Medicare Compliance & Reimbursement

Tip: Updated guidelines offer clarification on vaping.

There’s only one month until the new ICD-10-CM updates go live on Oct. 1. Now is a good time to review the changes and get your policies in line.

Logistics: On July 1, the Centers for Medicare & Medicaid Services (CMS) released the new ICD-10-CM codes and descriptors, with a total of 490 additions, 58 code deletions, and 47 revisions that will go into effect on Oct. 1. Read on for some code and guidance highlights.

Register Updates to the F10-F19 Range

Many of the changes to the 2021 code set involve additions to the F10 to F19 range, which involve substance use and/or abuse with withdrawal. These codes will offer new specificity for patients presenting with withdrawal symptoms from such substances as alcohol, cocaine, stimulants, and more.

For example, the new section F10.13 (Alcohol abuse, with withdrawal) has the following four codes under it:

• F10.130 (Alcohol abuse with withdrawal, uncomplicated)
• F10.131 (Alcohol abuse with withdrawal delirium)
• F10.132 (Alcohol abuse with withdrawal with perceptual disturbance)
• F10.139 (Alcohol abuse with withdrawal, unspecified)

These codes differ from the existing series, F10.23 (Alcohol dependence with withdrawal), by specifically denoting when abuse is present versus dependence.

You’ll also find new codes for alcohol use with withdrawal (F10.93-F10.939), opioid use with withdrawal (F11.13), cannabis use with withdrawal (F12.13), cocaine abuse with withdrawal (F14.13), and more codes for such substances as stimulants and psychoactive substances.

There are dozens of new codes for poisoning, too, such as the T40.49 (Poisoning by, adverse effect of and underdosing of other synthetic narcotics) series, which describes a variety of conditions that can result from overuse of synthetic narcotics, from self harm (T40.492) to assault (T40.493) and beyond.

Know These Changes on Esophagitis-Related Codes

Some of the changes to the 2021 code set are the result of stakeholder requests made at last year’s ICD-10-CM Coordination and Maintenance Committee (ICMC) Meeting, during which the ICMC’s Shannon McConnell-Lamptey offered some insight into the following new code additions:

• K20.80 (Other esophagitis without bleeding)
• K20.81 (… with bleeding)
• K21.00 (Gastro-esophageal reflux disease with esophagitis, without bleeding)
• K21.01 (…with bleeding)

The new codes rectify the problem of ICD-10 not including combination codes that reflect bleeding with these conditions. “In ICD-9-CM, there was a unique code for esophageal hemorrhage,” McConnell-Lamptey said when requesting these new code additions. Now the ICD-10 code listings will follow that lead, creating additional specificity for providers.

Add Influenza Coding Changes to Your List

You’ll also have to adjust your acute upper respiratory infection reporting just in time for flu season and “exercise more caution when using codes in the ‘Acute upper respiratory infections’ family [J00-J06] if influenza is involved,” cautions Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. In part, that’s because the note that previously appeared at the beginning of the J00-J06 code block has now been deleted and moved to three specific codes in the block.

In other words, the Excludes1 instruction not to report influenza virus with other respiratory manifestations (J09. X2 [Influenza due to identified novel influenza A virus with other respiratory manifestations], J10.1 [Influenza due to other identified influenza virus with other respiratory manifestations], J11.1 [Influenza due to unidentified influenza virus with other respiratory manifestations]) has been moved to the following codes exclusively:

• J00 (Acute nasopharyngitis (common cold))
• J02.9 (Acute pharyngitis, unspecified)
• J03.9 (Acute tonsillitis, unspecified)
• J06 (Acute upper respiratory infections of multiple and unspecified sites)

“This means J09.X2, J10.1, J11.1 are mutually exclusive to the codes under which they are listed. So, if the patient has influenza with respiratory manifestations, it would be inappropriate to also classify them as having a common cold [J00],” notes Moore.

“On the other hand, the new instruction to ‘Code also’ influenza with J04 [Acute laryngitis and tracheitis] and J05 [Acute obstructive laryngitis [croup] and epiglottitis] means you should add an influenza code when appropriate,” says Moore.

Get Ready for Headache Code Expansion

Most coders have the headache code (R51) committed to memory, but in a major adjustment to the code set, you’ll now find that R51 has become the parent code, and two additional codes will follow it:

• R51.0 (Headache with orthostatic component, not elsewhere classified)
• R51.9 (Headache, unspecified)

An orthostatic headache is one in which a patient has a headache while standing upright, but the headache goes away when the patient lies down or is otherwise horizontal. In the future, if the headache isn’t specified, you’ll use R51.9.

Feds Revisit U07.0 Guidelines

If you were paying attention to Centers for Disease Control and Prevention (CDC) announcements this April, you’ll know that they established guidelines surrounding the use of U07.0 (Vaping-related disorder). The guidelines, which now appear in section C.10.e., are significant, as the disorder “is an up-and-coming condition that requires accurate coding in order to track the frequency of respiratory conditions due to vaping,” explains Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico.

As with any condition, when a definitive diagnosis has not been established for the disorder, you should code for the presenting signs and symptoms such as cough (R05) or shortness of breath (R06.02).

However, for condition(s) related to vaping or for “lung injury due to vaping,” the guideline tells you to use U07.0. When you use U07.0 as the principal diagnosis, ICD-10-CM guidelines further instruct you to use an additional code to identify manifestations such as acute respiratory failure from subcategory J96.0- (Acute respiratory failure) or pneumonitis using code J68.0 (Bronchitis and pneumonitis due to chemicals, gases, fumes and vapors), when applicable.

Pay attention to the addenda: “Remember, in cases of a definitive diagnosis, you should follow the Use Additional Code instruction in the ICD-10 2021 addenda, which reminds you to code for additional manifestations such as abdominal pain [R10.84], diarrhea [R19.7], acute respiratory distress syndrome [J80], drug-induced interstitial lung disorder [J70.4], lipoid pneumonia [J69.1], and weight loss [R63.4], when applicable,” reminds Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana.

Resource: Read the entire new ICD-10 code set on the CMS website at www.cms.gov/medicare/icd-10/2021-icd-10-cm.