ED Coding and Reimbursement Alert

The 2020 diagnosis code list includes nearly 400 changes.

From heart conditions to bone injuries to overdoses, emergency departments see it all – and coding those conditions can be challenging, particularly when the ICD-10 code set has its limitations. Fortunately, CMS is expanding your options effective Oct. 1, thanks to almost 400 changes and updates to the ICD-10-CM code list. The agency published the full listing of codes in mid-June, but we’ve reviewed the list to identify the changes most relevant to emergency departments.

Check out New Pulmonary Embolism Codes

Effective Oct. 1, you’ll find new codes that allow additional specificity in pulmonary embolism coding. The codes open up the options when seeing patients who have blood clots in their lungs. The updates apply to the I26.9 category (Pulmonary embolism without acute cor pulmonale), as follows:

• I26.93 — Single subsegmental pulmonary embolism without acute cor pulmonale
• I26.94 — Multiple subsegmental pulmonary emboli without acute cor pulmonale

Here’s what that means: “Cor pulmonale” refers to an abnormal enlargement of the right side of the heart due to a diseases of the pulmonary blood vessels or the lungs.

The presence or absence of this added complication virtually decides the direction your coding goes in deciding the final code. If the ED physician notes cor pulmonale during the encounter, you will select from I26.0- (Pulmonary embolism with acute cor pulmonale) and these new codes. For example, a case of simple septic pulmonary embolism will now map to I26.93. If the physician can confirm the underlying infection, you would report this code as well. These new codes allow you to specify whether the patient has multiple emboli or just one in the absence of cor pulmonale.

Coder tip: If the ED physician can’t identify the type of pulmonary embolism, you have an easy way out. Pulmonary embolism not otherwise specified (NOS) will be classified to I26.99, informs Carol Pohlig, BSN, RN, CPC, ACS, Senior Coding & Education Specialist at the Hospital of the University of Pennsylvania.

Expansion of DVT Codes

Coding for deep vein thrombosis (DVT) will get a lot more detailed under ICD-10 starting in October. Here’s what you can expect.

Diagnosis: Embolism is the obstruction of a vessel by a clot or foreign substance (such as plaque or fatty deposits). Thrombosis is obstruction by a blood clot. The codes featured here are specific to deep vessels, and that means the codes are appropriate for DVT, whether the patient’s particular condition is considered acute or chronic.

Under the I82.4 (Acute embolism and thrombosis of deep veins of lower extremity) and I82.5 (Chronic embolism and thrombosis of deep veins of lower extremity) categories, ICD-10 will expand to debut four new sections:

• I82.45x (Acute embolism and thrombosis of peroneal vein): This five-code set ranges from I82.451 (…right peroneal vein) to I82.459 (…unspecified peroneal vein). These codes are site and laterality-specific.
• I82.46x (Acute embolism and thrombosis of calf muscular vein): This range also includes five codes ranging from I82.461 (…right calf muscular vein) to I82.469 (…unspecified calf muscular vein), each of which is site-specific to the side of the body affected.
• I82.55 (Chronic embolism and thrombosis of peroneal vein), which includes five codes from I82.551 (…right peroneal vein) to I82.559 (…unspecified peroneal vein), all describing laterality.
• I82.56 (Chronic embolism and thrombosis of calf muscular vein), which also expands out to five codes that specify laterality as above.

These codes better allow you to report DVT of the peroneal or calf muscular veins, but you must select the appropriate code depending on whether the condition is acute or chronic. Your clinician’s documentation will need to be clear about the vessel(s) and limb(s) involved for you to choose the most appropriate ICD-10 code. 

Poisoning Codes Expand

If you thought the section of ICD-10 related to poisoning codes could use some help, CMS delivers with several new codes for the T50.91 section (Poisoning by, adverse effect of and underdosing of multiple unspecified drugs, medicaments and biological substances). The new section now allows you to specify the manner in which a patient was poisoned by multiple drugs, whereas in the past, there wasn’t a section that specifically noted that patients were poisoned due to a variety of drugs.

For instance, you’ll find such codes as T50.912A (Poisoning by multiple unspecified drugs, medicaments and biological substances, intentional self-harm, initial encounter) and T50.911 (Poisoning by multiple unspecified drugs, medicaments and biological substances, accidental (unintentional)).

Similar sections follow to denote adverse effects of multiple drugs (T50.915) and underdosing of multiple unspecified drugs (T50.916).

New Heatstroke, Eye Fracture Codes Debut

When you see patients for heatstroke, you currently only have the option to note the heatstroke visit, and you can’t indicate whether the visit pertains to an initial, subsequent, or sequala-related encounter. The ICD-10 codebook will now expand out sections T67.01 (Heatstroke and sunstroke), T67.02 (Exertional heatstroke), and T67.09 (Other heatstroke and sunstroke) to allow you to explain the visit stage. In most cases in the ED, the patient will be presenting for an initial encounter, but in some situations, you may see a patient for a subsequent encounter or for sequela of the heat-related illness.

And because only one code currently exists for orbital bone fractures, you’ll find several new codes for these conditions, such as 20 codes under the new subcategory S02.12 (Fracture of orbital roof), as well as over 40 new options to describe the specific site of an orbital wall fracture (S02.83 to S02.84), and seven codes to describe “fracture of orbit, unspecified” (S02.85).

Resource: To check out the complete list of new ICD-10 codes, visit the CMS website at www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-CM.html.