ICD-10 Coding Changes for 2019: Carcinoma, Cannabis & Muscular Dystrophy

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The take-effect date for the 2019 ICD-10-CM – and the impact these medical coding changes will have on your healthcare specialty – is now less than two months away. October 1, 2018 will be here before you know it, and to help you prepare we have some more updates on to expect. Just remember this isn’t an exhaustive list, and changes can be made up to – and even after – the implementation deadline.

The biggest ICD-10 coding changes for 2019 address nuances to disorders – such as acute appendicitis, ecstasy poisoning, muscular dystrophy and squamous cell carcinoma, says coding consultant Jill Young in her live audio conference for ProfEdOnDemand. During her comprehensive presentation, “2019 ICD-10 Coding Changes: An Overview,” Young addresses these nuanced codes, as well as others addressing cannabis use and Merkel cell codes.

Muster the Nerve to Use 4 New Merkel Cell Carcinoma Codes

Merkel cell carcinoma updates (C4A) eliminated 2 vague codes and added 4 codes that specify which eyelid was affected:


  • 11, right eyelid, including canthus (corner of eye where eyelids meet)
  • 12, left eyelid, including canthus


  • 111, right upper eyelid, including canthus
  • 112, right lower eyelid, including canthus
  • 121, left upper eyelid, including canthus
  • 122, left lower eyelid, including canthus

Reach for the Right Squamous Cell Carcinoma Codes for Eyelids

Similar to the Merkel cell codes, two squamous cell carcinoma codes (C44) are no more: 122 (right eyelid, including canthus) and 129 (left eyelid, including canthus). As of October 1, you’ll use four replacement codes:

  • 1221, right upper eyelid, including canthus
  • 1222, right lower eyelid, including canthus
  • 1291, left upper eyelid, including canthus
  • 1292, left lower eyelid, including canthus

Smoke Out Errors with New Cannabis Codes

Two new codes deal with cannabis use:

  • 23, Cannabis dependence with withdrawal
  • 93, Cannabis use, unspecified with withdrawal

Get Specific with Added Muscular Dystrophy Codes

Previously, you just had one code to report any kind of muscular dystrophy – G71.0. This year you’re up to four codes:


  • 0, Muscular dystrophy


Good News: Yes, you’ll need time to learn all these added codes, but it’ll be well worth it in the long run when more specific claims improve reimbursement speed. Now payers can better see the exact nature of a patient’s episode or disorder from the claim itself, instead of having to request medical records.

Prepare for the Latest Ecstasy Poisoning Codes

Starting October 1, you’ll find 12 new codes in the T43.64x (Poisoning by ecstasy) section of the ICD-10 manual. These codes describe whether the poisoning was intentional, accidental, assault, or undetermined. Note also that the correct code depends on whether the visit was an initial visit, subsequent encounter, or sequela, as below:

T43.641, Poisoning by ecstasy, accidental (unintentional)

  • A, initial encounter
  • D, subsequent encounter
  • S, sequela

The other codes in the set are:

  • 642 (-A, -D, or -S), Poisoning by ecstasy, intentional self-harm
  • 643 (-A, -D, or -S), Poisoning by ecstasy, assault
  • 643, (A, -D, or -S), Poisoning by ecstasy, undetermined

Telling the difference: When determining intentional, accidental, or undetermined, read the documentation very carefully. Only use the T43.643 codes if the documentation specifies that it is impossible to determine the patient’s intent.

Pro tip: Alert medical providers about the added level of specificity with this year’s new ecstasy poisoning codes—and others wherever necessary—so that they will be sure to include the most detailed information available in the documentation. Remember, this information is new for them too, so it may take them time to absorb and adopt the changes.

Get the Best Training with Certified Conferences

As you know, constant training keeps you in the know and sets you up as a leader and role model in your field. Training from ProfEdOnDemand’s AHIMA and AAPC-certified online conferences—done on your own schedule, from home or the office— increase your chances of passing certification exams. Every year, coders find themselves overwhelmed by new changes. Don’t go it alone. With a bit of skill upgrading and updating, says Young, you’ll make payers happy when they don’t have to check up on your claims!

To join the conference or see a replay, order a DVD or transcript, or read more

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