Preparing for ICD-10-AM Thirteenth Edition: Your Guide to Success

As we approach the release of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) Thirteenth Edition, clinical coders across Australia are gearing up for significant changes in their field.

Set to be implemented on 1 July 2025, this update brings a host of modifications that will impact coding practices, data collection, and healthcare reporting.

As your trusted partner in healthcare education, we’ll explore the key changes, their implications, and how you can prepare for this important transition.

The Independent Health and Aged Care Pricing Authority (IHACPA) has announced that the ICD-10-AM Thirteenth Edition, along with the Australian Classification of Health Interventions (ACHI) and Australian Coding Standards (ACS), is scheduled for release on 1 July 2025. From the date of this article, this gives us all about 6 months to prepare, and we’re here to support you every step of the way.

The Thirteenth Edition brings several important updates to ICD-10-AM, addressing gaps in the classification and reflecting contemporary clinical knowledge and practice.

Key changes include:

a) New and Missing Clinical Concepts:

• Creation of a unique code for postural orthostatic tachycardia syndrome (POTS)
• Expansion of R10.2 Pelvic and perineal pain to distinguish between male and female pelvis
• Removal of the Excludes note for R45.81 Suicidal ideation, allowing it to be assigned alongside mental health conditions
• Creation of R45.82 Homicidal ideation
• New code Z72.7 Use of vaping device
• Consideration of codes to capture concepts relating to voluntary assisted dying

b) Social Factors:

• New codes for health literacy and other types of literacy
• Codes for workplace relationship and culture problems
• Expanded codes for homelessness, including sheltered and unsheltered categories
• Codes for Aboriginal and Torres Strait Islander people and migrant cultural issues
• Enhancements to capture social factors related to natural disasters, bullying, employment issues, and social isolation

c) Subacute Settings:

• New code R41.81 for Age-associated cognitive decline
• Amendment of R54 to Ageing associated decline
• Revision of category Z74 Problems related to care-provider dependency
• Expansion of Z75.2 Other waiting period for investigation and treatment

The Australian Classification of Health Interventions (ACHI) is also undergoing significant changes, primarily driven by updates to the Medicare Benefits Schedule (MBS) and the incorporation of new health technologies.

Key updates include:

a) MBS-driven changes:

• Amendments to blocks and codes for microvascular repair, anastomosis, and graft
• New codes for transcatheter mitral valvuloplasty and heart valve explants
• Expansion of arthrodesis and excision of lesion codes for ankle, hindfoot, and midfoot
• Addition of codes for neurolysis and nerve decompression of the arm.

b) New health technologies:

• Creation of a code for pulmonary embolectomy
• New code for reconstruction of breast, including therapeutic mammoplasty
• Creation of 30390-02 [1926] Laparoscopic approach, not elsewhere classified

c) Organ, tissue, and cell procurement and transplantation:

• New codes for transplantation and procurement of various tissues and cells
• Expansion of codes to identify living and posthumous donors

The Thirteenth Edition brings significant changes to the ACS, including:

a) Introduction of Cluster Coding:

• A new mechanism to link related diagnosis codes through a diagnosis cluster identifier (DCID)
• Initial implementation for external cause codes and chronic conditions
• Addition of ACS 0004 Diagnosis cluster identifier (DCID)

b) Revision of ACS 1904 Procedural complications:

• Renamed to “Complications of surgical and medical care”
• Clarification and simplification of guidelines
• Elimination of ambiguity and overlap with other standards

c) Clarification of ACS 1924 Difficult intubation:

• Revision to address ambiguity in code assignment
• Creation of new code Z98.3 Difficult airway for intubation

d) Standardisation of ACS structure and format:

• Implementation of a standard template for all ACS chapters
• Deletion or relocation of content from several ACS

The Australian Refined Diagnosis Related Groups (AR-DRG) classification is also being updated to Version 12.0, with several key changes:

a) New ADRGs:

• Creation of ADRG U69 Mental and Behavioural Disorders Associated with the Puerperium
• Disaggregation of ADRG O66 into four new ADRGs in MDC 14 Pregnancy, Childbirth and the Puerperium
• Creation of ADRG A41 Posthumous Organ Procurement

b) Enhancement of Diagnosis Complexity Level (DCL) precision:

• Increased granularity for 25 diabetes mellitus codes

c) Review of ADRG 801 General Interventions (GIs) Unrelated to Principal Diagnosis:

• Reassignment of certain GIs to more appropriate ADRGs

d) Impact of COVID-19 on Classification Development:

The development of AR-DRG V12.0 has taken into account the impact of the COVID-19 pandemic on hospital service delivery and coding practices. IHACPA has investigated:

• Volatility of cost per episode of care
• Changes in ICD-10-AM coding practices during the pandemic

While some fluctuations were observed, the overall impact on the complexity model appears to be limited. However, IHACPA will continue to monitor this as the development cycle progresses.

Whether you’re a current student, a recent graduate, or an experienced professional, here’s what you can do to prepare:

a) Stay Informed:

• Regularly check IHACPA’s website for updates and resources
• Participate in webinars and workshops focused on the changes

b) Review New Codes and Guidelines:

• Familiarise yourself with new and revised ICD-10-AM, ACHI, and ACS codes and guidelines when made available.
• Pay particular attention to areas of significant change, such as social factors and new clinical concepts.

c) Upskill and Practice:

• Enrol in our Diploma of Clinical Coding or consider a professional development course
• Use sample cases to practise applying new codes and guidelines
• Participate in coding exercises focused on the new edition’s changes

d) Prepare for Cluster Coding:

• Understand the concept of cluster coding and its implementation
• Practise linking related diagnosis codes using the new DCID

e) Engage in Continuous Learning:

• Participate in IHACPA’s education modules on IHACPA Learn
• Attend training sessions specific to the Thirteenth Edition

f) Collaborate and Network:

• Join our student community forums to discuss the changes with peers
• Form study groups to discuss and practise new coding concepts
• Share insights and challenges with fellow coders

g) Communicate with Clinicians:

• Educate clinicians on new documentation requirements, particularly for new codes and concepts
• Work closely with clinical teams to ensure accurate and complete documentation

h) Prepare for System Updates:

• Liaise with IT departments to ensure coding software is updated in time for the transition
• Familiarise yourself with any changes to the electronic health record system that may impact coding.

While preparing for the Thirteenth Edition, it’s important to note that IHACPA is also conducting an ICD-11 mapping project. This project aims to compare ICD-10-AM with ICD-11 and assess the potential benefits and gaps of implementing ICD-11 in Australia. While no immediate transition to ICD-11 is planned, this mapping project will inform future decisions about the classification system.

IHACPA will be releasing several resources to support the implementation of the Thirteenth Edition, including:

• Electronic code lists (ECLs) for ICD-10-AM and ACHI
• Mapping tables between editions
• Updated classification manuals
• Education modules on IHACPA Learn
• ICD-10-AM/ACHI/ACS Chronicle

Clinical coders should make use of these resources to facilitate their transition to the new edition.

We’re committed to ensuring that our students and graduates are at the forefront of these changes. Here’s how we’re updating our Diploma of Clinical Coding to meet the new standards:

• Comprehensive curriculum updates to incorporate all new codes and concepts
• Enhanced practical training with real-world scenarios using the new classification
• Introduction of cluster coding exercises to build your skills in this new area
• Flexible learning options to fit your busy schedule, including online modules and recorded tutorials.

When you enrol with us, you’re not just getting a diploma – you’re gaining a professional development partner. Here’s why our Diploma of Clinical Coding is your best choice:

• Up-to-the-minute curriculum aligned with Thirteenth Edition changes
• Practical, hands-on training that prepares you for real-world coding challenges
• Flexible learning options to suit your lifestyle
• Strong industry connections to support your career growth
• Ongoing support and resources for our graduates

Whether you’re looking to start your coding career or upgrade your skills for the Thirteenth Edition, we have a pathway for you:

• Prospective Students: Explore our Diploma of Clinical Coding and take the first step towards an exciting career in healthcare. There’s no reason to wait until 1 July 2025 (see the next point below).
• Current Students: Rest assured that your studies with us will incorporate all the latest changes, preparing you for success from day one in your new career.
• Experienced Coders and Health Information Managers: It’s never too late to gain a formal qualification in clinical coding. Check out our nationally-recognised Diploma of Clinical Coding to bring you up to speed with the Thirteenth Edition changes.

Remember, the transition to ICD-10-AM Thirteenth Edition is more than just a challenge – it’s an opportunity to enhance your skills and increase your value in the healthcare industry.

With TalentMed by your side, you’ll be well-equipped to navigate these changes and excel in your career.