ICD-10 Coding and Guideline Updates for FY 2022

Earlier this summer, the Centers for Medicare & Medicaid Services (CMS) released the ICD-10-CM code descriptions, tables and index, and addendum for the fiscal year 2022.

Then on July 12th, the Official Guidelines for Coding and Reporting of ICD-10-CM became available online. The updated manual and guidelines for FY 2022 revealed 159 new codes, along with the Tabular and Index Addenda. Below is a summary of the changes that will most affect the Skilled Nursing Facilities (SNF) in the upcoming year:


CHAPTER 3 - Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism (D50-D89)

  • D55.21 Anemia due to pyruvate kinase deficiency
  • D55.29 Anemia due to other disorders of glycolytic enzymes
  • D75.838 Other thrombocytosis
  • D75.839 Thrombocytosis
  • D89.44 Hereditary alpha tryptasemia

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

  • F32.A Depression, unspecified under revised category F32 Depressive episode
  • F78.A9 Other genetic related intellectual disabilities under a new subcategory
  • F78.A- Other genetic-related intellectual disabilities.

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

  • I5A Non-ischemic myocardial injury (non-traumatic)
  • I20-I25 Ischemic, now requires an appropriate HTN code

CHAPTER 12 - Diseases of the Skin and Subcutaneous Tissue (L00-L99)

  • Under L24.A- Irritant contact dermatitis due to friction or contact with body fluids, adds four new codes to identify the fluid type
  • Under L24.B- Irritant contact dermatitis related to stoma or fistula adds four new codes to enable 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)

  • New subcategory M45.A Non-radiographic axial spondyloarthritis and ten codes for non-radiographic axial spondyloarthritis
  • M54.50 Low back pain, unspecified
  • M54.51 Vertebrogenic low back pain
  • M54.59 Other low back pain.

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

  • R05 is not a reportable code in the 2022 code set. Instead, there are six new codes for cough with greater specificity
  • The addition of two codes to differentiate between nocturnal polyuria and polyuria is not otherwise specified (NOS)
  • R45.88 Non-suicidal self-harm
  • R79.83 Abnormal findings of blood amino-acid level
  • R63.30 Feeding difficulties, unspecified
  • R63.39 Other feeding difficulties (feeding problem (elderly) (infant) NOS, picky eater)

Coding Conventions

In addition to the above ICD-10 codes, changes and clarifications are also made to the coding conventions. Here is a quick summary of the changes that will affect Skilled Nursing Facilities. For detail on these changes, please refer to the Official Guidelines for Coding.

  • Additional instructions are added for situations when the patient's provider does not document laterality. Code assignment for the affected side can be based on medical record documentation from other clinicians.
  • Documentation by Clinicians Other than the Patient's Provider has expanded the exceptions. These exceptions now include codes for non-pressure chronic ulcers, social determinants of health (SDOH), laterality, and blood alcohol level.
  • New "post-COVID-19" guidance, including the assignment of code U09.9, Post COVID-19 condition, unspecified.

For More Information

ICD-10-CM Official Guidelines for Coding and Reporting FY 2022 https://www.cms.gov/files/document/fy-2022-icd-10-cm-coding-guidelines.pdf

CMS. Gov 2022 ICD-10-CM: https://www.cms.gov/medicare/icd-10/2022-icd-10-cm