What changes are being made to ICD-10-CM guidelines or codes for FY2022 that impact nursing facilities?



The code change that will have the greatest impact on nursing facilities is the new code for unspecified depression, which is F32.A. Prior to 10/01/21, we were directed to code depression (unspecified) to F32.9, Major depressive disorder, single episode, unspecified, as that was the default code for depression NOS. Moving forward after 10/01/21, you will need to change the code for those with unspecified depression from F32.9 to F32.A. Other relevant code changes include:

      • R05 Cough is no longer a reportable code in the 2022 code set. Instead, a 4th character is to be added to R05 to provide greater specificity regarding the cough. Coding options now include R05.1 Acute cough, R05.2 Subacute cough, R05.3 Chronic cough, R05.4 Cough syncope, R05.8 Other specified cough or R05.9 Unspecified cough.
      • 6 codes were added in Chapter 19  to differentiate traumatic brain compression with or without herniation under new subcategory S06.A- Traumatic brain cohesion and herniation

There were several updates to the ICD-10-CM Official Coding Guidelines. Below is a summary of pertinent changes:

      • The coding guidelines have been updated to reflect that when laterality is not documented by the provider, code assignment for the affected side may be based on medical record documentation from other clinicians. If there is conflicting documentation regarding the affected side, the patient’s attending provider should be queried for clarification. Codes for “unspecified” side should rarely be used, such as when documentation in the record is insufficient to determine the affected side and it is not possible to obtain clarification.
      • A guideline related to history of HIV managed by medication was added, which states “If a patient with documented history of HIV disease is currently managed on antiretroviral medications, assign code B20, Human immunodeficiency virus [HIV] disease. Code Z79.899, Other long-term (current) drug therapy, may be assigned as an additional code to identify the long-term (current) use of antiretroviral medications.”
      • A guideline related to Post COVID-19 Condition was added that states “For sequela of COVID-19, or associated symptoms or conditions that develop following a previous COVID-19 infection, assign a code(s) for the specific symptom(s) or condition(s) related to the previous COVID-19 infection, if known, and code U09.9, Post COVID-19 condition, unspecified. Code U09.9 should not be assigned for manifestations of an active (current) COVID-19 infection. If a patient has a condition(s) associated with a previous COVID-19 infection and develops a new active (current) COVID-19 infection, code U09.9 may be assigned in conjunction with code U07.1, COVID-19, to identify that the patient also has a condition(s) associated with a previous COVID-19 infection. Code(s) for the specific condition(s) associated with the previous COVID-19 infection and code(s) for manifestation(s) of the new active (current) COVID-19 infection should also be assigned.
      • The following was added to the Unstageable Pressure Ulcer guidance:  “If during an encounter, the stage of an unstageable pressure ulcer is revealed after debridement, assign only the code for the stage revealed following debridement.”
      • Other added guidance includes guidance on medical conditions due to psychoactive substance use, abuse, and dependence; blood alcohol level; and social determinants of health

Answer by Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, CLNC, CPC, Proactive Medical Review

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