Over the past eight plus weeks there has been lots of education, discussion, and even formal presentations about the FY2022 new ICD-10-CM codes. I myself have researched and presented on these codes around 6 different times, and each time, even I learn something new, especially when it comes to identifying hints where we will most likely need to query in order to capture the specificity of these new codes.

As always, we must follow the AHIMA/ACDIS Practice Brief on “Guidelines for Achieving a Compliant Query Practice” from 2019. This resource is essential to understanding the who, what, where, when, why and how of querying for documentation clarification in a compliant manner. You can obtain this practice brief at the following link: https://bok.ahima.org/doc?oid=302673#.YXRxNJrMLx4

There are many hints within the tabular index of the new ICD-10-CM codes for FY2022 that may help identify documentation query opportunities. Take a close look at these new codes, see those instructional notes; “Code first,” “Use additional code”, “Code also”, these are some the documentation hints. In addition, some of the new codes have a description or title that includes a stage, grade, region or with a specific organ dysfunction, these are also the hints I’m referring to. The following are some of the new codes for FY2022 and the tabular inclusion terms and instructional notes which can provide hints regarding the documentation needed to capture these specific code(s):

  1. There are different “grades” within the ICD-10-CM classification for the condition of Immune effector cell-associated neurotoxicity, so the documentation needs to state the specific grade. Develop a multiple choice query to capture the “grade” for this condition (see the underlined tabular wording)
    • NEW ICD-10-CM code G92.00 Immune effector cell-associated neurotoxicity syndrome, grade unspecified
    • ICANS, grade unspecified
    • NEW ICD-10-CM code G92.01 Immune effector cell-associated neurotoxicity syndrome, grade 1
    • ICANS, grade 1
    • NEW ICD-10-CM code G92.02 Immune effector cell-associated neurotoxicity syndrome, grade 2
    • ICANS, grade 2
    • New ICD-10-CM code G92.03 Immune effector cell-associated neurotoxicity syndrome, grade 3
    • ICANS, grade 3
    • NEW code G92.04 Immune effector cell-associated neurotoxicity syndrome, grade 4
    • ICANS, grade 4
    • NEW code G92.05 Immune effector cell-associated neurotoxicity syndrome, grade 5
    • ICANS, grade 5
  2. Greater specificity is offered in the classification for the condition “encephalopathy.” Check the medical record documentation carefully for any mention or evidence of poisoning or adverse effect and remember you may need to query to clarify this, as the classification has an instruction to “code first” poisoning due to a drug or toxin, or due to an adverse affect (see the underlined tabular wording below).
    • NEW ICD-10-CM code G92.8 Other toxic encephalopathy
    • Toxic encephalitis
    • Toxic metabolic encephalopathy
    • Code first poisoning due to drug or toxin, if applicable, (T36-T65 with fifth or sixth character 1-4 or 6)
    • Use Additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
    • NEW ICD-10-CM code G92.9 Unspecified toxic encephalopathy
    • Code first poisoning due to drug or toxin, if applicable, (T36-T65 with fifth or sixth character 1-4 or 6)
    • Use Additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
  3. For FY2022 there is a series of new codes to capture gastric intestinal metaplasia or GIM. Within the coding system the tabular index classification breaks down the condition of GIM as with and without dysplasia. In addition, when GIM is without dysplasia the involving anatomic area is identified. Thus, a query for GIM specificity should include choices for with and without, plus the anatomic area(s) and see below and note the underlined tabular word(s). When GIM is with dysplasia, the classification captures the “grade,” so consider a query that clarifies the grade as well, see the underline tabular wording below.
    • NEW K31.A Gastric intestinal metaplasia
    • NEW ICD-10-CM code K31.A0 Gastric intestinal metaplasia, unspecified
    • Gastric intestinal metaplasia indefinite for dysplasia
    • Gastric intestinal metaplasia NOS
    • NEW ICD-10-CM code K31.A1 Gastric intestinal metaplasia without dysplasia
    • NEW ICD-10-CM code K31.A11 Gastric intestinal metaplasia without dysplasia, involving the antrum
    • NEW ICD-10-CM code K31.A12 Gastric intestinal metaplasia without dysplasia, involving the body (corpus)
    • NEW ICD-10-CM code K31.A13 Gastric intestinal metaplasia without dysplasia, involving the fundus
    • NEW ICD-10-CM code K31.A14 Gastric intestinal metaplasia without dysplasia, involving the cardia
    • NEW ICD-10-CM code K31.A15 Gastric intestinal metaplasia without dysplasia, involving multiple sites
    • NEW ICD-10-CM code K31.A19 Gastric intestinal metaplasia without dysplasia, unspecified site
    • NEW ICD-10-CM code K31.A21 Gastric intestinal metaplasia with low grade dysplasia
    • NEW ICD-10-CM code K31.A22 Gastric intestinal metaplasia with high grade dysplasia
    • NEW ICD-10-CM code K31.A29 Gastric intestinal metaplasia with dysplasia, unspecified
  4. The condition of Thrombotic microangiopathy is now captured with two specific ICD-10-CM codes, but the tabular gives insight into several documentation components that the HIM Coding and Clinical Documentation Integrity professionals should be aware of. Take note of the tabular instructions for code M31.11, there is a “Code first” instruction for complications of bone marrow transplant and stem cell transplant complication. Another important instructional note is “Use additional code,” which can lead to querying for clarification of organ dysfunction that may be present, see the underlined tabular words below. As you can see there are many possible organ dysfunction choices that would need to be included in a query.
    • NEW ICD-10-CM code M31.10 Thrombotic microangiopathy, unspecified
    • NEW ICD-10-CM code M31.11 Hematopoietic stem cell transplantation-associated thrombotic microangiopathy [HSCT-TMA]
    • Transplant-associated thrombotic microangiopathy [TA-TMA]
    • Code first if applicable:
    • complications of bone marrow transplant (T86.0-)
    • complications of stem cell transplant (T86.5)
    • Use Additional code to identify specific organ dysfunction, such as:
    • acute kidney failure (N17.-)
    • acute respiratory distress syndrome (J80)
    • capillary leak syndrome (I78.8)
    • diffuse alveolar hemorrhage (R04.89)
    • encephalopathy (metabolic) (septic) (G93.41)
    • fluid overload, unspecified (E87.70)
    • graft versus host disease (D89.81-)
    • hemolytic uremic syndrome (D59.3)
    • hepatic failure (K72.-)
    • hepatic veno-occlusive disease (K76.5)
    • idiopathic interstitial pneumonia (J84.11-)
    • sinusoidal obstruction syndrome (K76.5
  5. Although there are many other examples or hints regarding documentation and querying within the tabular, the last one I’ll share in ICD-10-CM code(s) is for Social Determinants of Health (SDOH). This is an important area in Chapter 21 not to be missed. For FY2022 we have greater specificity especially in relation to homelessness, adequate food, and regarding housing instability. Developing a documentation clarification would be beneficial in capturing these socioeconomic determinants.
    • Z59.0 Homelessness
    • NEW ICD-10-CM code Z59.00 Homelessness unspecified
    • NEW ICD-10-CM code Z59.01 Sheltered homelessness
    • Doubled up
    • Living in a shelter such as: motel, scattered site housing, temporary or transitional living situation
    • NEW ICD-10-CM code Z59.02 Unsheltered homelessness
    • Residing in place not meant for human habitation such as: abandoned buildings, cars, parks, sidewalk
    • Residing on the street
    • Z59.4 Lack of adequate food
    • Excludes2:deprivation of food (T73.0)
    • Effects of hunger (T73.0)
    • Inappropriate diet or eating habits (Z72.4)
    • Malnutrition (E40-E46)
    • NEW ICD-10-CM code Z59.41 Food insecurity
    • New ICD-10-CM code Z59.48 Other specified lack of adequate food
    • Inadequate food
    • Lack of food
    • The classification has expanded Z59.8 Other problems related to housing and economic circumstances
    • NEW ICD-10-CM code Z59.81 Housing instability, housed
    • Foreclosure on home loan
    • Past due on rent or mortgage
    • Unwanted multiple moves in the last 12 months
    • NEW ICD-10-CM code Z59.811 Housing instability, housed, with risk of homelessness
    • Imminent risk of homelessness
    • NEW ICD-10-CM code Z59.812 Housing instability, housed, homelessness in past 12 months
    • NEW ICD-10-CM code Z59.819 Housing instability, housed unspecified
    • NEW ICD-10-CM Z59.89 Other problems related to housing and economic circumstances
    • Foreclosure on loan
    • Isolated dwelling
    • Problems with creditors

The best practice to take is to review the tabular details for each new code, identify instructional notes that may impact the documentation and benefit from a possible query. Work together, with HIM Coding and Clinical Documentation Integrity staff in this effort and help develop queries that are compliant and are successful in clarifying the clinical documentation. Always have query quality assurance (QA) processes in place also, this can help identify gaps and weakness in your queries and the query process itself.

Be sure to review closely the American Hospital Association (AHA) ICD-10-CM/PCS Coding Clinic fourth quarter 2021, as this issue focuses on the FY2022 new codes. Be on the look out for “hints” (as I like to call them), within the tabular with other similar query opportunities.

Reimbursement Management Consultants (RMC) can provide assistance with medical coding support, auditing, education, compliance consulting, and HCC/risk adjustment services. RMC is a woman-owned, US-based and operated company which specializes in a variety of medical coding and auditing services. Contact us here.

Written by Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA Approved ICD-10-CM/PCS Trainer