ICD 10 Coding Alert

Think of this as a survey of important code changes you need to know about.

While some specialties have seen myriad code changes, coding primary care encounters means knowing at least a little about a lot of diagnoses. This article includes updates pertinent to practices that see patients of all ages, including pediatric patients.

Check these ICD-10 coding and guideline updates to make sure you’re choosing the most accurate diagnosis codes possible.

Note This Major Change to Headache Code

If, like most coders, you have R51 (Headache) burned into your brain, prepare to rewrite over some brain cells. That’s because “coding this common symptom will now require a fourth digit,” cautions Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians, reminds coders. You’ll now have two choices if your physician records the symptom: R51.0 (Headache with orthostatic component, not elsewhere classified) or R51.9 (Headache, unspecified).

Terminology tip: Headaches are described as orthostatic if they occur while the patient is vertical and are relieved when the patient is horizontal.

The Excludes1 instructions for the R51.- codes have also changed to Excludes2 status. So, the listed conditions — atypical face pain (G50.1), migraine and other headache syndromes (G43-G44), and trigeminal neuralgia (G50.0) — “are no longer considered mutually exclusive to headache. Instead, they become separately reportable in addition to headache when applicable,” Moore says.

Incorporate These Specific Devices for Transportation Injury Codes

ICD-10 has also added hoverboards, segways, and electric scooters to its growing list of transportation injury codes. Like many of the injury codes, the new codes take seventh characters of A (Initial), D (Subsequent), and S (Sequela) to indicate the stage of care.

Accidents involving hoverboards and segways — which ICD-10 refers to as micro-mobility conveyances — now have dedicated codes. So, you would add V03.038A (Pedestrian on other standing micro-mobility pedestrian conveyance injured in collision with car, pick-up or van in nontraffic accident, initial encounter) after the appropriate injury code(s) for a patient seeing your provider for an initial encounter after riding their hoverboard into a parked car.

Similarly, ICD-10 has introduced new codes for injuries involving electric scooters. “I think that all these codes will be used frequently, but remember that these will not be primary diagnoses but codes that describe how something happened. For example, if a patient reports for an initial encounter for a fracture of an unspecified phalanx of left thumb after colliding with a stationary object while standing on an electric scooter, you would record S62.502A as the primary diagnosis with V00.842A as the reason it happened,” says Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana.

Reach for More Specificity When Coding Sickle Cell Disorder Complications

“According to the Centers for Disease Control and Prevention [CDC], sickle cell disorder is a common inherited blood disorder in the United States, affecting an estimated 70,000 to 100,000 Americans,” Moore says. So, it should come as no surprise that “there are multiple new codes in this family [D57], which will allow greater specificity but also require more granular coding in the process.”

The 24 new codes in the group, along with numerous Code Also and Use Additional code instructions, add specificity to parent codes by describing various medical crises that occur when red blood cells stick together and block small blood vessels. As an example, existing code D57.21- (Sickle-cell/ Hb-C disease with crisis), which previously had three code options, has two additional options as of Oct. 1, 2021: D57.213 (Sickle-cell/Hb-C disease with cerebral vascular involvement), which has an instruction to code also, if applicable, cerebral infarction (I63.-), and D57.218 (Sickle-cell/Hb-C disease with crisis with other specified complication), which contains instructions to use an additional code to identify complications, such as cholelithiasis (K80.-) and priapism (N48.32).

New Codes Added to the F10-F19 Group

Many of the changes to the F10-F19 (Mental and behavioral disorders due to psychoactive substance use) group involve “the addition of a sixth character to a code previously used to identify when substance use or abuse turns into withdrawal,” Moore says. The characters are:

• 0 — with withdrawal, uncomplicated
• 1 — with withdrawal delirium
• 2 — with withdrawal with perceptual disturbance
• 9 — with withdrawal, unspecified

“Primary care physicians are often the first contact for mental health issues, so they will need to be aware of the multiple new codes in this section,” says Moore.

Follow Added Code Instruction for Parkinson’s Disease

This small but significant change to ICD-10 asks you to “Use Additional code to identify dementia with behavioral disturbance (F02.81) and/or dementia without behavioral disturbance (F02.80).” So, “when either of those circumstances applies, primary care providers [PCPs] will need to use an additional code rather than relying on G20 alone,” Moore notes.

Understand Major Update to T40 Codes

“The existing T40.4X [Poisoning by, adverse effect of and underdosing of other synthetic narcotics] code family, which only specifies ‘synthetic narcotics,’ has been deleted and will be replaced by three code sets that allow coders to specify fentanyl or fentanyl analogs [T40.41-], tramadol [T40.42-], and ‘other’ synthetic narcotics [T40.49-]. Given the attention being paid to fentanyl these days, this does not seem a surprise,” notes Moore.

Fortunately, ICD-10 has retained the structure of the codes, so you’ll still be able to document whether the poisoning was accidental, intentional self-harm, assault, or undetermined, or whether the patient is suffering from adverse effects or underdosing using sixth characters 1-6, respectively. And you’ll still need to add seventh characters of A, D, or S to indicate the stage of care.

Keep New Foreign Body Codes in Mind

The expansion of the Z03.82- (Encounter for observation for suspected foreign body ruled out) codes will come as a welcome addition to any primary care coder who is used to dealing with children.

“Kids are known for putting objects into their nose, ears and other places, so new codes for ruling out suspected ingestion [Z03.821], aspiration [Z03.822], or insertion [Z03.823] of a foreign body will probably get a lot of use!” Holle says.

Resource: For the full 2021 ICD-10 addenda, go to: www.cms.gov/medicare/icd-10/2021-icd-10-cm and download the zip file labeled 2021 Addendum.