New and Revised Diagnosis Codes for 2019

The 2019 ICD-10-CM code set includes 279 new codes, 143 revised codes, and 51 deleted codes. These changes go into effect October 1, 2018. This article will review some of the changes that are most important to radiology. You can find the complete ICD-10-CM code set for Fiscal Year 2019 on the website of the National Center for Health Statistics (NCHS): https://www.cdc.gov/nchs/icd/icd10cm.htm

Please see the separate article in this issue for a discussion of the 2019 changes to the ICD-10-CM guidelines.

Neoplasms of the Eyelid

There are 44 new codes in the Neoplasms chapter to distinguish between neoplasms of the upper eyelid and lower eyelid. Previously, the codes only identified the eyelid, without specifying if the upper or lower eyelid is affected. These changes are reflected in both the Tabular List as well as the Neoplasm Table. For example:

C4A.111 Merkel cell carcinoma of the right upper eyelid, including canthus

C4A.112 Merkel cell carcinoma of the right lower eyelid, including canthus

Refer to the ICD-10-CM Manual to see all of the changes.

Facial Nerve Disorders

Four new codes for clonic hemifacial spasm have been subdivided to create individual codes identifying laterality – G51.31 (right), G51.32 (left), G51.33 (bilateral) and G51.39 (unspecified).

Muscular Dystrophy

All of the inclusion terms under G71.0 (Muscular Dystrophy) were deleted and replaced with 4 new codes and corresponding inclusion terms under this subcategory.

G71.00 Muscular dystrophy, unspecified
G71.01 Duchenne or Becker muscular dystrophy
G71.02 Facioscapulohumeral muscular dystrophy
G71.09 Other specified muscular dystrophies

Cerebral Infarction

Codes I63.219 and I63.239 were revised to read “artery” rather than “arteries” in the code definitions.

There are also 2 new codes under subcategory I63.8 (Other cerebral infarction):

I63.81 Other cerebral infarction due to occlusion or stenosis of small artery
I63.89 Other cerebral infarction

Hereditary Cerebrovascular Diseases

A new subcategory has been created to identify hereditary cerebrovascular disease (I67.85). This includes codes I67.850 (Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) and I67.858 (Other hereditary cerebrovascular disease).

Acute Appendicitis

The inclusion terms under subcategories K35.2 (Acute appendicitis with generalized peritonitis) and K35.3 (Acute appendicitis with localized peritonitis) have been deleted and replaced with new codes and corresponding inclusion terms to specify complications such as gangrene and abscess. Subcategory K35.89 (Other acute appendicitis) has also been expanded to specify with or without gangrene. See Table 1 for complete code descriptions.

Table 1
Code Description
K35.20 Acute appendicitis with generalized peritonitis, without abscess
K35.21 Acute appendicitis with generalized peritonitis, with abscess
K35.30 Acute appendicitis with localized peritonitis, without perforation or gangrene
K35.31 Acute appendicitis with localized peritonitis and gangrene, without perforation
K35.32 Acute appendicitis with perforation and localized peritonitis, without abscess
K35.33 Acute appendicitis with perforation and localized peritonitis, with abscess
K35.890 Other acute appendicitis without perforation or gangrene
K35.891 Other acute appendicitis without perforation, with gangrene

Disorders of the Gallbladder and Biliary Tract

Two new codes have been added to identify gangrene (K82.A1) or perforation (K82.A2) of the gallbladder in cholecystitis. In turn, a note has been added under cholelithiasis subcategories K80.0, K80.1, K80.4, and K80.6, and under category K81 (Cholecystitis) to “Use additional code if application for associated gangrene of gallbladder (K82.A1), or perforation of gallbladder (K82.A2).”

All of the inclusion terms under subcategory K83.0 (Cholangitis) have been deleted and replaced with new codes and corresponding inclusion terms to distinguish between primary sclerosing cholangitis (K83.01) and other cholangitis (K83.09).

Multiple Gestation

Three new subcategories and 12 new codes were added for multiple gestation to include more code options to identify the number of placentas and amniotic sacs present, as shown in Table 2.

Table 2
Code Description
O30.131 Triplet pregnancy, trichorionic/triamniotic, first trimester
O30.132 Triplet pregnancy, trichorionic/triamniotic, second trimester
O30.133 Triplet pregnancy, trichorionic/triamniotic, third trimester
O30.139 Triplet pregnancy, trichorionic/triamniotic, unspecified trimester
O30.231 Quadruplet pregnancy, quadrachorionic/quadra-amniotic, first trimester
O30.232 Quadruplet pregnancy, quadrachorionic/quadra-amniotic, second trimester
O30.233 Quadruplet pregnancy, quadrachorionic/quadra-amniotic, third trimester
O30.239 Quadruplet pregnancy, quadrachorionic/quadra-amniotic, unspecified trimester
O30.831 Other specified multiple gestation, number of chorions and amnions are both equal to the number of fetuses, first trimester
O30.832 Other specified multiple gestation, number of chorions and amnions are both equal to the number of fetuses, second trimester
O30.833 Other specified multiple gestation, number of chorions and amnions are both equal to the number of fetuses, third trimester
O30.839 Other specified multiple gestation, number of chorions and amnions are both equal to the number of fetuses, unspecified trimester

Congenital Malformation of Uterus

Subcategory Q51.2 (Other doubling of uterus) has been divided to specify unspecified (Q51.20), complete (Q51.21), partial (Q51.22), or other specified (Q51.28) doubling of the uterus.

Coma Scale

Inclusion terms have been added to the coma scale codes under subcategory R40.2 (Coma) to indicate the corresponding coma scale scores.

Abnormal Findings

Subcategory R93.81 (Abnormal radiologic findings on diagnostic imaging of testis) has been divided to specify laterality – right (R93.811), left (R93.812), bilateral (R93.813), and unspecified (R93.819).

Fracture of Finger

The code descriptions have been revised to read “middle” phalanx rather than “medial” phalanx for applicable codes under subcategory S626.6 [Fracture of other and unspecified finger(s)].

Post-Procedural Infection

All of the inclusion terms under code T81.4 (Infection following a procedure) have been deleted and replaced with 6 new codes and corresponding inclusion terms in order to provide more specificity, as shown on Table 3.

Table 3
Code Description
T81.40 Infection following a procedure, unspecified
T81.41 Infection following a procedure, superficial incisional surgical site
T81.42 Infection following a procedure, deep incisional surgical site
T81.43 Infection following a procedure, organ and space surgical site
T81.44 Sepsis following a procedure
T81.49 Infection following a procedure, other surgical site