2019 ICD-10-CM guidelines include updates for sepsis, pregnancy reporting

The National Center for Health Statistics  recently released the 2019 ICD-10-CM Official Guidelines for Coding and Reporting, effective October 1, which include updated language and added specificity for classifying diagnoses.

The guidelines include updated language conventions to improve coding accuracy. Per guideline I.C.1.15, “with” or “in” should be interpreted to mean “associated with” or “due to” when they appear in the Alphabetic Index (either under a main term or subterm), a code title, or an instructional note in the Tabular List. 

Some notable chapter-specific guideline changes include:

• Chapter 1, Sepsis due to postprocedural infection
  • Per guideline I.C.1.5.b, when coding for a postprocedural infection, coders should look to 2019 ICD-10 subcategories T81.40- to T81.43- (infections following a procedure) or within subcategories O86.00 to O86.03 (Infections of an obstetric surgical wound) to identify the site of the infection. An additional 2019 code should be assigned to identify sepsis following a procedure (T81.44-) or sepsis following an obstetrical procedure (O86.04-). Coders must select an additional ICD-10 code to identify the infectious agent.
• Chapter 2, Current malignancy versus personal history of malignancy
  • The 2019 guidelines clarify reporting for a current malignancy versus a personal history of malignancy. Per guideline I.C.2.m., subcategories Z85.0- through Z85.7- should be assigned for the former site of a primary malignancy, not the site of a secondary malignancy.  
• Chapter 5, Factious disorder
  • A new section was added on reporting factious disorder, a psychological condition that will be added to ICD-10-CM on October 1.
• Chapter 15, Drug use during pregnancy, childbirth and the puerperium
  • A new subsection was added to guideline I.C.15.l.c. (Drug use during pregnancy, childbirth and the puerperium) for any pregnancy case when a mother uses drugs during the pregnancy or postpartum. This subsection was added to clarify reporting of new, more specific 2019 codes for drug use during pregnancy.
• Chapter 18, Glascow coma scale
  • Guideline I.C.18.e now notes that individual or total Glasgow coma scale scores should not be reported for patients who were sedated or in a medically induced coma.

Coders should familiarize themselves with these changes, which will impact diagnosis reporting from October 1, 2018, through September 30, 2019.