a condition associated with the previous infection along with the new infection. (I.C.1.g.1) (m)).
    • Breast Implant associated anaplastic large cell lymphoma – BIA-ALCL describes a type of lymphoma that occurs around breast implants. Assign the new code C84.7A for this condition and not a complication code from Chapter 19. (I.C.2.s).
    • Social Determinants of Health – This section was added to the guidelines to allow for use of these codes when the information is documented. Coding professionals may use documentation related to social information from social workers, community health workers, case managers, or nurses if the documentation is included in the official medical record. In addition, patient self-reporting may be used for code assignment if incorporated into the medical record by a clinician or provider and signed off by the provider/clinician. (I.C.21.c.17).

    Staying on Top of Coding Updates

    It is imperative that your coding provider is updated with the new guidelines and changes to ensure accuracy in code assignment and optimization of reimbursements. This will also maintain the integrity of your documentation to prevent denial of claims. 

    Further guidelines are yet to be released, such as updates on the ‘excludes notes’ and on how the new codes will affect the home health clinical groupings under Patient-Driven Groupings Model (PDGM). The latter is critical, so being vigilant for updates and new information is key.