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New ICD-10 Diagnosis Codes and Inpatient ICD-10-PCS Procedure Codes Effective April 1, 2023

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective for dates of service on or after April 1, 2023, the Centers for Disease Control and Prevention’s (CDC’s) National Center for Health Statistics (NCHS) is implementing 42 new diagnosis codes into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM).

For those same days of service the Centers for Medicare & Medicaid Services (CMS) is implementing 34 new Procedure Coding System (PCS) inpatient hospital surgical procedure codes into the ICD-10-CM.

The following ICD-10 diagnosis codes will be added:

Added Diagnosis Codes

T74A1XA

T74A1XD

T74A1XS

T74A2XA

T74A2XD

T74A2XS

T76A1XA

T76A1XD

T76A1XS

T76A2XA

T76A2XD

T76A2XS

Y07010

Y07011

Y07020

Y07021

Y07030

Y07031

Y07040

Y07041

Y07050

Y07051

Y0744

Y0745

Y0746

Y0747

Y0754

Z556

Z5881

Z5889

Z5910

Z5911

Z5912

Z5919

Z62814

Z62815

Z91141

Z91148

Z91151

Z91158

Z91413

Z91414

The following ICD-10-PCS inpatient hospital surgical procedure codes will be added. These codes must be submitted only on inpatient hospital claims (as applicable):

Added PCS Surgical Procedure Codes

02LW0DJ

04L00DJ

0P530Z3

0P533Z3

0P534Z3

0P540Z3

0P543Z3

0P544Z3

0Q500Z3

0Q503Z3

0Q504Z3

0Q510Z3

0Q513Z3

0Q514Z3

302A3H0

302A3H1

302A3J0

302A3J1

302A3K0

302A3K1

302A3L0

302A3L1

302A3N0

302A3N1

302A3P0

302A3P1

302A3R0

302A3R1

XW013G6

XW0DXK8

XW0G7K8

XW0H7K8

XW133J8

XW143J8

Note: These procedure codes are surgical codes used to assign the proper Diagnosis-Related Group (DRG) for an inpatient hospital stay and are processed as informational only.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.