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Coding Changes are Coming, Ensure Your Organization is Ready

For discharges occurring on and after April 1, 2022, coders will have access to new ICD-10-CM and ICD-10-PCS codes. April 1st will also introduce the new Medicare Code Editor (MCE) edit 20 – Unspecified Code Edit.

The 2022 IPPS Final Rule stated there would now be coding updates in both October and April. The goal is to allow for earlier recognition of diagnoses, conditions, and illnesses as well as procedures, services, and treatments in the claims data. Previously, new codes were introduced annually on October 1st or for specific reasons, such as our current public health emergency.

CMS announced that any associated files with the April 1 updates will be available on the CMS website by February 1.

New Medicare Code Edit 20 (Unspecified Code Edit)

When documentation doesn’t provide the level of specificity needed to support reporting a more specific code, unspecified codes are available. The new Edit 20 (Unspecified Code Edit) was developed to flag certain codes that further specify the laterality of an anatomic site.

CMS states that it should be rare in an inpatient setting that a coder is unable to find documentation in the medical record to report the laterality of a condition. This new edit is applicable on any diagnosis reported on an inpatient claim that is unspecified and is:

  • Either a Complication or Comorbidity (CC), or Major Complication or Comorbidity (MCC)
  • Includes other codes in that code subcategory that further specify the anatomic site

Hospitals may want to review their unspecified code rate in preparation for this edit. The Medicare Claims Processing Manual was edited with CR 12471 and provides additional instruction for users who encounter this edit. Examples of codes that are subject to this edit are codes describing unspecified laterality of non-pressure chronic ulcers, fractures, and chronic embolisms and thromboses.

The full list of codes subject to Medicare Code Edit 20 are available in Table 6P.3a of the FY 2022 IPPS/LTCH PPS Final Rule.

New ICD-10-CM Codes

New ICD-10-PCS Codes

For more information on MS-DRG Grouper Version 39.1, please visit CMS MS-DRG Classifications and Software.

Contact Us

To learn more about how these coding changes going into effect on April 1, 2022, can impact your healthcare organization, please reach out to your local Blue & Co. Advisor or a member of the revenue cycle team listed below.

Nicole Cameron, Senior Consultant, RHIA, CDIP, CCS

The information regarding updates to CMS coding is correct as of the date of this publication (February 18, 2022). Coding information is subject to change based on CMS updates.

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