Highlights of the 2024 ICD-10-CM Code Updates

Each year, the ICD-10 diagnosis codes are updated by the World Health Organization (WHO) and the Centers for Medicare and Medicaid Services (CMS).  The code updates frequently include additions, deletions, and modifications.  The changes occur on a fiscal year basis; therefore, the ICD-10 codes 2024 go into effect on October 1, 2023.  Keeping up with the changes each year is crucial to avoid denials.

The ICD-10-CM (clinical modifications) apply to your office.  For the fiscal year 2024, there are 395 new codes, 22 revised codes, and no deletions.   There are several different subspecialties in chiropractic.  As such, some offices may use codes such as Parkinson’s disease,  endocrine and metabolic disorders.  Although these codes have changed for 2024, we will not be discussing those changes in this article; however, offices that use these codes should be aware that revisions have occurred.

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Every year, codes continue to become more specific.  As anyone who has tried to assemble an IKEA dresser, it is crucial to read the instruction manual first.  Each year, WHO and CMS continue to emphasize that it is essential that every provider code to the highest level of specificity.  Only in the United States do the codes we choose determine the number of treatments approved for patient care.  Diagnosis codes such as cervicalgia are outdated and should be avoided.  Signs and symptoms codes are only used if that is all the doctor knows.  You should ask yourself, “Why does the patient  have neck pain?”  For example, if your answer is degenerative disc disease (DDD), the more specific diagnosis code would be DDD.

In addition, specific codes should typically be used together, while others should never be used together.  An Excludes1 designation on a set of codes instructs you to use one or the other code but not to use them together.  An Excludes2 code indicates to the coder that these two codes may be used together and should be considered as a couple.  Misuse of the Excludes1 code will lead to a denial.

The following are highlights of the ICD-10 code changes for 2024.  Remember, these are just highlights of changes and not all-inclusive.  Also, remember that these code changes are effective on October 1, 2023.

Chapter 5 – Mental, Behavioral, and Neurodevelopmental Disorders (F01 – F99)

New guidance on the use of the F05 codes, delirium due to a known physiological condition, you must Code First the underlying physiological condition, such as dementia (F03.9-).

Chapter 6 – Diseases of the Nervous System (G00-G99) contains new subcategories and codes for reporting chronic migraine headaches and differentiating whether the pain is manageable or not.

Chapter 13 – Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) contains 42 new codes to help further define osteoporosis with pathological fracture.

As any parent knows, kids (and adults) will do the darndest things.  Apparently, CMS agrees.  Many changes have occurred in Chapter 20 – External Causes of Morbidity (V00 – Y99), which contains nearly half of all the new codes.  If used properly, the External Cause codes will supply information on how the injury occurred, whether it was due to a work injury or an auto accident, and what the patient was doing at the time of the injury.  These codes are helpful and often are required in personal injury cases, worker’s compensation cases, and insurance companies who send out intrusive questionnaires to patients asking about their injuries.  To put a stop to questionnaires, start using External Cause codes.

A new category was added in the External Cause Codes section, W44 Foreign body entering into or through a natural orifice.

Other examples of the increased specificity of how injuries occur include e-bikes and other sharp objects.  As an example, W44.H1 Needle entering into or through a natural orifice includes classifications of darts, hypodermic needles, safety pins, or a sewing needle.

As micromobility products such as e-scooters, hoverboards, and e-bikes increase in popularity, so do the injuries.  Many are riding e-bikes without proper training or equipment.  Patients with e-bike accidents had a higher incidence of moderate traumatic brain injuries than those with pedal bicycle accidents.

New codes have been added to specify:

• Was the patient a driver, passenger, or unspecified rider in the accident?
• Was the patient in transit or getting on or off the bike?
• Did the collision occur with a pedestrian, animal, two-or-three wheeled motor vehicle, pedal cycle, or other vehicle such as a car, bus, railway train, or a fixed object?

An example of these codes includes:

V28.31  Person boarding or alighting an electric assisted bicycle injured in a noncollision transport accident.

These are just the highlights of the many codes that may affect your practice.  For a complete list of the ICD-10 code changes:https://www.cms.gov/files/zip/2024-code-descriptions-tabular-order-updated-06/29/2023.zip