What You Need To Know About the 2023 ICD-10 Code Sets

On October 1, CMS transitions to the 2023 ICD-10-CM codes. With over 1,000 changes, home health and hospice agencies need to prepare for documenting cases with increased specificity in order to be reimbursed for services.

Highlights of the 2023 ICD-10-CM Code Set: The Expanded Dementia Codes

The 2023 ICD-10-CM coding changes are in effect from October 1, 2022 to September 30, 2023. The changes that require your attention by October 1 include 1,176 new codes, 28 revised codes and 287 deleted codes. Note that the most significant changes are the expanded dementia codes which include 69 new codes to identify the stage of severity and the specific behavioral and psychological symptoms of dementia. Providers must clearly document the severity of the patient’s condition or risk rejection of the claim.

To get you started on your 2023 ICD-10-CM journey, Corridor has prioritized a list of the main categories that will require your attention as shown in the table below. This list is not comprehensive, but it anticipates areas that have the highest potential to cause delays in reimbursement based on this year’s code updates.

FY2023 ICD-10-CM Crosswalk
2022 ICD-10-CM Deleted Codes After October 1st, 2022 2023 ICD-10-CM Equivalent Unspecified Code
F03.91 – Unspecified dementia w/ behavioral disturbance

F02.81 – Dementia in other diseases classified elsewhere behavioral disturbance

F01.51 – Vascular dementia w/ behavioral disturbance

The 2023 ICD 10 classifies dementia on the basis of etiology and severity (unspecified, mild, moderate, or severe)
There is no default for unspecified behaviors for 2023. will need to obtain MD documentation of the specific behaviors such as agitation, other behaviors, psychotic disturbances, mood disorders, or anxiety in order to determine accurate code
B37.3 – Candidiasis of vulva and vagina B37.31 – Acute candidiasis of vulva and vagina
Includes candidiasis of vulva and vagina NOS
E87.2 – Acidosis E87.20 – Acidosis, unspecified
G93.3 – Postviral fatigue syndrome G93.31 – Postviral fatigue syndrome
I47.2 – Ventricular tachycardia I47.20 – Ventricular tachycardia, unspecified
I71.2 – Thoracic aortic aneurysm, without rupture I71.20 – Thoracic aortic aneurysm, without rupture, unspecified
I71.4 – Abdominal aortic aneurysm, without rupture I71.40 – Abdominal aortic aneurysm, without rupture, unspecified
I71.6 – Thoracoabdominal aortic aneurysm, without rupture I71.60 – Thoracoabdominal aortic aneurysm, without rupture, unspecified

Timing is (Almost) Everything

In addition to ensuring your coding is accurate and well-documented, CMS requires that the new codes be used for all patient services provided after the October 1, 2022 start date. This not only affects new patients, but the new code sets affect claims arising from a patient service that began under 2022 ICD-10 codes on or before September 30, 2022 and continued after October 1, 2022.

For existing clients, codes will need to be changed if subsequent encounters occur on or after October 1st. This may impact both 1st and 2nd 30-day billing periods.  For example, if a SOC (start of care) visit occurred on September 4 using the 2022 codes, a subsequent nursing visit on October 6 would need to utilize the 2023 codes on the new claim.

A caveat on timing: The October 1 implementation date of the 2023 ICD-10-CM code set applies to CMS claims. However, commercial payers may use a different implementation schedule. Check with your individual payers as some commercial and private payer implementation dates may differ from the CMS date.

Take Some Actions Now

Implementing the 2023 ICD-10-CM code set changes throughout your organization requires a winning strategy to ensure your claims submissions are compliant. Identify cases that have claims with codes that are changing, and have a process for getting new orders for codes that have changed. Educate internal coders about the new code sets or coordinate with external partners who do your claims coding to ensure they are implemented throughout the organization. Here is a quick checklist to get you started on your 2023 ICD-10-CM journey:

  • Discuss the new code sets with your EMR vendor to assure compliance with the changes.
  • Identify patients with a diagnosis impacted by the changes for both the 1st and 2nd 30-day episode periods.
  • For non-Medicare patients, determine if the private or commercial payor will be requiring new coding after October 1, 2022.
  • Follow your internal processes for updating your claim codes. It is not necessary to change the codes on your prior POC (plan of care) or OASIS assessments. The changes only apply to services rendered after October 1, 2022.
  • Still need help? Reach out to Corridor so we may assist you with your plan to avoid delays in reimbursement.

For help integrating the 2023 ICD-10 coding changes into your organization’s claims submission process, contact Corridor at 1-866-263-3795 or by clicking here. Our coding and reimbursement experts can help ensure that your claims are accurate, timely, and properly prepared for submission.

About Corridor

For more than 30 years, Corridor has been a trusted partner for home-based care providers. We offer effective and time-tested solutions to support the unique challenges of caring for patients in the home. Our team of operating executives, clinicians, information technology experts and nationally renowned home health and hospice industry experts have run provider organizations. We have faced – and resolved – the same challenges you face. When we work with your organization, we focus on the key operational, regulatory, and financial levers known to improve your financial and clinical performance.

At Corridor,  our experts deliver solutions in coding and clinical documentation, process automationcompliancebilling, staffing, and education. To receive the most important industry updates, insights and news impacting home health and hospice, please be sure to sign up for our weekly newsletter.

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