Changes in Guidelines for ICD10CM 2017.

The 2017 ICD-10-CM Official Guidelines for Coding and Reporting is now available for download on the Centers for Medicare & Medicaid Services (CMS) website. This latest version includes several changes worth noting.

This year’s guidelines help explain the significant changes to the code set.

Guideline Changes 2017 ICD10CM

Excludes1 Clarified

For example, in Section I.A.12(a), a new paragraph explains an exception to the Excludes1 definition. CMS defines an Excludes1 note as an indication “that the code excluded should never be used at the same time as the code above the Excludes1 note.”

CMS adds for 2017:

An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider. For example, code F45.8, Other somatoform disorders, has an Excludes1 note for ‘sleep related teeth grinding (G47.63),’ because ‘teeth grinding’ is an inclusion term under F45.8. Only one of these two codes should be assigned for teeth grinding. However psychogenic dysmenorrhea is also an inclusion term under F45.8, and a patient could have both this condition and sleep related teeth grinding. In this case, the two conditions are clearly unrelated to each other, and so it would be appropriate to report F45.8 and G47.63 together.”

The 2016-2017 guidelines also expand on the meaning of “with;” and clarify in a new paragraph (Section I.A.19) that code assignment should be based on the provider’s diagnostic statement that the condition exits and not on clinical criteria used to establish the diagnosis.

Laterality Clarified:

CMS also clarifies the meaning of “laterality;” expands on hypertension coding in Chapter 9: Diseases of the Circulatory System (I00-I99); revises guidelines for prenatal outpatient visits for high-risk patients (Section I.C.15(b)2); and more. Make sure to read all of the changes carefully.

Also available on the CMS website are 2017 General Equivalence Mappings for diagnosis and procedure codes, the 2017 ICD-10-PCS Official Guidelines for Coding and Reporting, and 2017 present-on-admission exempt codes.

Note: 2017 ICD-10 codes and guidelines take effect Oct. 1, 2016.