Updates to ICD-10 occur twice each year—once in April and again in October. An upcoming ICD-10 coding update will take effect on October 1. While the April releases may bring some changes, and occasionally none at all, the October update is typically more significant.
In April, no new codes were added, but there were updates to the official coding guidelines and conventions. One key change is that a positive COVID-19 test alone is no longer sufficient for diagnosis—provider confirmation is now required. Additionally, when coding for obesity, a specific obesity class must be assigned, and that classification must come directly from the provider. A BMI code may also be included if there is supporting clinical documentation of the patient’s height and weight.
For the October update, there are a substantial number of changes, including 487 new ICD-10 codes, with 28 deletions, and 38 revisions. One of the most significant additions is the inclusion of 111 new codes specifically for documenting non-pressure ulcers. In addition, three new codes have been introduced for malignant inflammatory neoplasm of the breast. There are also several new codes related to multiple sclerosis and thyroid eye disease.
In addition, as we’ve noted on several occasions, CMS remains focused on gathering data related to Social Determinants of Health. As part of this effort, new diagnosis codes have been added in the October update to specifically address financial insecurity among patients. Given some of the previously proposed elements related to Social Determinants of Health, there is an anticipated possibility of a new OASIS being introduced in 2027.
It is essential to understand the new diagnosis codes and to recognize the crucial role that accurate coding plays in both home health and hospice care. In home health specifically, it’s essential to ensure that the primary diagnosis is one that is acceptable under PDGM for Medicare patients. Additionally, any comorbidities the patient has should be accurately documented—not just in the Plan of Care, but also on the claims—so they can be factored into the PDGM payment calculation.
Please make sure that anyone responsible for coding on your behalf fully understands that all diagnoses submitted on home health or hospice claims must be supported by documentation from a physician or practitioner. This information cannot be based solely on input from nurses or from the patient verbally stating a condition. It is essential to have proper provider documentation to substantiate each diagnosis used for coding purposes.
One final coding clarification: In a previous Monday Minute, we mentioned an issue with claims being flagged when a primary diagnosis of dementia—previously ruled out for some outpatient settings—was used in home health. Although it wasn’t originally intended to impact home health, those claims were being placed into T-status when certain dementia codes were submitted. This edit has now been corrected. You will need to manually re-file those affected claims or release them from T-status, and they should now process for payment.
Healthcare Provider Solutions is here to support you with all your ICD-10 coding needs. We’ll be covering these new codes, along with the latest OASIS updates, in depth at our two-day Home Health Workshop this August in Nashville. For more information, and to register, click here.
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