Otolaryngology Coding Alert

Find expanded options for brain injuries, external causes, and more.

If your patients are experiencing symptoms related to a concussion, you’ll soon have a new way to report this condition.

Here’s why: The Centers for Disease Control and Prevention (CDC) has released its latest list of ICD-10-CM codes. With 1,468 additions, 251 deletions, 35 revisions, and 36 codes converted to parent, there’s a lot to unpack before the new codes go into effect on Oct. 1, 2022.

Even though otolaryngology (ENT) isn’t affected as much as other specialties, there are still a few very important additions and revisions for you to consider. Keep reading for a breakdown of some V codes and fundamental brain injury diagnoses that are bound to impact your practice.

Look to New V Codes for Reporting E-Bike Injuries

Many of the newly debuted codes are located in Chapter 20, External Causes of Morbidity. At first glance, trying to make sense of the nearly 900 additions and deletions may seem overwhelming, but don’t worry — these modifications essentially boil down to one concept.

Starting Oct. 1, you can go one step beyond the term “motorcycle” and choose from V codes that allow further specification: “electric (assisted) bicycle” or “other motorcycle.” You will no longer report V20.1XXA (Motorcycle passenger injured in collision with pedestrian or animal in nontraffic accident, initial encounter) as an external cause code, for example. Instead, you will select from two more specific codes: V20.19X- (Other motorcycle passenger injured in collision …) or if they were on an e-bicycle, V20.11X- (Electric (assisted) bicycle passenger injured in collision …).

Example: Your otolaryngologist is evaluating a patient with tinnitus and otorrhea following a traffic accident. He told the doctor that his injuries resulted from a collision with a pedestrian while driving an e-bicycle.

Once the new codes take effect, you will no longer report this with V20.4XXA (Motorcycle driver injured in collision …). Instead, you will report the incident using V20.41XA (Electric (assisted) bicycle driver injured in collision with pedestrian or animal in traffic accident, initial encounter).

Brain Injuries Get Big Code Boost

ICD-10-CM 2023 also introduces new codes for concussion, traumatic brain injury, cerebral edema, and hemorrhage when it’s not known whether the patient lost consciousness at the time of the injury. These conditions affect the head and can cause loss of smell (anosmia), hearing problems, tinnitus, and other symptoms for which people will see your ENT.

Here are the new codes you need to learn before October:

• S06.0XA- (Concussion with loss of consciousness status unknown)
• S06.1XA- (Traumatic cerebral edema with loss of consciousness status unknown)
• S06.2XA- (Diffuse traumatic brain injury with loss of consciousness status unknown)
• S06.30A- (Unspecified focal traumatic brain injury with loss of consciousness status unknown)
• S06.34A- (Traumatic hemorrhage of right cerebrum with loss of consciousness status unknown)
• S06.35A- (Traumatic hemorrhage of left cerebrum with loss of consciousness status unknown)
• S06.36A- (Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness status unknown)
• S06.5XA- (Traumatic subdural hemorrhage with loss of consciousness status unknown)
• S06.6XA- (Traumatic subarachnoid hemorrhage with loss of consciousness status unknown)

Remember this: Before you use these codes, be sure to pay attention to the instructional note that accompanies the S06.- (Intracranial injury) group that tells you to use an additional code to identify mild neurocognitive disorders due to a known physiological condition using one of the new F06.7- (Mild neurocognitive disorder due to known physiological condition) codes, if applicable.

Also, as with most external cause codes, you’ll add a 7th character to these new codes — A (… initial encounter), D (… subsequent encounter), or S (… sequela) — to indicate the type of encounter.

Example: A patient was driving an e-bicycle and crashed into a parked car. They hit their head and had a nasal hemorrhage after falling from the e-bike. The emergency room physician diagnoses them with a displaced nasal fracture and asks for an ENT consult. After evaluating the patient, the ENT recommends rest to allow the nasal swelling to subside before they reduce the fracture. The doctor is concerned about a concussion given the head trauma, and he tells the patient’s wife what to watch for over the next 24 hours.

According to Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, CMCS, of CRN Healthcare in Tinton Falls, New Jersey, this patient encounter includes the following diagnoses:

• S02.2XXA (Fracture of nasal bones, initial encounter for closed fracture)
• S06.0X0A (Concussion without loss of consciousness, initial encounter)
• V23.01XA (Electric (assisted) bicycle driver injured in collision with car, pick-up truck or van in nontraffic accident, initial encounter)

Go Beyond Codes for Maximum Context

If you want to get the most out of the ICD-10-CM updates, you must 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, CRC, CDEO, CCS-P, managing consultant for risk adjustment at Granite GRC Consulting in Salt Lake City. To fully understand all the changes to ICD-10-CM year after year, you should also:

1. Review the ICD-10-CM Alphabetic Index addendum because there are some circumstances where the index reroutes terms and sub-terms from one code to another.
2. Scour the ICD-10-CM Tabular List modifications for all the important parenthetical note changes. These include new and revised Excludes1/2, Use additional, and Code also notes.
3. Analyze the ICD-10-CM Official Guidelines to understand any changes that may affect code use.