Pathology/Lab Coding Alert

Find new and expanded codes for detailed reporting.

With the 2022 ICD-10-CM update that takes effect Oct. 1, 2021, the Centers for Disease Control and Prevention (CDC) presents some new COVID codes and reporting instructions, as well as multiple system condition codes.

With nearly 160 new codes, let our experts help you focus on the changes you might encounter in your clinical lab or pathology practice, whether an ordering clinician or your pathologist assigns the diagnosis.

Dial In Coding for COVID-19 Symptoms and Sequalae

To acknowledge the many “long hauler” COVID-19 cases, ICD-10-CM provides new code U09.9 (Post COVID-19 condition, unspecified) in Chapter 22, Codes for Special Purposes. The instructions clarify that reporting U09.9 allows clinicians to establish a link to COVID-19, but that you should code first the related condition (symptom), if known, using one of the following codes:

• J96.1- (Chronic respiratory failure)
• R43.0 (Anosmia)
• R43.8 (Other disturbances of smell and taste)
• M35.81 (Multisystem inflammatory syndrome)
• I26.- (Pulmonary embolism)
• J84.10 (Pulmonary fibrosis, unspecified)

Key: Don’t report U09.9 for active COVID-10 cases unless it is a re-infection case that occurs with a condition related to prior COVID-19 infection. In that case, correct coding includes U07.1 (COVID-19), the symptom code, and U09.9.

Learn Specific Cough Diagnoses with Converted Parent Code

You’ll find several 2022 ICD-10-CM codes that have been “converted to parents to help increase specificity,” says Kristen Taylor, CPC, CHC, CHIAP, Associate Partner at Pinnacle Enterprise Risk Consulting Services in Columbia, South Carolina. One example you might encounter on lab test orders is R05 (Cough), which is now a parent code requiring a fourth character from one of the six new expanded codes:

• R05.1 (Acute cough)
• R05.2 (Subacute cough)
• R05.3 (Chronic cough)
• R05.4 (Cough syncope)
• R05.8 (Other specified cough)
• R05.9 (Cough, unspecified)

The codes now give you three levels of severity, from acute through subacute to chronic, the last of which also has three synonyms: persistent cough, refractory cough, and unexplained cough. For instance, you might see R05.4 to document cough syncope, a condition where a patient loses consciousness after a coughing bout.

Tip: You should avoid the unspecified code, R05.8 whenever possible “in favor of a code with greater specificity,” says Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement.

Exclusion Notes: The new R05 codes come with instructions that smoker’s cough (J41.0) and paroxysmal cough due to Bordetella pertussis (A37.0-) are Excludes1 codes. However, R04.2 (Cough with hemorrhage) is now an Excludes2 code.

Grasp Specific System Codes for Pathology

Pathologists need to know new codes across multiple ICD-10-CM chapters that will require more specific reporting of certain conditions such as some ovarian, gastrointestinal, skin, and blood disorders.

The following new codes capture bilateral ovarian malignancies, allowing classification as malignant or secondary malignant neoplasm:

• C56.3 (Malignant neoplasm of bilateral ovaries)
• C79.63 (Secondary malignant neoplasm of bilateral ovaries).

Chapter 11: Diseases of the Digestive System offer up these new codes you should know for esophageal conditions:

• K22.1 (Esophageal polyp)
• K22.82 (Esophagogastric junction polyp)
• K22.89 (Other specified disease of esophagus (hemorrhage of the esophagus NOS))

You’ll also find new subcategory K31.A- (Gastric intestinal metaplasia) with the following 10 specific codes that will require documentation of the anatomic site and presence of dysplasia:

• K31.A0 (… unspecified)
• K31.A11 (… without dysplasia, involving the antrum)
• K31.A12 (… without dysplasia, involving the body (corpus))
• K31.A13 (… without dysplasia, involving the fundus)
• K31.A14 (… without dysplasia, involving the cardia)
• K31.A15 (… without dysplasia, involving multiple sites)
• K31.A19 (… without dysplasia, unspecified site)
• K31.A21 (… with low grade dysplasia)
• K31.A22 (… with high grade dysplasia)
• K31.A29 (… with dysplasia, unspecified)

Chapter 12: Diseases of the Skin and Subcutaneous Tissue brings eight new codes under two new subcategories for irritant contact dermatitis:

• Under L24.A- (Irritant contact dermatitis due to friction or contact with body fluids) the 2022 code set adds four new codes to identify the type of fluid.
• Under L24.B- (Irritant contact dermatitis related to stoma or fistula) you’ll find four new codes that specify the type of stoma or fistula, such as digestive, respiratory, fecal/urinary.

Chapter 3: The 2022 code set brings five novel codes to this chapter. For instance, the codes under D55.2 (Anemia due to disorders of glycolytic enzyme) allow more specific options such as D55.21 (Anemia due to pyruvate kinase deficiency) and D55.29 (Anemia due to other disorders of glycolytic enzymes)

Other Chapter 3 changes include adding new subcategory D75.83- (Thrombocytosis) with the following two specific codes:

• D75.838 (Other thrombocytosis)
• D75.839 (Thrombocytosis, unspecified)

Resource: Find the full list of added, revised, and deleted 2022 ICD-10-CM codes at www.cdc.gov/nchs/icd/icd10cm.htm. Click on the ICD-10-CM FY 2022 Addenda PDF 2022 link to download the Table and Index zip files.