Otolaryngology Coding Alert

Question: I’ve heard about new guidelines for COVID-19-related diagnoses and disorders due to vaping, but nothing pertaining to other sections of the ICD-10-CM guidelines. Is there anything I’ve missed?

Washington Subscriber

Answer: While the COVID-19 guidelines have taken up most of the headlines, there are two other areas within the ICD-10-CM 2021 code book that include new rules and coding instruction to take note of. Some of these guidelines may not pertain to otolaryngology, but it’s always important to be aware of what’s new in order to avoid getting caught off guard. First, have a look at Sections I.C.4.a.3 and I.C.4.a.6.a, which include the same guideline as it pertains to primary and secondary diabetes mellitus:

• If the patient is treated with both insulin and an injectable noninsulin antidiabetic drug, assign codes Z79.4, Long term (current) use of insulin, and Z79.899, Other long term (current) drug therapy. If the patient is treated with both oral hypoglycemic drugs and an injectable non-insulin antidiabetic drug, assign codes Z79.84, Long term (current) use of oral hypoglycemic drugs, and Z79.899, Other long term (current) drug therapy.

These guidelines may apply to patients being treated for respiratory manifestations and complications due to diabetes diagnoses. Some of these conditions may include bladder cystopathy, urinary tract infections (UTIs), and sexual dysfunction.

Next up, there’s an important ICD-10-CM guideline change to consider surrounding puerperal sepsis diagnoses for obstetrical patients during or following an obstetrical procedure:

• Code O85 should not be assigned for sepsis following an obstetrical procedure (See Section I.C.1.d.5.b., Sepsis due to a postprocedural infection).

Refresher: According to Dorland’s Illustrated Medical Dictionary, puerperal sepsis, also known as puerperal fever, is “an infectious, sometimes fatal, type of septicemia with fever associated with childbirth; the focus of infection is the uterus, and the etiologic agent is frequently a streptococcus.”

For puerperal sepsis patients treated by a urologist or gynecologist, you need to consider how these new guidelines change the way in which you’ll go about your diagnosis coding. While code O85 (Puerperal sepsis) is still appropriate during most clinical encounters, these new guidelines restrict O85 reporting when the puerperal sepsis follows an obstetrical procedure. If the patient is diagnosed with puerperal sepsis during delivery or in the days or weeks following, you should follow the guidelines outlined in Section I.C.1.d.5.b, which state the following:

• For infections following a procedure, a code from T81.40, to T81.43 Infection following a procedure, or a code from O86.00 to O86.03, Infection of obstetric surgical wound, that identifies the site of the infection should be coded first, if known. Assign an additional code for sepsis following a procedure (T81.44) or sepsis following an obstetrical procedure (O86.04). Use an additional code to identify the infectious agent. If the patient has severe sepsis, the appropriate code from subcategory R65.2 should also be assigned with the additional code(s) for any acute organ dysfunction.

The last new ICD-10-CM 2021 to consider has to do with the following three observation category codes:

• Z03 (Encounter for medical observation for suspected diseases and conditions ruled out)
• Z04 (Encounter for examination and observation for other reasons)
• Z05 (Encounter for observation and evaluation of newborn for suspected diseases and conditions ruled out)

In previous versions of the ICD-10-CM guidelines, you’ve received instruction to exclusively report observation codes as first-listed diagnoses. The 2021 guidelines revise the wording to state that codes from code range Z03-Z05 should “primarily” be used as principal/first-listed diagnoses. It adds the following instruction outlining what circumstances allow for reporting of code range Z03-Z05 as secondary codes:

• The observation codes are primarily to be used as a principal/first-listed diagnosis. An observation code may be assigned as a secondary diagnosis code when the patient is being observed for a condition that is ruled out and is unrelated to the principal/ first-listed diagnosis (e.g., patient presents for treatment following injuries sustained in a motor vehicle accident and is also observed for suspected COVID-19 infection that is subsequently ruled out).

While these sorts of clinical scenarios may be few and far between, it’s always important to take note of instances where the guidelines shift from speaking in absolutes (always, never) to offering more leeway on code reporting depending on the clinical situation.