On October 1, 2023, the health care industry welcomed a fresh set of updates to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). These updates are vital for health care providers, coders, and payers as they ensure both excellent resident care and accurate documentation and billing. This article reviews the ICD-10-CM changes pertaining to Parkinson’s disease, parkinsonism, chronic obstructive pulmonary disease (COPD), and osteoporosis with pathological fracture of the pelvis. Understanding these updates is crucial for delivering optimal health care services and maintaining compliance with coding standards.

Parkinson’s Disease (G20)

Parkinson’s disease is a progressive neurodegenerative disorder that affects millions of individuals worldwide. Accurate coding is essential to track and treat this condition effectively. In line with the updated guidelines, facility coders must now distinguish whether a resident’s G20 Parkinson’s disease code corresponds to Parkinson’s disease or parkinsonism. As per the new coding system, these two conditions, previously classified under the ICD-10-CM code G20, now have separate designations. For Parkinson’s disease, coders should use G20.A- and G20.B-. For parkinsonism, G20.C is the correct code.

This change may require a comprehensive review of the patient’s medical records. If the documentation is unclear, facility coders must query physicians and nonphysician practitioners (NPPs) to provide a precise description of the actual condition. If parkinsonism is determined to be the correct diagnosis, further clarification is required to identify its underlying cause. If the resident is diagnosed with Parkinson’s disease, facility coders need to seek information from the provider regarding the presence or absence of dyskinesia and fluctuations to ensure the assignment of the most specific diagnosis code.

Here is further clarification on how to differentiate these two conditions:

Parkinson’s disease is a neurologic disorder characterized by involuntary and uncontrollable movements, such as tremors, rigidity, and difficulties in maintaining balance and coordination. These symptoms typically develop gradually and worsen over time. As the disease progresses, individuals may face challenges related to mobility and communication. Additionally, they may experience changes in mental and behavioral states, sleep disturbances, feelings of depression, memory problems, and increased fatigue.1

Parkinsonism, a broad term encompassing various neurologic conditions that share movement difficulties akin to those seen in Parkinson’s disease, is characterized by symptoms such as tremors, limited mobility, and muscle rigidity.2

Chronic Obstructive Pulmonary Disease (J44)

COPD is a prevalent respiratory condition characterized by persistent airflow limitation. ICD-10-CM updates related to COPD aim to improve accuracy in diagnosis and documentation related to COPD combined with asthma and bronchitis. The additional code of J44.89 was added to indicate when COPD includes asthmatic bronchitis or emphysematous bronchitis. A medical record review or provider inquiry is needed to ensure the medical record documentation supports this code. Note that “Not otherwise specified (unspecified) COPD” continues to be coded as J44.9.

Osteoporosis with Current Pathological Fracture of Pelvis (M80.0B- and M80.8B-)

Osteoporosis is a common condition characterized by weakening of bones that make them more susceptible to fractures. The ICD-10-CM updates for osteoporosis with current pathological fracture of the pelvis aim to enhance coding accuracy for the fracture location. Before the FY 2024 updates, a pathological fracture of the pelvis was identified by the “Other specified site” code of M80.0A-. This code included several fractures that were not represented by an individual code in the coding set. The addition of M80.0B-, Age-related osteoporosis with current pathological fracture, pelvis, and M80.8B-, Other osteoporosis with current pathological fracture, pelvis, adds a more specific site code. Medical record review and physician query are necessary to determine if the current “Other specified site” code is referring to the pelvis. Only if the site of the fracture is the pelvis can the new code be applied.

Next Steps for FY2024 Codes

To ensure the accuracy of diagnosis coding within the health care team, staff need the essential tools. They must have access to up-to-date ICD-10-CM coding manuals that should be renewed every October to incorporate the latest coding guidelines. It is also imperative to discuss with the medical director the importance of precise and specific diagnoses. This open dialogue will help underscore the significance of accurate coding practices in the long term care setting.

It’s also crucial to inform physicians that they may receive queries related to their diagnoses. This proactive communication ensures that the medical staff is prepared to address any inquiries and maintain the quality of patient records.

Every new fiscal year, a series of crucial steps should be taken to ensure the accuracy of diagnosis coding within the facility. To begin, diagnostic reports must be generated from the electronic health record (EHR) to pinpoint records that contain either deleted or updated codes. This initial review serves as the foundation to maintain the integrity of the coding system. Codes that require update as of October 1 can be found in the Conversion Table at https://www.cms.gov/medicare/coding-billing/icd-10-codes/2024-icd-10-cm.3

Subsequently, a detailed examination of the physician documentation within each flagged medical record will determine which updated code would best suit the condition of the resident. This process guarantees that the code aligns with the most current and relevant clinical information.

In cases where more specific details are required for accurate coding, staff must reach out to the physician or NPP. This collaborative communication ensures the coding process is as precise as possible, benefiting both patient care and health care data management.

By diligently following these steps each new fiscal year, facilities can maintain the quality and accuracy of their coding practices.


Jennifer LabayThe October 1, 2023, ICD-10-CM updates are critical for health care professionals, ensuring accurate documentation, diagnosis, and treatment of patients. Staying informed about these changes is essential for providing high-quality health care services while maintaining compliance with coding standards. Health care organizations, coders, and providers should invest the time and effort to understand and implement these updates and thus improve patient care and billing accuracy. 

Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, is curriculum development specialist for the American Association of Post-Acute Care Nursing (AAPACN).

1.    National Institute on Aging. (2022, April 14). Parkinson’s disease: Causes, symptoms, and treatments. https://www.nia.nih.gov/health/parkinsons-disease#:~:text=Parkinson’s%20disease%20is%20a%20brain,have%20difficulty%20walking%20and%20talking
2.    Parkinson’s Foundation. (2018). Parkinson’s disease vs. parkinsonism. https://www.parkinson.org/library/fact-sheets/parkinsonism
3.    Centers for Medicare & Medicaid Services. (2023). 2024 ICD-10-CM. https://www.cms.gov/medicare/coding-billing/icd-10-codes/2024-icd-10-cm