2018 ICD-10-CM and ICD-10-PCS Codeset Update – Key Highlights

The FY 2018 ICD-10-CM and PCS annual codeset update goes into effect October 1, 2017. Below are the key changes:

Summary of Changes

Codes ICD-10-CM ICD-10-PCS
New 360 3,562
Revised 250+ 1,821
Deleted 142 646


New Acute Myocardial Infarction Codes

I21.9 MCC Acute myocardial infarction, unspecified
I21.A MCC Other type of myocardial infarction
I21.A1 MCC Myocardial infarction type 2
I21.A9 MCC Other myocardial infarction type
  • Type 1 is a spontaneous MI related to ischemia from a primary coronary event (e.g., plaque rupture, thrombotic occlusion)
  • Type 2 is secondary to ischemia from a supply-and-demand mismatch and is always due to another underlying condition (e.g. septic shock)
    • Decrease supply (e.g. hypotension)
    • Increase demand (e.g. tachycardia)
  • Type 2 MI due to demand ischemia or ischemic balance is assigned to code I21.A1, MI type 2 not8, Other forms of acute ischemic heart disease
  • Type 2 MI’s do not require documentation of site/artery affected

New Heart Failure Codes

I50.811 Non-CC Acute right heart failure
I50.812 Non-CC Chronic right heart failure
I50.813 Non-CC Acute on chronic right heart failure
I50.810 Non-CC Unspecified right heart failure
  • Previously, right heart failure was coded to I50.9, Heart failure, unspecified
  • There are new codes for acute, chronic, acute on chronic, and unspecified right heart failure
  • None of these new codes are CCs


Index Changes

  • The root operation Extraction was applied to new body systems, to specify fine needle aspiration biopsies, and to other body systems to specify non-excisional debridement of deep tissue layers, such as muscle and tendon
  • A new body part value was added to uniquely identify procedures performed on the common hepatic duct (before the duct branches into the left or right hepatic duct)
  • The endoscopic approach value was added to many more PCS tables
  • The word greater and lesser has been removed from saphenous vein and omentum procedures
    • Example:
      • Revise from: 061P07Y Bypass Right Greater Saphenous Vein to Lower Vein with Autologous Tissue Substitute, Open Approach
      • Revise to: 061P07Y Bypass Right Saphenous Vein to Lower Vein with Autologous Tissue Substitute, Open Approach
      • Revise from: 0D5S0ZZ Destruction of Greater Omentum, Open Approach
      • Revise to: 0D5U0ZZ Destruction of Omentum, Open Approach
    • Laterality is no longer required for procedures on the trunk, occipital, sphenoid, and maxilla. Specificity must be upper or lower.
      • Example:
        • Revise from: 0M5C0ZZ Destruction of Right Trunk Bursa and Ligament, Open Approach
        • Revise to: 0M5C0ZZ Destruction of Upper Spine Bursa and Ligament, Open Approach
        • Revise from: 0NSR45Z Reposition Right Maxilla with External Fixation Device, Percutaneous Endoscopic Approach
        • Revise to: 0NSR45Z Reposition Maxilla with External Fixation Device, Percutaneous Endoscopic Approach
      • Laterality is no longer required for Rib procedures. Coders must specify how many ribs are included in the procedure. Choose from 1 or 2 ribs or 3 or more.
        • Example:
          • Revise from: 0P510ZZ Destruction of Right Rib, Open Approach
          • Revise to: 0P510ZZ Destruction of 1 to 2 Ribs, Open Approach
        • Hemodialysis codes changed for duration specificity
          • Example:
            • Revise from: 5A1D00Z Performance of Urinary Filtration, Single
            • Revise to: 5A1D80Z Performance of Urinary Filtration, Prolonged Intermittent, 6-18 hours Per Day


  1. https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2018-ICD-10-CM-Coding-Guidelines.pdf
  2. https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2018-PCS-Guidelines.pdf
  3. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/acute-myocardial-infarction/

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