Five Major ICD-10-CM Changes That Can Affect Your Organization

On October 1, 2021, the ICD-10-CM code changes became effective. This means that claims to certain health insurance payers must be updated to reflect the changes as of this date. If your practice is one that handles workers compensation claims, it will be important to determine which year of the ICD-10-CM, HCPCS, and CPT codes your state will be using and comply with those requirements, while simultaneously fulfilling obligations for Medicare, Medicaid, and other commercial payers who use the most up-to-date code sets. On October 7th, Find-A-Code presented a webinar, "2021 ICD-10-CM Guideline and Code Changes" (free to the public) pointing out the many guideline and code changes, additions, and deletions. 

Five (5) Major ICD-10-CM Changes FY 2022 (Effective October 1, 2021)  

The following list contains five of the most significant changes to the ICD-10-CM code set, which became effective on October 1, 2021:

  1. Other clinicians' documentation may be used to report laterality when the treating provider has not included it in the encounter note. Special criteria must be met.
  2. Reporting an unspecified diagnosis is strongly discouraged and may elicit a request for medical records by payers. 
  3. The addition of several new Social Determinants of Health (SDoH) codes and clarification of reporting SDoH documented by providers other than the provider of record.
  4. The addition or expansion of widely reported conditions and symptoms such as:
    - Depression, unspecified vs major depression, single episode
    - Cough to include acute, subacute, and chronic along with other descriptive types of coughs
    - Low back pain vs vertebrogenic low back pain
  5. Many official guidelines were added throughout 2020 and 2021 that are now present in the updates, especially additional changes to the COVID-19 coding guidelines.

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content