ED Coding and Reimbursement Alert

ICD-10-CM Coding:

Latest ICD-10-CM Update Includes New Codes for Cough, COVID-19

Published on Thu Aug 12, 2021

Plus: EDs can benefit from new back pain diagnosis codes.

You’ll see 191 new codes added to the ICD-10-CM code set beginning on Oct. 1, 2021, but that’s not all. CMS also revised and deleted some diagnosis codes, in addition to creating new guidelines for them. To get a handle on the changes most relevant to emergency departments, read on.

COVID-19 Updates Continue

Unsurprisingly, there are a number of code changes related to COVID-19. “All of them are related to a new special purposes code, U09.9 [Post COVID-19 condition, unspecified], which has its own notes and Code First instructions that are also new,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. The changes include:

Notes for new code U09.9 that explain the code “enables establishment of a link with COVID-19.” The notes go on to tell you that the code is to be used to document “post-acute sequela of COVID-19,” and not for “cases that are still presenting with active COVID-19,” though it can be used for “cases of re-infection with COVID-19, occurring with a condition related to prior COVID-19.”
Code first instructions for U09.9 that tell you to code conditions related to COVID-19 “such as chronic respiratory failure (J96.1-), loss of smell (R43.8), loss of taste (R43.8), multisystem inflammatory syndrome (M35.81), pulmonary embolism (I26.-), and pulmonary fibrosis (J84.10).”
A new Excludes2 note under B94.9 (Sequelae of unspecified infectious and parasitic disease) that allows you to code U09.9 in addition, if applicable.
A change in the note under M35.81(Multisystem inflammatory syndrome) that tells you to no longer use sequelae of COVID-19 (B94.8) but to use U09.9 if the condition is a result of COVID-19.
And a new note under Z86.16 (Personal history of COVID-19) that tells you U09.9 is now an Excludes1 code.

Capture Cough With These New Codes

Another big change that will be sure to affect your coding when it takes effect involves the expansion of R05 (Cough) to six new codes:

R05.1 (Acute cough)
R05.2 (Subacute cough)
R05.3 (Chronic cough)
R05.4 (Cough syncope)
R05.8 (Other specified cough)
R05.9 (Cough, unspecified)

The codes now give you more specificity for this common symptom, giving you the choice of three levels of severity, from acute through subacute to chronic, the last of which also has three synonyms: persistent cough, refractory cough, and unexplained cough. You now also have R05.4 to document cough syncope, a condition where a patient loses consciousness after a coughing bout.

But even with this expanded range of R05 codes, “the unspecified code, R05.8, should be avoided whenever possible in favor of a code with greater specificity,” says Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana.

Code this first: R05.4 comes with a Code first note to add syncope and collapse (R55) as a the first-listed diagnosis when the two are documented together and when applicable.

But beware of this: All the R05 codes also come with changed Excludes1 instructions, which tell you that cough with hemorrhage (R04.2) in now an Excludes2 code rather than an Excludes1 code, while paroxysmal cough due to Bordetella pertussis (A37.0-) remains an Excludes1 code.

Lower Back Pain, Concussion

You’ll also find expanded code choices for one of the most common conditions seen in the ED: lower back pain. When the changes take effect, you’ll be able to use M54.50 (Low back pain, unspecified) for documenting loin pain and lumbago NOS, synonyms that have moved from parent code M54.5 (Low back pain).

Look to M54.51 (Vertebrogenic low back pain) if your provider documents lower back pain emanating from the vertebral end plates in the patient’s lumbar spine, and M54.59 (Other low back pain) if your provider has specified the pain and there is no other specific code for you to use.

Plus, get ready for your concussion code set (S06.0) to nearly double in October. You’ll find options for traumatic brain compression (S06.A), with or without herniation. For instance, if you see a patient with a traumatic brain compression without herniation for an initial encounter, you’ll report new code S06. A0XA (Traumatic brain compression without herniation, initial encounter).

Feeding Issues, Aspiration Pneumonia

2022 also brings you a lot of new codes and instructions to document patients with feeding difficulties. The CDC has broken out R63.3 (Feeding difficulties) into four new codes:

R63.30 (Feeding difficulties, unspecified)
R63.31 (Pediatric feeding disorder, acute)
R63.32 (Pediatric feeding disorder, chronic)
R63.39 (Other feeding difficulties)

Code these conditions also: The CDC has also added instructions for R63.31 and R63.32 to code also associated conditions such as aspiration pneumonia (J69.0), dysphagia (R13.1-), gastro-esophageal reflux disease (K21.-), and malnutrition (E40-E46) if applicable.

New ‘Z’ Codes Allow for More Clarity

You’ll find many of the newly-debuted codes are located in Chapter 21: Factors influencing health status and contact with health services. Among them are numerous codes that will enable you to document social determinants of health (SDoH) — the way social circumstances affect a patient’s health — in much greater detail.

But they’re not the only changes you’ll find in that chapter. Here’s what to expect from next year’s ICD-10.

Social Determinants of Health (1): Housing Insecurity

In its continuing efforts to facilitate documentation of SDoH, the Centers for Disease Control and Prevention (CDC) has added a number of new codes to the existing Z59.- (Problems related to housing and economic circumstances) codes.

Code Z59.0 (Homelessness) is now broken out to three codes:

Z59.00 (Homelessness unspecified)
Z59.01 (Sheltered homelessness), which the code’s synonyms tell you to use when a patient is “living in a shelter such as: motel, scattered site housing, temporary or transitional living situation” and
Z59.02 (Unsheltered homelessness), which you will use for patients “residing in [a] place not meant for human habitation such as: abandoned buildings, cars, parks, sidewalk” or “residing on the street.”

Additionally, “the CDC has broken out Z59.8 (Other problems related to housing and economic circumstances) into a number of new codes. You will now be able to document when a patient’s health is affected by housing instability, but the patient is currently not homeless, by adding sixth characters to Z59.81- (Housing instability, housed),” Moore adds.

So, you will now be able to report:

Z59.811 (Housing instability, housed, with risk of homelessness)
Z59.812 (Housing instability, housed, homelessness in past 12 months)
Z59.819 (Housing instability, housed unspecified)

Synonyms for all the Z59.81- codes tell you that you can use them when a patient is dealing with problems due to a foreclosure on home loan, is past due on rent or mortgage, and/or has undergone unwanted multiple moves in the last 12 months. Confusingly, the CDC moved similar synonyms (“foreclosure on loan,” “isolated dwelling,” and “problems with creditors,”) that were originally assigned to what is now parent code Z59.8- to new code Z59.89 (Other problems related to housing and economic circumstances).

Social Determinants of Health (2): Food Insecurity

You also now have two codes to address health determinants based on lack of, or lack of access to, food: Z59.41 (Food insecurity) (defined as occurring when “food intake of household members is reduced and their normal eating patterns are disrupted because the household lacks money and other resources for food,” according to the U.S. Department of Agriculture (Source: www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security.aspx)) and Z59.48 (Other specified lack of adequate food), which is accompanied by the synonyms “inadequate food” and “lack of food.”

For the Z59.4- codes, Excludes1 codes for effects of hunger (T73.0), inappropriate diet or eating habits (Z72.4), and malnutrition (E40-E46) will now become Excludes2 codes, with deprivation of food (T73.0) added to the list.

Additionally, “parent code Z59.4 gets a name change from ‘Lack of adequate food and safe drinking water’ to ‘Lack of adequate food’ with the synonym ‘Inadequate drinking water supply’ deleted. But to address that issue, you’ll have a new code, Z58.6 [Inadequate drinking-water supply], which is accompanied by the synonym ‘Lack of safe drinking water,’” Moore notes.

Personal History

You’ll find two more new codes by expanding Z91.5 (Personal history of self-harm) with fourth character codes for documenting Z91.51 (Personal history of suicidal behavior) and Z91.52 (Personal history of nonsuicidal self-harm). Synonyms previously under Z91.5 — personal history of parasuicide (a suicidal attempt where the goal is not death, or an unsuccessful suicide), personal history of self-poisoning, and personal history of suicide attempt — now appear under Z91.51, while personal history of nonsuicidal self-injury, personal history of self-inflicted injury without suicidal intent, and personal history of self-mutilation appear as synonyms for Z91.52.

Immunization Counseling

Last, one new code that will probably get an immediate workout in the ED is Z71.85 (Encounter for immunization safety counseling). The ICD-10 code will pair with immunization administration service codes, including the numerous new COVID-19 vaccine administration codes, when your provider offers education regarding the safety of a particular vaccine. It may also be appropriate in some situations where vaccine counseling occurs, but no vaccine is administered, such as 99401-99404 (Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure) …).

The code comes with Code also instructions to code an encounter for immunization (Z23) or immunization not carried out (Z28.-) as applicable, along with an Excludes1 note that you should use the encounter for health counseling related to travel (Z71.84) code instead if your provider’s immunization safety counseling is travel-related.

For the full list of added, revised, and deleted ICD-10 codes for 2022, go to www.cdc.gov/nchs/icd/icd10cm.htm, click on the ICD-10-CM FY 2022 Addenda PDF 2022 link, and download the Table and Index zip file.