ICD-10 Update Effective April 1: What You Need to Know

The April 1 ICD-10 update includes important changes to coding instructions, such as updates to ‘Excludes’ notes and ‘code also’ guidance in 13 chapters. While these updates do not introduce any new, deleted, or revised diagnosis codes, they can still affect code selection and sequencing.

It is important for home health coders to be aware of these updates and to ensure that all coding systems are updated accordingly. Even small note changes can impact compliance and reporting accuracy. 

Changes to “Excludes” Notes

A significant number of updates convert “Excludes 1” notes to “Excludes 2” notes.

As a reminder, Excludes 1 means the two conditions cannot be reported together. Excludes 2 means the excluded condition is not part of the listed code, but both codes may be reported together when appropriate.

• Example:
  • Neoplasms of uncertain behavior (D37–D44, D48) will change from an Excludes 1 relationship to an Excludes 2 relationship with D49 (Neoplasm of unspecified behavior).
    
    This adjustment allows both codes to be reported together if supported by documentation.

Additional “Code Also” and Instructional Note Updates

Several other instructional notes, including “code also” and sequencing instructions, have been revised. These changes cover a variety of conditions, including:

• Coding sequela of concussion (S06.0X- with appropriate 7th character) with F07.81 (Postconcussional syndrome), when applicable.
  
• Coding underlying conditions such as diabetes mellitus (E08.39, E09.39, E10.39, E11.39, E13.39) with H40.84 (Neovascular secondary angle closure glaucoma). The instruction to code diabetes first has now been revised to a “code also” note.

The April 1 update may look minor at first glance, but revisions to Excludes notes and sequencing instructions can significantly impact code assignment. Taking time to review the addendum now will help prevent errors and ensure compliant reporting moving forward.