2024 Diagnosis Coding Guidelines Are Here!
Review the changes to ensure quality reporting of ICD-10-CM codes.
The National Center for Health Statistics posted, July 5, the fiscal year (FY) 2024 update to the ICD-10-CM Official Guidelines for Coding and Reporting (diagnosis coding guidelines). Medical coders and auditors should review these guidelines at least annually to ensure quality reporting of patient conditions and encounters. With this latest version of the guidelines (and the ICD-10-CM code set) going into effect Oct. 1, now is a good time to review the changes.
Chapter Specific Changes to Guidelines
Most of the changes to the diagnosis coding guidelines for FY 2024 are chapter specific. Changes include minor narrative corrections and the addition of a few new diagnosis codes. There are also a few significant additions of note.
Note: Narrative changes to the diagnosis coding guidelines are bolded; text that has been moved is underlined; and heading revisions are italicized.
Under section I.C.1.g.1, the following is added to the guidelines:
(f) Screening for COVID-19
“For screening for COVID-19, including preoperative testing, assign code Z11.52, Encounter for screening for COVID-19.“
This code was added Jan. 1, 2021, and replaced Z11.59 Encounter for screening for other viral diseases. For COVID-19 screening encounters on or after Oct. 1, 2023, assign code Z11.52.
Under section I.C.9.e. Acute myocardial infarction (AMI), the following is added to the guidelines:
6) Myocardial Infarction with Coronary Microvascular Dysfunction
“Coronary microvascular dysfunction (CMD) is a condition that impacts the microvasculature by restricting microvascular flow and increasing microvascular resistance. Code I21.B, Myocardial infarction with coronary microvascular dysfunction, is assigned for myocardial infarction with coronary microvascular disease, myocardial infarction with coronary microvascular dysfunction, and myocardial infarction with non-obstructive coronary arteries (MINOCA) with microvascular disease.“
ICD-10-CM code I21.B is newly added for FY 2024 and also describes myocardial infraction with coronary microvascular disease and myocardial infarction with nonobstructive coronary arteries (MINOCA) with microvascular disease.
Under section I.C.18.e. Coma, the following is added to the guidelines:
“Code R40.20, Unspecified coma, should be assigned when the underlying cause of the coma is not known, or the cause is a traumatic brain injury and the coma scale is not documented in the medical record.
“Do not report codes for unspecified coma, individual or total Glasgow coma scale scores for a patient with a medically induced coma or a sedated patient.
Coma Scale
The coma scale codes (R40.21- to R40.24-) can be used in conjunction with traumatic brain injury codes. These codes cannot be used with code R40.2A, Nontraumatic coma due to underlying condition. They are primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma scale codes should be sequenced after the diagnosis code(s).”
Code R40.2A is newly added for FY 2024 and also describes secondary coma. A parenthetical note in the ICD-10-CM code book instructs you to code first the underlying condition.
Under section I.C.21.c, the following is added:
8) Follow-up
“Codes Z08, Encounter for follow-up examination after completed treatment for malignant neoplasm, and Z09, Encounter for follow up examination after completed treatment for conditions other than malignant neoplasm, may be assigned following any type of completed treatment modality (including both medical and surgical treatments).“
Guidelines for Reporting Additional Diagnoses
Under section III. Reporting Additional Diagnoses, two impactful words were added to the definition for “other diagnoses:”
“For reporting purposes, the definition for ‘other diagnoses’ is interpreted as additional clinically significant conditions that affect patient care in terms of requiring …”
The FY 2024 diagnosis coding guidelines are available for download from the NCHS website.