Otolaryngology Coding Alert

Leave some extra room for parenthetical note changes, as well.

It’s anyone’s guess on a year-to-year basis as to whether the annual changes to the ICD-10-CM will have a profound impact on a given specialty. This year, some specialties are getting off light, while others will have their hands full digesting a variety of new, revised, and deleted code changes impacting their practices.

On first review of all the new changes, you’ll find that otolaryngology was not spared when it comes to a broad set of new and revised codes to add to your coding arsenal. However, you’ll find that you’ve got to go even further than simply addressing the new, revised, and deleted codes to get the most out of the 2021 ICD-10-CM changes.

Tag along and highlight some of the most pertinent otolaryngology-specific coding considerations to be well-prepared for October 1, 2020.

Report U07.0 for Vaping-Related Respiratory Damage

While some of the most prevalent changes in 2021 come by way of ICD-10-CM code revisions, there are a few key code additions you should take note of.

While most of the new COVID-19 codes and guidelines dominated the headlines in the month of April, another code for vaping-related disorders was also implemented at the same time. For patients that present with various degrees of lung (or other specified organ) damage that are linked to vaping, you’ll report the following code:

• U07.0 (Vaping-related disorder)

The index will now include routes to reach this code via Damage ⇒ lung or Damage ⇒ organ. Sub terms that will yield code U07.1 include dabbing, electronic cigarette, and vaping. You can reach the same code following the route of Disease ⇒ lung, as well.

Note: Make sure to scour the list of “Use Additional” notes underneath U07.0 to include any accompanying diagnoses. For instance, if the patient presents with vaping-related damage to the larynx in addition to acute respiratory distress syndrome (ARDS), report code J80 (Acute respiratory distress syndrome) as a secondary diagnosis.

Address Changes to CSF Otorrhea Coding

Next, you should home in on a comprehensive list of new codes added to category code G96 (Other disorders of central nervous system). With respect to cerebrospinal fluid (CSF) otorrhea, reporting using the current ICD-10-CM manual begins and ends at G96.0 (Cerebrospinal fluid leak). In 2021, unspecified CSF otorrhea will be reported as G96.00 (Cerebrospinal fluid leak, unspecified). However, you’ll also have the option of reporting more specified forms of CSF otorrhea:

• G96.01 (Cranial cerebrospinal fluid leak, spontaneous)
• G96.02 (Spinal cerebrospinal fluid leak, spontaneous)
• G96.08 (Other cranial cerebrospinal fluid leak)
• G96.09 (Other spinal cerebrospinal fluid leak)

Include Documentation of Esophageal Bleeding With K20 Codes

Finally, turn your attention to a new set of codes featured in the Diseases of the digestive system (K00-K95) chapter. Coding for esophagitis was previously limited to a set of three codes, two of which being K20.8 (Other esophagitis) and K20.9 (Esophagitis, unspecified). ICD-10-CM will add another degree of specificity in 2021 by including documentation of with or without bleeding:

• K20.90 (Esophagitis, unspecified without bleeding)
• K20.91 (Esophagitis, unspecified with bleeding)

The same concept applies to Gastroesophageal reflux disease (GERD) coding under K21.0 (Gastro-esophageal reflux disease with esophagitis). In 2021, you’ll be required to document whether the GERD includes bleeding with the following codes:

• K21.00 (Gastro-esophageal reflux disease with esophagitis, without bleeding)
• K21.01 (Gastro-esophageal reflux disease with esophagitis, with bleeding)

Dive Deeper Than Just New ICD-10-CM Codes

If you want to get the most out of the ICD-10-CM updates, you’ve got to look beyond the mere addition of new codes. “Many coders think if they review their new ICD-10-CM book, focusing on ‘new code’ icons, they will be alerted to all the changes in the ICD for the year; nothing could be further from the truth,” says Sheri Poe Bernard, CPC, of Poe Bernard Consulting in Salt Lake City.

Another set of changes that doesn’t fall into one of the new, revised, and deleted code categories has to do with the addition of index terms for existing codes. In some instances, you’ll now find rearranged sub-terms that lead to a given existing code. Be sure to thoroughly scour the 2021 addenda to the alphabetic index to see what codes may have been “rerouted.”

Don’t Forget About Crucial Parenthetical Note Changes

To round out what you’ve learned, take a deeper dive into one set of important Excludes1 and Code Also note changes you’ll find in Chapter 10 (Diseases of the respiratory system (J00-J99)). Previously, code range J00-J06 had an all-encompassing Excludes 1 note that stated the following:

• Excludes1: influenza virus with other respiratory manifestations (J09.X2, J10.1, J11.1)

Beginning in October, that parenthetical note will be deleted and parenthetical notes will instead be added to each respective category code. Category codes J00, J02, J03, and J06 will remain unchanged; meaning that the same Excludes1 note will be applied. However, ICD-10-CM is swapping out this Excludes1 note in category codes J04 and J05 for the following Code also note:

• Code also, if present, such as:

o influenza due to identified novel influenza A virus with other respiratory manifestations (J09.X2)

o influenza due to other identified influenza virus with other respiratory manifestations (J10.1)

o influenza due to unidentified influenza virus with other respiratory manifestations (J11.1).