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Coding Alert

The Big Thaw

ICD-10-CM and ICD-10-PCS – October 2016 Proposed Updates

Updates to the ICD-10 code system have been partially frozen since 2011. After five years, this partial freeze has now ended and the updates will begin flowing again in October 2016!

The ICD-10 Maintenance and Coordination Committee met on March 9, 2016 and reviewed the five year backlog of all proposals for ICD-10-CM and ICD-10-PCS changes.

If finalized, the CMS proposal will be implemented on October 1, 2016 and will add approximately 1,900 ICD-10-CM diagnosis codes and 3,651 ICD-10-PCS inpatient procedure codes to the code sets. The large number of proposed new codes is partially due to the backlog of proposals for new ICD-10 codes. The proposed rule became available in April 2016 with the final rule set to be available on August 1, 2016. The full code update and addendums will be published this month (June 2016).

In addition to the 1,900 new ICD-10 CM diagnosis codes, the proposal includes recommendations to delete 305 diagnosis codes and make 422 revisions to the code set. Many of the deleted diagnosis codes include the unspecified codes and codes that were not classified elsewhere.

The proposed updates to the ICD-10 CM diagnosis code set include –

  • New diabetes codes – 260 new ICD-10 codes for reporting diabetes manifestations have been added
  • New codes for fractures and other injuries – Chapter 19 includes 885 new codes for reporting Injury, Poisoning and Certain Other Consequences of External Causes. These new codes are primarily linked to fractures
  • New codes for Diseases of the Musculoskeletal System and Connective Tissue – 152 new codes have been added to the Chapter

A new diagnosis code specific to the Zika virus in line with World Health Organization update will be reviewed for October 2016 implementation.


The majority of the 3,651 proposed new ICD-10-PCS codes are cardiovascular codes for unique device values and new codes for bifurcation and congenital cardiac procedures. New ICD-10-PCS codes for lower joint procedures are also expected. Stay tuned to the CMS website for continuing updates on this topic!

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REMINDER – Corrected Claims

When submitting a corrected claim, please do not send a brand new claim as it may be denied as a duplicate claim. Rather, you should send a corrected claim.

If you are submitting electronically, please fill in the “Claim Frequency Type Code” field (CLM05-3) with a “7”. If submitting on paper, it is necessary that you stamp or write on the claims that it is a replacement or corrected claim. Following these steps will ensure that your claims are handled appropriately and in a timely manner. We appreciate your attention to this detail.

If you have coding questions, contact your Provider Coordinator. We’re happy to help.


View List of Summer 2016 Unity Communicator Articles