ICD 10 CM Codes Official Updates and Changes - 2024

There are 500+ code changes in 2024 including new, deleted, revised, and parent codes. These 2024 ICD-10-CM codes are to be used from the effective date of services from October 1, 2023, through September 30, 2024. 

New Codes  - 501 Additions

Deleted Codes - 25 Deletions

Revised Codes -  17 Revisions 

Converted to Parent Code - 25 Codes

New Codes

ICD Code Code Description

A41.54 Sepsis due to Acinetobacter baumannii

B96.83 Acinetobacter baumannii as the cause of diseases classified elsewhere

D13.91 Familial adenomatous polyposis

D13.99 Benign neoplasm of ill-defined sites within the digestive system

D48.110 Desmoid tumor of head and neck

D48.111 Desmoid tumor of chest wall

D48.112 Desmoid tumor, intrathoracic

D48.113 Desmoid tumor of abdominal wall

D48.114 Desmoid tumor, intraabdominal

D48.115 Desmoid tumor of upper extremity and shoulder girdle

D48.116 Desmoid tumor of lower extremity and pelvic girdle

D48.117 Desmoid tumor of back

D48.118 Desmoid tumor of other site

D48.119 Desmoid tumor of unspecified site

D48.19 Other specified neoplasm of uncertain behavior of connective and other soft tissue

D57.04 Hb-SS disease with dactylitis

D57.214 Sickle-cell/Hb-C disease with dactylitis

D57.414 Sickle-cell thalassemia, unspecified, with dactylitis

D57.434 Sickle-cell thalassemia beta zero with dactylitis

D57.454 Sickle-cell thalassemia beta plus with dactylitis

D57.814 Other sickle-cell disorders with dactylitis

D61.02 Shwachman-Diamond syndrome

D89.84 IgG4-related disease

E20.810 Autosomal dominant hypocalcemia

E20.811 Secondary hypoparathyroidism in diseases classified elsewhere

E20.812 Autoimmune hypoparathyroidism

E20.818 Other specified hypoparathyroidism due to impaired parathyroid hormone secretion

E20.819 Hypoparathyroidism due to impaired parathyroid hormone secretion, unspecified

E20.89 Other specified hypoparathyroidism

E74.05 Lysosome-associated membrane protein 2 [LAMP2] deficiency

E75.27 Pelizaeus-Merzbacher disease

E75.28 Canavan disease

E79.81 Aicardi-Goutieres syndrome

E79.82 Hereditary xanthinuria

E79.89 Other specified disorders of purine and pyrimidine metabolism

E88.43 Disorders of mitochondrial tRNA synthetases

E88.810 Metabolic syndrome

E88.811 Insulin resistance syndrome, Type A

E88.818 Other insulin resistance

E88.819 Insulin resistance, unspecified

E88.A Wasting disease (syndrome) due to underlying condition

G11.5 Hypomyelination - hypogonadotropic hypogonadism - hypodontia

G11.6 Leukodystrophy with vanishing white matter disease

G20.A1 Parkinson's disease without dyskinesia, without mention of fluctuations

G20.A2 Parkinson's disease without dyskinesia, with fluctuations

G20.B1 Parkinson's disease with dyskinesia, without mention of fluctuations

G20.B2 Parkinson's disease with dyskinesia, with fluctuations

G20.C Parkinsonism, unspecified

G23.3 Hypomyelination with atrophy of the basal ganglia and cerebellum

G31.80 Leukodystrophy, unspecified

G31.86 Alexander disease

G37.81 Myelin oligodendrocyte glycoprotein antibody disease

G37.89 Other specified demyelinating diseases of central nervous system

G40.C01 Lafora progressive myoclonus epilepsy, not intractable, with status epilepticus

G40.C09 Lafora progressive myoclonus epilepsy, not intractable, without status epilepticus

G40.C11 Lafora progressive myoclonus epilepsy, intractable, with status epilepticus

G40.C19 Lafora progressive myoclonus epilepsy, intractable, without status epilepticus

G43.E01 Chronic migraine with aura, not intractable, with status migrainosus

G43.E09 Chronic migraine with aura, not intractable, without status migrainosus

G43.E11 Chronic migraine with aura, intractable, with status migrainosus

G43.E19 Chronic migraine with aura, intractable, without status migrainosus

G90.B LMNB1-related autosomal dominant leukodystrophy

G93.42 Megaloencephalic leukoencephalopathy with subcortical cysts

G93.43 Leukoencephalopathy with calcifications and cysts

G93.44 Adult-onset leukodystrophy with axonal spheroids

H36.811 Nonproliferative sickle-cell retinopathy, right eye

H36.812 Nonproliferative sickle-cell retinopathy, left eye

H36.813 Nonproliferative sickle-cell retinopathy, bilateral

H36.819 Nonproliferative sickle-cell retinopathy, unspecified eye

H36.821 Proliferative sickle-cell retinopathy, right eye

H36.822 Proliferative sickle-cell retinopathy, left eye

H36.823 Proliferative sickle-cell retinopathy, bilateral

H36.829 Proliferative sickle-cell retinopathy, unspecified eye

H36.89 Other retinal disorders in diseases classified elsewhere

H50.621 Inferior oblique muscle entrapment, right eye

H50.622 Inferior oblique muscle entrapment, left eye

H50.629 Inferior oblique muscle entrapment, unspecified eye

H50.631 Inferior rectus muscle entrapment, right eye

H50.632 Inferior rectus muscle entrapment, left eye

H50.639 Inferior rectus muscle entrapment, unspecified eye

H50.641 Lateral rectus muscle entrapment, right eye

H50.642 Lateral rectus muscle entrapment, left eye

H50.649 Lateral rectus muscle entrapment, unspecified eye

H50.651 Medial rectus muscle entrapment, right eye

H50.652 Medial rectus muscle entrapment, left eye

H50.659 Medial rectus muscle entrapment, unspecified eye

H50.661 Superior oblique muscle entrapment, right eye

H50.662 Superior oblique muscle entrapment, left eye

H50.669 Superior oblique muscle entrapment, unspecified eye

H50.671 Superior rectus muscle entrapment, right eye

H50.672 Superior rectus muscle entrapment, left eye

H50.679 Superior rectus muscle entrapment, unspecified eye

H50.681 Extraocular muscle entrapment, unspecified, right eye

H50.682 Extraocular muscle entrapment, unspecified, left eye

H50.689 Extraocular muscle entrapment, unspecified, unspecified eye

H54.512 Low vision, right eye, category 2

H57.8A1 Foreign body sensation, right eye

H57.8A2 Foreign body sensation, left eye

H57.8A3 Foreign body sensation, bilateral eyes

H57.8A9 Foreign body sensation, unspecified eye

I1A Other hypertension

I1A.0 Resistant hypertension

I20.81 Angina pectoris with coronary microvascular dysfunction

I20.89 Other forms of angina pectoris

I21.B Myocardial infarction with coronary microvascular dysfunction

I24.81 Acute coronary microvascular dysfunction

I24.89 Other forms of acute ischemic heart disease

I25.85 Chronic coronary microvascular dysfunction

I47.10 Supraventricular tachycardia, unspecified

I47.11 Inappropriate sinus tachycardia, so stated

I47.19 Other supraventricular tachycardia

J15.61 Pneumonia due to Acinetobacter baumannii

J15.69 Pneumonia due to other Gram-negative bacteria

J44.81 Bronchiolitis obliterans and bronchiolitis obliterans syndrome

J44.89 Other specified chronic obstructive pulmonary disease

J4A.0 Restrictive allograft syndrome

J4A.8 Other chronic lung allograft dysfunction

J4A.9 Chronic lung allograft dysfunction, unspecified

K35.200 Acute appendicitis with generalized peritonitis, without perforation or abscess

K35.201 Acute appendicitis with generalized peritonitis, with perforation, without abscess

K35.209 Acute appendicitis with generalized peritonitis, without abscess, unspecified as to perforation

K35.210 Acute appendicitis with generalized peritonitis, without perforation, with abscess

K35.211 Acute appendicitis with generalized peritonitis, with perforation and abscess

K35.219 Acute appendicitis with generalized peritonitis, with abscess, unspecified as to perforation

K63.8211 Small intestinal bacterial overgrowth, hydrogen-subtype

K63.8212 Small intestinal bacterial overgrowth, hydrogen sulfide-subtype

K63.8219 Small intestinal bacterial overgrowth, unspecified

K63.822 Small intestinal fungal overgrowth

K63.829 Intestinal methanogen overgrowth, unspecified

K68.2 Retroperitoneal fibrosis

K68.3 Retroperitoneal hematoma

K90.821 Short bowel syndrome with colon in continuity

K90.822 Short bowel syndrome without colon in continuity

K90.829 Short bowel syndrome, unspecified

K90.83 Intestinal failure

M80.0B1A Age-related osteoporosis with current pathological fracture, right pelvis, initial encounter for fracture

M80.0B1D Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with routine healing

M80.0B1G Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with delayed healing

M80.0B1K Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with nonunion

M80.0B1P Age-related osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with malunion

M80.0B1S Age-related osteoporosis with current pathological fracture, right pelvis, sequela

M80.0B2A Age-related osteoporosis with current pathological fracture, left pelvis, initial encounter for fracture

M80.0B2D Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with routine healing

M80.0B2G Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with delayed healing

M80.0B2K Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with nonunion

M80.0B2P Age-related osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with malunion

M80.0B2S Age-related osteoporosis with current pathological fracture, left pelvis, sequela

M80.0B9A Age-related osteoporosis with current pathological fracture, unspecified pelvis, initial encounter for fracture

M80.0B9D Age-related osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with routine healing

M80.0B9G Age-related osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with delayed healing

M80.0B9K Age-related osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with nonunion

M80.0B9P Age-related osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with malunion

M80.0B9S Age-related osteoporosis with current pathological fracture, unspecified pelvis, sequela

M80.8B1A Other osteoporosis with current pathological fracture, right pelvis, initial encounter for fracture

M80.8B1D Other osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with routine healing

M80.8B1G Other osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with delayed healing

M80.8B1K Other osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with nonunion

M80.8B1P Other osteoporosis with current pathological fracture, right pelvis, subsequent encounter for fracture with malunion

M80.8B1S Other osteoporosis with current pathological fracture, right pelvis, sequela

M80.8B2A Other osteoporosis with current pathological fracture, left pelvis, initial encounter for fracture

M80.8B2D Other osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with routine healing

M80.8B2G Other osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with delayed healing

M80.8B2K Other osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with nonunion

M80.8B2P Other osteoporosis with current pathological fracture, left pelvis, subsequent encounter for fracture with malunion

M80.8B2S Other osteoporosis with current pathological fracture, left pelvis, sequela

M80.8B9A Other osteoporosis with current pathological fracture, unspecified pelvis, initial encounter for fracture

M80.8B9D Other osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with routine healing

M80.8B9G Other osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with delayed healing

M80.8B9K Other osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with nonunion

M80.8B9P Other osteoporosis with current pathological fracture, unspecified pelvis, subsequent encounter for fracture with malunion

M80.8B9S Other osteoporosis with current pathological fracture, unspecified pelvis, sequela

N02.B1 Recurrent and persistent immunoglobulin A nephropathy with glomerular lesion

N02.B2 Recurrent and persistent immunoglobulin A nephropathy with focal and segmental glomerular lesion

N02.B3 Recurrent and persistent immunoglobulin A nephropathy with diffuse membranoproliferative glomerulonephritis

N02.B4 Recurrent and persistent immunoglobulin A nephropathy with diffuse membranous glomerulonephritis

N02.B5 Recurrent and persistent immunoglobulin A nephropathy with diffuse mesangial proliferative glomerulonephritis

N02.B6 Recurrent and persistent immunoglobulin A nephropathy with diffuse mesangiocapillary glomerulonephritis

N02.B9 Other recurrent and persistent immunoglobulin A nephropathy

N04.20 Nephrotic syndrome with diffuse membranous glomerulonephritis, unspecified

N04.21 Primary membranous nephropathy with nephrotic syndrome

N04.22 Secondary membranous nephropathy with nephrotic syndrome

N04.29 Other nephrotic syndrome with diffuse membranous glomerulonephritis

N06.20 Isolated proteinuria with diffuse membranous glomerulonephritis, unspecified

N06.21 Primary membranous nephropathy with isolated proteinuria

N06.22 Secondary membranous nephropathy with isolated proteinuria

N06.29 Other isolated proteinuria with diffuse membranous glomerulonephritis

O26.641 Intrahepatic cholestasis of pregnancy, first trimester

O26.642 Intrahepatic cholestasis of pregnancy, second trimester

O26.643 Intrahepatic cholestasis of pregnancy, third trimester

O26.649 Intrahepatic cholestasis of pregnancy, unspecified trimester

O90.41 Hepatorenal syndrome following labor and delivery

O90.49 Other postpartum acute kidney failure

Q44.70 Other congenital malformation of liver, unspecified

Q44.71 Alagille syndrome

Q44.79 Other congenital malformations of liver

Q75.001 Craniosynostosis unspecified, unilateral

Q75.002 Craniosynostosis unspecified, bilateral

Q75.009 Craniosynostosis unspecified

Q75.01 Sagittal craniosynostosis

Q75.021 Coronal craniosynostosis unilateral

Q75.022 Coronal craniosynostosis bilateral

Q75.029 Coronal craniosynostosis unspecified

Q75.03 Metopic craniosynostosis

Q75.041 Lambdoid craniosynostosis, unilateral

Q75.042 Lambdoid craniosynostosis, bilateral

Q75.049 Lambdoid craniosynostosis, unspecified

Q75.051 Cloverleaf skull

Q75.052 Pansynostosis

Q75.058 Other multi-suture craniosynostosis

Q75.08 Other single-suture craniosynostosis

Q87.83 Bardet-Biedl syndrome

Q87.84 Laurence-Moon syndrome

Q87.85 MED13L syndrome

Q93.52 Phelan-McDermid syndrome

R09.A0 Foreign body sensation, unspecified

R09.A1 Foreign body sensation, nose

R09.A2 Foreign body sensation, throat

R09.A9 Foreign body sensation, other site

R40.2A Nontraumatic coma due to underlying condition

R92.30 Dense breasts, unspecified

R92.311 Mammographic fatty tissue density, right breast

R92.312 Mammographic fatty tissue density, left breast

R92.313 Mammographic fatty tissue density, bilateral breasts

R92.321 Mammographic fibroglandular density, right breast

R92.322 Mammographic fibroglandular density, left breast

R92.323 Mammographic fibroglandular density, bilateral breasts

R92.331 Mammographic heterogeneous density, right breast

R92.332 Mammographic heterogeneous density, left breast

R92.333 Mammographic heterogeneous density, bilateral breasts

R92.341 Mammographic extreme density, right breast

R92.342 Mammographic extreme density, left breast

R92.343 Mammographic extreme density, bilateral breasts

T56.821A Toxic effect of gadolinium, accidental (unintentional), initial encounter

T56.821D Toxic effect of gadolinium, accidental (unintentional), subsequent encounter

T56.821S Toxic effect of gadolinium, accidental (unintentional), sequela

T56.822A Toxic effect of gadolinium, intentional self-harm, initial encounter

T56.822D Toxic effect of gadolinium, intentional self-harm, subsequent encounter

T56.822S Toxic effect of gadolinium, intentional self-harm, sequela

T56.823A Toxic effect of gadolinium, assault, initial encounter

T56.823D Toxic effect of gadolinium, assault, subsequent encounter

T56.823S Toxic effect of gadolinium, assault, sequela

T56.824A Toxic effect of gadolinium, undetermined, initial encounter

T56.824D Toxic effect of gadolinium, undetermined, subsequent encounter

T56.824S Toxic effect of gadolinium, undetermined, sequela

W44.8XXA Other foreign body entering into or through a natural orifice, initial encounter

W44.8XXD Other foreign body entering into or through a natural orifice, subsequent encounter

W44.8XXS Other foreign body entering into or through a natural orifice, sequela

W44.9XXA Unspecified foreign body entering into or through a natural orifice, initial encounter

W44.9XXD Unspecified foreign body entering into or through a natural orifice, subsequent encounter

W44.9XXS Unspecified foreign body entering into or through a natural orifice, sequela

W44.A0XA Battery unspecified, entering into or through a natural orifice, initial encounter

W44.A0XD Battery unspecified, entering into or through a natural orifice, subsequent encounter

W44.A0XS Battery unspecified, entering into or through a natural orifice, sequela

W44.A1XA Button battery entering into or through a natural orifice, initial encounter

W44.A1XD Button battery entering into or through a natural orifice, subsequent encounter

W44.A1XS Button battery entering into or through a natural orifice, sequela

W44.A9XA Other batteries entering into or through a natural orifice, initial encounter

W44.A9XD Other batteries entering into or through a natural orifice, subsequent encounter

W44.A9XS Other batteries entering into or through a natural orifice, sequela

W44.B0XA Plastic object unspecified, entering into or through a natural orifice, initial encounter

W44.B0XD Plastic object unspecified, entering into or through a natural orifice, subsequent encounter

W44.B0XS Plastic object unspecified, entering into or through a natural orifice, sequela

W44.B1XA Plastic bead entering into or through a natural orifice, initial encounter

W44.B1XD Plastic bead entering into or through a natural orifice, subsequent encounter

W44.B1XS Plastic bead entering into or through a natural orifice, sequela

W44.B2XA Plastic coin entering into or through a natural orifice, initial encounter

W44.B2XD Plastic coin entering into or through a natural orifice, subsequent encounter

W44.B2XS Plastic coin entering into or through a natural orifice, sequela

W44.B3XA Plastic toy and toy part entering into or through a natural orifice, initial encounter

W44.B3XD Plastic toy and toy part entering into or through a natural orifice, subsequent encounter

W44.B3XS Plastic toy and toy part entering into or through a natural orifice, sequela

W44.B4XA Plastic jewelry entering into or through a natural orifice, initial encounter

W44.B4XD Plastic jewelry entering into or through a natural orifice, subsequent encounter

W44.B4XS Plastic jewelry entering into or through a natural orifice, sequela

W44.B5XA Plastic bottle entering into or through a natural orifice, initial encounter

W44.B5XD Plastic bottle entering into or through a natural orifice, subsequent encounter

W44.B5XS Plastic bottle entering into or through a natural orifice, sequela

W44.B9XA Other plastic object entering into or through a natural orifice, initial encounter

W44.B9XD Other plastic object entering into or through a natural orifice, subsequent encounter

W44.B9XS Other plastic object entering into or through a natural orifice, sequela

W44.C0XA Glass unspecified, entering into or through a natural orifice, initial encounter

W44.C0XD Glass unspecified, entering into or through a natural orifice, subsequent encounter

W44.C0XS Glass unspecified, entering into or through a natural orifice, sequela

W44.C1XA Sharp glass entering into or through a natural orifice, initial encounter

W44.C1XD Sharp glass entering into or through a natural orifice, subsequent encounter

W44.C1XS Sharp glass entering into or through a natural orifice, sequela

W44.C2XA Intact glass entering into or through a natural orifice, initial encounter

W44.C2XD Intact glass entering into or through a natural orifice, subsequent encounter

W44.C2XS Intact glass entering into or through a natural orifice, sequela

W44.D0XA Magnetic metal object unspecified, entering into or through a natural orifice, initial encounter

W44.D0XD Magnetic metal object unspecified, entering into or through a natural orifice, subsequent encounter

W44.D0XS Magnetic metal object unspecified, entering into or through a natural orifice, sequela

W44.D1XA Magnetic metal bead entering into or through a natural orifice, initial encounter

W44.D1XD Magnetic metal bead entering into or through a natural orifice, subsequent encounter

W44.D1XS Magnetic metal bead entering into or through a natural orifice, sequela

W44.D2XA Magnetic metal coin entering into or through a natural orifice, initial encounter

W44.D2XD Magnetic metal coin entering into or through a natural orifice, subsequent encounter

W44.D2XS Magnetic metal coin entering into or through a natural orifice, sequela

W44.D3XA Magnetic metal toy entering into or through a natural orifice, initial encounter

W44.D3XD Magnetic metal toy entering into or through a natural orifice, subsequent encounter

W44.D3XS Magnetic metal toy entering into or through a natural orifice, sequela

W44.D4XA Magnetic metal jewelry entering into or through a natural orifice, initial encounter

W44.D4XD Magnetic metal jewelry entering into or through a natural orifice, subsequent encounter

W44.D4XS Magnetic metal jewelry entering into or through a natural orifice, sequela

W44.D9XA Other magnetic metal objects entering into or through a natural orifice, initial encounter

W44.D9XD Other magnetic metal objects entering into or through a natural orifice, subsequent encounter

W44.D9XS Other magnetic metal objects entering into or through a natural orifice, sequela

W44.E0XA Non-magnetic metal object unspecified, entering into or through a natural orifice, initial encounter

W44.E0XD Non-magnetic metal object unspecified, entering into or through a natural orifice, subsequent encounter

W44.E0XS Non-magnetic metal object unspecified, entering into or through a natural orifice, sequela

W44.E1XA Non-magnetic metal bead entering into or through a natural orifice, initial encounter

W44.E1XD Non-magnetic metal bead entering into or through a natural orifice, subsequent encounter

W44.E1XS Non-magnetic metal bead entering into or through a natural orifice, sequela

W44.E2XA Non-magnetic metal coin entering into or through a natural orifice, initial encounter

W44.E2XD Non-magnetic metal coin entering into or through a natural orifice, subsequent encounter

W44.E2XS Non-magnetic metal coin entering into or through a natural orifice, sequela

W44.E3XA Non-magnetic metal toy entering into or through a natural orifice, initial encounter

W44.E3XD Non-magnetic metal toy entering into or through a natural orifice, subsequent encounter

W44.E3XS Non-magnetic metal toy entering into or through a natural orifice, sequela

W44.E4XA Non-magnetic metal jewelry entering into or through a natural orifice, initial encounter

W44.E4XD Non-magnetic metal jewelry entering into or through a natural orifice, subsequent encounter

W44.E4XS Non-magnetic metal jewelry entering into or through a natural orifice, sequela

W44.E9XA Other non-magnetic metal objects entering into or through a natural orifice, initial encounter

W44.E9XD Other non-magnetic metal objects entering into or through a natural orifice, subsequent encounter

W44.E9XS Other non-magnetic metal objects entering into or through a natural orifice, sequela

W44.F0XA Objects of natural or organic material unspecified, entering into or through a natural orifice, initial encounter

W44.F0XD Objects of natural or organic material unspecified, entering into or through a natural orifice, subsequent encounter

W44.F0XS Objects of natural or organic material unspecified, entering into or through a natural orifice, sequela

W44.F1XA Bezoar entering into or through a natural orifice, initial encounter

W44.F1XD Bezoar entering into or through a natural orifice, subsequent encounter

W44.F1XS Bezoar entering into or through a natural orifice, sequela

W44.F2XA Rubber band entering into or through a natural orifice, initial encounter

W44.F2XD Rubber band entering into or through a natural orifice, subsequent encounter

W44.F2XS Rubber band entering into or through a natural orifice, sequela

W44.F3XA Food entering into or through a natural orifice, initial encounter

W44.F3XD Food entering into or through a natural orifice, subsequent encounter

W44.F3XS Food entering into or through a natural orifice, sequela

W44.F4XA Insect entering into or through a natural orifice, initial encounter

W44.F4XD Insect entering into or through a natural orifice, subsequent encounter

W44.F4XS Insect entering into or through a natural orifice, sequela

W44.F9XA Other object of natural or organic material, entering into or through a natural orifice, initial encounter

W44.F9XD Other object of natural or organic material, entering into or through a natural orifice, subsequent encounter

W44.F9XS Other object of natural or organic material, entering into or through a natural orifice, sequela

W44.G0XA Other non-organic objects unspecified, entering into or through a natural orifice, initial encounter

W44.G0XD Other non-organic objects unspecified, entering into or through a natural orifice, subsequent encounter

W44.G0XS Other non-organic objects unspecified, entering into or through a natural orifice, sequela

W44.G1XA Audio device entering into or through a natural orifice, initial encounter

W44.G1XD Audio device entering into or through a natural orifice, subsequent encounter

W44.G1XS Audio device entering into or through a natural orifice, sequela

W44.G2XA Combination metal and plastic toy and toy part entering into or through natural orifice, initial encounter

W44.G2XD Combination metal and plastic toy and toy part entering into or through natural orifice, subsequent encounter

W44.G2XS Combination metal and plastic toy and toy part entering into or through natural orifice, sequela

W44.G3XA Combination metal and plastic jewelry entering into or through a natural orifice, initial encounter

W44.G3XD Combination metal and plastic jewelry entering into or through a natural orifice, subsequent encounter

W44.G3XS Combination metal and plastic jewelry entering into or through a natural orifice, sequela

W44.G9XA Other non-organic objects entering into or through a natural orifice, initial encounter

W44.G9XD Other non-organic objects entering into or through a natural orifice, subsequent encounter

W44.G9XS Other non-organic objects entering into or through a natural orifice, sequela

W44.H0XA Other sharp object unspecified, entering into or through a natural orifice, initial encounter

W44.H0XD Other sharp object unspecified, entering into or through a natural orifice, subsequent encounter

W44.H0XS Other sharp object unspecified, entering into or through a natural orifice, sequela

W44.H1XA Needle entering into or through a natural orifice, initial encounter

W44.H1XD Needle entering into or through a natural orifice, subsequent encounter

W44.H1XS Needle entering into or through a natural orifice, sequela

W44.H2XA Knife, sword or dagger entering into or through a natural orifice, initial encounter

W44.H2XD Knife, sword or dagger entering into or through a natural orifice, subsequent encounter

W44.H2XS Knife, sword or dagger entering into or through a natural orifice, sequela

Z02.84 Encounter for child welfare exam

Z05.81 Observation and evaluation of newborn for suspected condition related to home physiologic monitoring device ruled out

Z05.89 Observation and evaluation of newborn for other specified suspected condition ruled out

Z16.13 Resistance to carbapenem

Z22.340 Carrier of carbapenem-resistant Acinetobacter baumannii

Z22.341 Carrier of carbapenem-sensitive Acinetobacter baumannii

Z22.349 Carrier of Acinetobacter baumannii, unspecified

Z22.350 Carrier of carbapenem-resistant Enterobacterales

Z22.358 Carrier of other Enterobacterales

Z22.359 Carrier of Enterobacterales, unspecified

Z29.81 Encounter for HIV pre-exposure prophylaxis

Z29.89 Encounter for other specified prophylactic measures

Z62.23 Child in custody of non-parental relative

Z62.24 Child in custody of non-relative guardian

Z62.823 Parent-step child conflict

Z62.831 Non-parental relative-child conflict

Z62.832 Non-relative guardian-child conflict

Z62.833 Group home staff-child conflict

Z62.892 Runaway [from current living environment]

Z83.710 Family history of adenomatous and serrated polyps

Z83.711 Family history of hyperplastic colon polyps

Z83.718 Other family history of colon polyps

Z83.719 Family history of colon polyps, unspecified

Z91.85 Personal history of military service

Z91.A41 Caregiver's other noncompliance with patient's medication regimen due to financial hardship

Z91.A48 Caregiver's other noncompliance with patient's medication regimen for other reason

Z91.A51 Caregiver's noncompliance with patient's renal dialysis due to financial hardship

Z91.A58 Caregiver's noncompliance with patient's renal dialysis for other reason

Z91.A91 Caregiver's noncompliance with patient's other medical treatment and regimen due to financial hardship

Z91.A98 Caregiver's noncompliance with patient's other medical treatment and regimen for other reason

Revised Codes

ICD Code Code Description

H54.511 Low vision, right eye, category 1

I25.112 Atherosclerotic heart disease of native coronary artery with refractory angina pectoris

I71.51 Supraceliac aneurysm of the thoracoabdominal aorta, ruptured

I71.52 Paravisceral aneurysm of the thoracoabdominal aorta, ruptured

I71.61 Supraceliac aneurysm of the thoracoabdominal aorta, without rupture

I71.62 Paravisceral aneurysm of the thoracoabdominal aorta, without rupture

M41.12 Adolescent idiopathic scoliosis

N35.812 Other bulbous urethral stricture, male

P19.9 Metabolic acidemia in newborn, unspecified

Q85.81 PTEN hamartoma tumor syndrome

Q87.40 Marfan syndrome, unspecified

Q87.410 Marfan syndrome with aortic dilation

Q87.418 Marfan syndrome with other cardiovascular manifestations

Q87.42 Marfan syndrome with ocular manifestations

Q87.43 Marfan syndrome with skeletal manifestation

Converted to Parent Code

ICD Code Code Description

D13.9 Benign neoplasm of ill-defined sites within the digestive system

D48.1 Neoplasm of uncertain behavior of connective and other soft tissue

E20.8 Other hypoparathyroidism

E79.8 Other disorders of purine and pyrimidine metabolism

E88.81 Metabolic syndrome and other insulin resistance

G20 Parkinson's disease

G37.8 Other specified demyelinating diseases of central nervous system

H36 Retinal disorders in diseases classified elsewhere

I20.8 Other forms of angina pectoris

I24.8 Other forms of acute ischemic heart disease

I47.1 Supraventricular tachycardia

J15.6 Pneumonia due to other Gram-negative bacteria

K35.20 Acute appendicitis with generalized peritonitis, without abscess

K35.21 Acute appendicitis with generalized peritonitis, with abscess

N04.2 Nephrotic syndrome with diffuse membranous glomerulonephritis

N06.2 Isolated proteinuria with diffuse membranous glomerulonephritis

O90.4 Postpartum acute kidney failure

Q44.7 Other congenital malformations of liver

Q75.0 Craniosynostosis

Z05.8 Observation and evaluation of newborn for other specified suspected condition ruled out

Z29.8 Encounter for other specified prophylactic measures

Z83.71 Family history of colonic polyps

Z91.A4 Caregiver's other noncompliance with patient's medication regimen

Z91.A5 Caregiver's noncompliance with patient's renal dialysis

Z91.A9 Caregiver's noncompliance with patient's other medical treatment and regimen

Click HERE to refer to the summary of the ICD 10 CM changes in 2024

ICD 10 CM Official Updates and Changes - 2024 Summary

There are 500+ code changes in 2024 including new, deleted, revised, and parent codes. These 2024 ICD-10-CM codes are to be used from the effective date of services from October 1, 2023, through September 30, 2024. 

New Codes  - 501 Additions

Deleted Codes - 25 Deletions

Revised Codes -  17 Revisions 

Converted to Parent Code - 25 Codes

Summary of the changes and updates

The updates include new codes, revised codes & deletions in 17 different chapters of ICD-10-CM. Changes to the Index and other revisions are also included in the updates. 

The distribution of codes and a summary of selected conditions are listed below,

Chapter 1: Infectious and parasitic diseases – 2 codes for Acinetobacter baumannii sepsis or the cause of diseases classified elsewhere.

Chapter 2: Neoplasms – 13 codes, including 10 codes for desmoid tumors. Desmoid tumors are a rare type of tumor arising in deep connective and soft tissues and often have a variable and unpredictable course. Desmoid tumors do not metastasize and are not classified as malignant. They tend to be locally aggressive, infiltrative, and destructive. They may also be known as aggressive fibromatosis. Desmoid tumors can occur in any soft or connective tissue throughout the body, but are usually categorized into four general areas: abdominal wall; extremities/shoulder and pelvic girdles/chest wall; intraabdominal/retroperitoneal/pelvic cavity; head and neck/intrathoracic.

Chapter 3: Diseases of blood and blood-forming organs and disorders involving immune mechanism – 8 codes, including codes for Sickle-cell conditions with dactylitis. Dactylitis is a severe inflammation of the fingers and toes commonly seen in infants with sickle cell anemia.

Chapter 4: Endocrine, nutritional, and metabolic diseases – 18 codes. Included are codes for insulin resistance and hypoparathyroidism.

Chapter 6: Diseases of nervous system – 24 codes. There are new codes for Lafora Body Disease, or Lafora progressive myoclonus epilepsy, which is a neurodegenerative condition caused by a glycogen metabolism disorder that results in the accumulation of abnormal glycogen aggregates called Lafora Bodies in the brain, heart, and liver. Four codes are new for chronic migraine with aura, and five codes for Parkinson’s disease with/without dyskinesia, with/without fluctuations. Parkinson’s disease (PD) is a progressive neurodegenerative disease that presents with motor symptoms such as bradykinesia with muscle rigidity, tremor, and/or postural instability, as well as non-motor symptoms such as anxiety/panic attacks, problems with executive function, and pain.

Chapter 7: Diseases of eye and adnexa – 34 codes, including new codes for sickle-cell retinopathy, muscle entrapment by site, and foreign body sensations.

Chapter 9: Diseases of circulatory system – 10 codes. Codes include codes related to tachycardia, angina, and microvascular dysfunction.

Chapter 10: Diseases of respiratory system – 7 codes. Codes include pneumonia due to Acinetobacter baumannii and lung allograft dysfunction.

Chapter 11: Diseases of digestive system – 17 codes. New codes include acute appendicitis with generalized peritonitis, small intestinal bacterial or fungal overgrowth, and short bowel syndrome.

Chapter 13: Diseases of musculoskeletal system – 36 codes specific to osteoporosis of pelvis with pathological fracture.

Chapter 14: Diseases of genitourinary system – 15 codes including recurrent and persistent immunoglobulin A nephropathy (IgAN), the most common form of glomerulonephropathy.

Chapter 15: Pregnancy, childbirth, and puerperium – 6 codes, including new codes for intrahepatic cholestasis of pregnancy (ICP), a pregnancy-specific disorder where bile acid transport in the liver is altered. This leads to a build-up of bile acid in both the maternal circulation as well as the fetal amniotic fluid.

Chapter 17: Congenital malformations – 22 codes, including specific types of craniosynostosis.

Chapter 18: Symptoms, signs, and abnormal clinical and laboratory findings – 18 codes, including codes for foreign body sensation and breast density.

Chapter 19: Injury, Poisoning – 12 codes for the toxic effect of gadolinium.

Chapter 20: External causes of morbidity – 123 codes for objects entering through a natural orifice. Examples are buttons, batteries, plastic objects, jewelry, etc.

Chapter 21: Factors influencing health status and contact with health services – 30 codes. These codes include a variety of conditions such as carrier status, history codes, and codes related to Social Determinants of Health (SDOH). The new subcategory “Caregiver’s noncompliance with patient’s medical treatment and regimen” is an example.

Click HERE to refer to the details changes of ICD 10 CM codes 2024

Telehealth Updates 2023

The CMS released new updates in January 2023 for the medicare fee schedule summary for telehealth services. 

The updates are effective from January 1, 2023 and the implemented date is January 3, 2023. 

The major changes are Medicare Physician Fee Schedule and mentioned following four category and every providers, coders and billing staff knows this guidelines and changes.

• Telehealth originating site facility fee payment amount
• Expansion of coverage for colorectal cancer screening
• Coverage of Audiology services
• Other covered services

The Medicare will continue to pay the telehealth service payment at same rate in person outpatient fee rate through out end of the 2023, And there is no changes and or decrease the fee rate. 

And also, the Medicare will continuously paying the audio visit service CPT code 99441, 99442 & 99443 at the same rate of outpatient established office rate for the length of service/time spends with the patient.

For Medicare patients, the provider would continue to bill the telehealth claims with the place of services indicate that the service bill under In-Person visit. And the claims must be billed with modifier 95 to indicate the service is performed in telehealth.

For Medicare adding new HCPCS codes to the list of telehealth services on a category 1, and the HCPCS codes are G0316, G0317, G0318, G3002, and G3003.

We are keeping many services that are temporarily available as telehealth services for the duration of  the COVID-19 Public Health Emergency (PHE) on a Category 3 basis through CY 2023 and including the following CPT codes.

The CPT codes are 90875, 90901, 92012, 92014, 92550, 92552, 92553, 92555-92557, 92563, 92567, 92568, 92570, 92587, 92588, 92601, 92625-92627, 94005, 95970, 95983, 95984, 96105, 96110, 96112, 96113, 96127, 96170, 96171, 97129, 97130, 97150-97158, 97530, 97537, 97542, 97763, 98960-98962, 99473, 0362T, and 0373T. 

These codes are available up to through December 31, 2023 in Medicare telehealth list.

The Category 3 CPT codes in telehealth services will be covered through 2023 and the Non-facility payment rates for telehealth services will remain the same through 2023 (physician offices are defined by Medicare as “Non-Facility” setting.

So this means telehealth payments will remain the same as in-person through 2023 and the direct supervision may continue to be provided virtually through 2023.

The CMS decided to continue paying for all of the codes on the telehealth list that were scheduled to stop 151 days after the PHE through the end of 2023.

Telehealth Originating site facility fee rate Update

The payment amount for HCPCS code Q3014 (Telehealth originating site facility fee) is 80% of the lesser of the actual charge, or $28.64 for CY 2023 services.

Other than office visit codes, the E/M visits includes following,

• Hospital inpatient, 
• Hospital observation, 
• Emergency department, 
• Nursing facility, 
• Home services, 
• Residence services, and 
• Cognitive impairment assessment visits.

For 2023, Medicare adopting the revised CPT codes for Other E/M visits (except for prolonged services)

• G0316 for reporting prolonged hospital inpatient or observation services
• G0317 for prolonged nursing facility services
• G0318 for prolonged home or residence services
• G2212, for  prolonged office/outpatient services
• G3002 - Chronic Pain Management
  
• G3003 - Chronic Pain Management 

Place of Service Updates

The place of services code is provided to pay the claims correctly at the same time the health care providers need for the specificity than Medicare for the services rendered. And the Medicare does not always need this greater the specificity to pay the claims.

The following two codes are created to meet the industry standards,

POS 02: Telehealth Provided Other than in Patient’s Home Descriptor

• The location where health services and health related services are provided or received, through telecommunication technology. 
• Patient is not located in their home when receiving health services or health related services through telecommunication technology. 

POS 10: Telehealth Provided in Patient’s Home Descriptor

• The location where health services and health related services are provided or received through telecommunication technology. 
  
• Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology

But the Medicare does not identified a need for new place of service code (POS 10). The MACs will instruct their providers to continue to use the Medicare billing instructions for Telehealth claims in specified under section Pub. 100-04.

Biofeedback Procedures Guidelines

CPT Code History & Guidelines

There are three CPT codes are available,

• 90901 -  Biofeedback training by any modality
  
• 90912 - Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; initial 15 minutes of one-on-one physician or other qualified health care professional contact with the patient
• +90913 - Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; each additional 15 minutes of one-on-one physician or other qualified health care professional contact with the patient (List separately in addition to code for primary procedure)

The CPT 90911 was deleted in 2022 and the CPT 90912 & +90913 was added in Jan'2020. The purpose of this codes added,

The provider or other qualified healthcare professional will be trained the patients to control of involuntary bodily functions. There are,

• Altering brain activity,
• Blood pressure,
• Heart rate, and
• Other bodily functions that the patient cannot normally control voluntarily.

This service is done for conditions such as fecal or urinary incontinence. EMG and manometry, if performed, are included with this service.

• The CPT 90912 can reported for the first 15 minutes of face–to–face service with the patients, and 
• The CPT 90913 can be reported for each additional 15 minutes of face–to–face biofeedback training with the patient.
  

 

Clinical View

The physician uses the equipment that measures and responds to very slight changes in the body, such as changes in temperature, heart rate, blood pressure, and muscle tension, and provides feedback to the patient via lights, sounds, and meters.

And by using this equipment, and other therapeutic methods, the provider guides the patient through practices to alter his bodily functions and learn to control his reactions to help treat his disorders.

In this service, the provider is usually a urologist who first assesses and documents that reasons why the patient is a good candidate for biofeedback.

The provider then uses biofeedback–assisted pelvic muscle education (PME) which may include measurement of muscle contraction through an electromyography (EMG) and vaginal or rectal sensors and/or rectal manometry devices to help the patient become more aware of the pelvic muscles and assist in their movement.

The service may also include other techniques, such as relaxation, to help control involuntary bodily movements.

After completion of the test, the providers will take the printouts from the testing and his/her written interpretation of each of the tests in the patient’s medical record.

Limitation and Frequency

The Biofeedback sessions often have limits of four to six treatments over a four–week period. If it's exceeded as a result, payers will deny claims that exceed the frequency limit unless you can prove that the patient's specific condition requires additional services.

Payer Specific Updates

Some payers still consider biofeedback bladder training to be experimental and investigational services.

BCBS Updates

 

Covered ICD Codes

The listed below diagnosis are considered as the medical necessity

• G44.201 Tension-type headache, unspecified, intractable
• G44.209 Tension-type headache, unspecified, not intractable
• G44.211 Episodic tension-type headache, intractable
• G44.219 Episodic tension-type headache, not intractable
• G44.221 Chronic tension-type headache, intractable
• G44.229 Chronic tension-type headache, not intractable
• G43.001 Migraine without aura, not intractable, with status migrainosus
• G43.009 Migraine without aura, not intractable, without status migrainosus
• G43.011 Migraine without aura, intractable, with status migrainosus
• G43.019 Migraine without aura, intractable, without status migrainosus
• G43.101 Migraine with aura, not intractable, with status migrainosus
• G43.109 Migraine with aura, not intractable, without status migrainosus
• G43.111 Migraine with aura, intractable, with status migrainosus
• G43.119 Migraine with aura, intractable, without status migrainosus
• G43.401 Hemiplegic migraine, not intractable, with status migrainosus
• G43.409 Hemiplegic migraine, not intractable, without status migrainosus
• G43.411 Hemiplegic migraine, intractable, with status migrainosus
• G43.419 Hemiplegic migraine, intractable, without status migrainosus
• G43.501 Persistent migraine aura without cerebral infarction, not intractable, with status migrainosus
• G43.509 Persistent migraine aura without cerebral infarction, not intractable, without status migrainosus
• G43.511 Persistent migraine aura without cerebral infarction, intractable, with status migrainosus
• G43.519 Persistent migraine aura without cerebral infarction, intractable, without status migrainosus
• G43.601 Persistent migraine aura with cerebral infarction, not intractable, with status migrainosus
• G43.609 Persistent migraine aura with cerebral infarction, not intractable, without status migrainosus
• G43.611 Persistent migraine aura with cerebral infarction, intractable, with status migrainosus
• G43.619 Persistent migraine aura with cerebral infarction, intractable, without status migrainosus
• G43.701 Chronic migraine without aura, not intractable, with status migrainosus
• G43.709 Chronic migraine without aura, not intractable, without status migrainosus
• G43.711 Chronic migraine without aura, intractable, with status migrainosus
• G43.719 Chronic migraine without aura, intractable, without status migrainosus
• G43.801 Other migraine, not intractable, with status migrainosus
• G43.809 Other migraine, not intractable, without status migrainosus
• G43.811 Other migraine, intractable, with status migrainosus
• G43.819 Other migraine, intractable, without status migrainosus
• G43.821 Menstrual migraine, not intractable, with status migrainosus
• G43.829 Menstrual migraine, not intractable, without status migrainosus
• G43.831 Menstrual migraine, intractable, with status migrainosus
• G43.839 Menstrual migraine, intractable, without status migrainosus
• G43.901 Migraine, unspecified, not intractable, with status migrainosus
• G43.909 Migraine, unspecified, not intractable, without status migrainosus
• G43.911 Migraine, unspecified, intractable, with status migrainosus
• G43.919 Migraine, unspecified, intractable, without status migrainosus
• G89.3 Neoplasm related pain (acute) (chronic)
• K59.00 Constipation, unspecified
• K59.01 Slow transit constipation
• K59.02 Outlet dysfunction constipation
• K59.03 Drug induced constipation
• K59.04 Chronic idiopathic constipation
• K59.09 Other constipation
• N39.3 Stress incontinence (female) (male)
• N39.41 Urge incontinence
• N39.46 Mixed incontinence
• N39.490 Overflow incontinence
• R15.0 Incomplete defecation
• R15.1 Fecal smearing
• R15.2 Fecal urgency
• R15.9 Full incontinence of feces

Modifier

• Some payers may require modifier GP, Services delivered under an outpatient physical therapy plan of care.

Experimental or investigational

Biofeedback is considered experimental or investigational for treatment of all other conditions, including but not limited to

• Anxiety disorders
• Asthma
• Bell palsy
• Chronic pain (including but not limited to low back pain)
• Cluster headache
• Depression
• Functional urinary incontinence
• Hypertension
• Insomnia
• Mechanical urinary incontinence
• Movement disorders, such as motor function after stroke, injury, or lower-limb surgery
• Multiple sclerosis
• Orthostatic hypotension in patients with spinal cord injury
• Pain management during labor
• Post-traumatic stress disorder
• Prevention of preterm birth
• Psychosomatic conditions
• Raynaud’s disease
• Sleep bruxism
• Tinnitus
• Vaginismus
• Vulvodynia

BCBS Updates to Billing CPT 99080 & 99499

The Centers for Medicare and Medicaid services are allowed to submit claims with 12 diagnoses in CMS 1500 form.

However, some of the practice management systems will limit the diagnoses to fewer than 12 diagnoses.

If any practice management system limits the number of diagnoses to fewer than 12 and the supplemental claims can be submitted with E&M Codes with $ 0.01 or $0.00 based on whether the system allows it. 

 

Billing and Coding Guidelines

 

The simple question is, how to capture all the diagnosis and billed it out to Florida Blue Insurance?. 

 

Submit a second line item with CPT 99080 other than the first 12 diagnoses. Initially, the BCBS accepted only CPT 99080 for additional diagnoses but now, the BCBS insurance will allow to bill CPT 99499 as well for the additional diagnoses. 

The BCBS can accept a zero-dollar charge ($0.00), or a penny charge ($0.01) if your system does not allow zero-dollar charges. 

 

If the claim is electronic, use frequency code “0.” This code will deny as incidental to the procedure code submitted on the primary claim and no payment will be applied. 

 

Billing with a penny charge needs no reconciliation on the outstanding balance for providers.

Use at least one clinical diagnoses code from the original claim in first position and all other additional ICD 10 CM codes in position 2 to 12. 

 

The billed all the diagnoses must be documented in the medical record and they should be supported as per the CMS guidelines. 

The supplemental claims must be submitted within 180 days from the original E&M services. 

 

If you have a capitated payment arrangement, do not submit date-span claims for office services (Place of Service 11).

The CMS may requires documentation, diagnosis coding, and claims submissions to align to each individual date of service and face-to-face encounter for the review. 

Please do not submit a corrected claim Frequency Type 7 or Type 8. A corrected claim Type 7 tells Florida Blue the original claim was wrong, and a Type 8 claim will void or cancel the original claim.

Evaluation and management 2023 updates

Evaluation and Management 2021 Updates 

The E&M 2021 changes primarily focused on the documentation and coding guidelines for office and outpatient visits (commonly referred to as E&M codes 99202-99215). 

The main goals of these changes were to reduce administrative burden, simplify documentation, and recognize the value of cognitive work performed by healthcare professionals.

Key aspects of the E&M 2021 changes included

The Elimination of history and physical examination requirements as key components for code selection.

The E&M guidelines now allow providers to choose the level of service based on either Medical Decision Making (MDM) or Total time spent on the encounter. 

While the documentation of the history and physical examination is still important for patient care, it is not required to determine the appropriate code level but it should be documented in the medical records.

A Revised guidelines for code selection based on medical decision-making (MDM. The MDM now has a greater role in a code selection. 

The E&M guidelines provide clear definitions and examples of the components of MDM, such as.,

1. Number and complexity of problems addressed,
2. Data reviewed and analyzed, and
3. Risk of complications or morbidity.

Guidelines for Time Based Code Selection

Expansion of time as a determining factor for code selection. The Providers can now select the code level based on total time spent on the patient encounter, including both face-to-face and non-face-to-face time.

This change benefits providers who spend a significant amount of time on activities like care coordination, reviewing records, and discussing cases with other healthcare professionals.

E&M Updates for 2023 

Initially the above said guidelines were introduced to use only for office and outpatient visits and now , effective from Jan 1st 2023, these guidelines will be applicable for across all the level of E&M code selection. 

 There are some new guidelines Introduced for the specific services,

• Hospital Inpatient and Observation (99221 to 99223, 99231 to 99239)
• Emergency Department Visits (99281 to 99285)
• Consultations codes (99242-99245, 99252-99255)
• Nursing Facility Services codes (99304-99310, 99315, 99316)
• Home or Residence Services codes 99341, 99342, 99344, 99345, 99347-99350

Glimpses of 2023 Changes and Updates

• Deletion of Hospital Observation Services E/M codes 99217-99220
• Revision of Hospital Inpatient and Observation Care Services E/M codes 99221-99223, 99231-99239 and guidelines
• Deletion of Consultations E/M codes 99241 and 99251
• Revision of Consultations E/M codes 99242-99245, 99252-99255 and guidelines
• Revision of Emergency Department Services E/M codes 99281-99285 and guidelines
• Deletion of Nursing Facility Services E/M code 99318
• Revision of Nursing Facility Services E/M codes 99304-99310, 99315, 99316 and guidelines
• Deletion of Domiciliary, Rest Home (eg, Boarding Home), or Custodial Care Services E/M codes 99324-99238, 99334-99337, 99339, 99340
• Deletion of Home or Residence Services E/M code 99343
• Revision of Home or Residence Services E/M codes 99341, 99342, 99344, 99345, 99347-99350 and guidelines
• Deletion of Prolonged Services E/M codes 99354-99357
• Revision of guidelines for Prolonged Services E/M codes 99358, 99359, 99415, 99416
• Revision of Prolonged Services E/M code 99417 and guidelines
• Establishment of Prolonged Services E/M code 993X0 and guidelines

Summary of Hospital inpatient and observation Changes

The Observation Care Discharge Services CPT 99217 has been deleted. 

• To report observation care discharge services, see 99238, 99239

Initial Observation Care New or Established Patient 99218, 99219, 99220 have been deleted. 

• To report initial observation care, new or established patient, see 99221, 99222, 99223 

Subsequent Observation Care 99224, 99225, 99226 have been deleted. 

• To report subsequent observation care, see 99231, 99232, 99233
  

Revised CPT Code Description

Admission Service (Initial hospital inpatient or observation)

99221 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making.

When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.

99222 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.

When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.

99223 Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making.

When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.

Follow up Service (Subsequent hospital inpatient or observation)

99231 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically
appropriate history and/or examination and straightforward or low level of medical decision making.

When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.

99232 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.

When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.

99233 Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making.

When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.

Discharge Service - Hospital inpatient or observation

99238 Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter.

99239 more than 30 minutes on the date of the encounter.

For hospital inpatient or observation care including the admission and discharge of the patient on the same date, see 99234, 99235, 99236

*** For 99211 and 99281, the face-to-face services may be performed by clinical staff