Pediatric Coding Alert

COVID-10, vaping coding rules finalized for next year.

Don’t stress about the updated guidelines to the 2021 ICD-10-CM. Because, if you’ve been paying attention to ICD-10 changes over the last few months, they will look pretty familiar.

But just in case you need a refresher, we’ve put this guideline guide together for easy reference.

COVID-19 Coding Confirmed …

“The major changes to the guidelines for FY2021 involve the addition of rules with regard to COVID-19,” says Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico. Many of those changes are found at the beginning of the chapter-specific coding guidelines.

Here, an entirely new section, 1.C.1.g., spells out in detail what you must do when coding for COVID-19. However, like the code for a confirmed diagnosis, U07.1, the guidelines are not new, as the Centers for Disease Control and Prevention (CDC) first established them in April 2020.

As a reminder, the guidelines address several COVID-19 coding issues, such as:

• Sequencing U07.1 as the principal/first-listed diagnosis when it meets the definition of principal diagnosis, then coding for respiratory manifestations, such as J20.8 (Acute bronchitis due to other specified organisms) or J98.8 (Other specified respiratory disorders) for a respiratory infection NOS associated with COVID-19.
• Sequencing U07.1 as the principal/first-listed diagnosis when the reason for the encounter/admission is a non-respiratory manifestation, then coding for any manifestations as additional diagnoses.
• Coding for signs and symptoms in cases of a “suspected,” “possible,” “probable,” or “inconclusive” COVID-19 diagnosis.
• Using Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases) “for asymptomatic individuals with actual or suspected exposure to COVID-19” and “for symptomatic individuals with actual or suspected exposure to COVID-19 and the infection has been ruled out, or test results are inconclusive or unknown.”
• Not using a screening code, but coding Z20.828 for COVID-19 screens.
• Using Z09 (Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm) and Z86.19 (Personal history of other infectious and parasitic diseases) for follow-up visits for “individuals who previously had COVID-19 and are being seen for follow-up evaluation, and COVID-19 test results are negative.”
• Using Z01.84 (Encounter for antibody response examination) “for an encounter for antibody testing that is not being performed to confirm a current COVID-19 infection, nor is a follow-up test after resolution of COVID-19.”

… While COVID-19 Guidelines for Chapters 15 and 16 Added …

ICD-10 2021 also offers specific guidelines for COVID-19 infection in pregnancy, childbirth, and the puerperium and guidelines for COVID-19 infection in newborn in chapter-specific guidelines C.15.s and C.16.h, respectively.

Coding for newborns that test positive for COVID-19: ICD-10 tells you to “assign code U07.1 … and the appropriate codes for associated manifestation(s) in neonates/newborns in the absence of documentation indicating a specific type of transmission.”

Coding for newborns contracting COVID-19 in utero or during the birth process and testing positive for COVID-19 per provider documentation: ICD-10 tells you to assign codes P35.8 (Other congenital viral diseases), and U07.1. “When coding the birth episode in a newborn record,” ICD-10 guidelines tell you to use “the appropriate code from category Z38 Liveborn infants according to place of birth and type of delivery,” which “should be assigned as the principal diagnosis.”

Coding alert: “It will be imperative that all coders and providers be familiar to these new guidelines in order to help with correct data collection in the coming months and years as we try and get a handle on this disease,” Witt says.

… Vaping-Related Disorder Guidelines Set …

Another new set of guidelines involves the use of U07.0 (Vaping-related disorder). “This is an up-and-coming condition that also requires accurate coding in order to track the frequency of respiratory conditions due to vaping,” Witt explains.

However, like the COVID-19 guidelines, this code and its guidelines are also not new, having been introduced in April 2020. So, you may be already familiar with guideline C.10.e., too, though it has yet to appear in your manual.

Simply stated, the guideline tells you to use the code on its own “for lung injury due to vaping” and to use an additional code to identify manifestations such as acute respiratory failure from subcategory J96.0- (Acute respiratory failure) or pneumonitis using code J69.1 (Pneumonitis due to inhalation of oils and essences).

The guideline also goes on to instruct you not to code separately such vaping-associated signs and symptoms as cough or shortness of breath “when a definitive diagnosis has been established.” However, the guideline goes on to tell you that gastrointestinal symptoms are appropriate to code separately, meaning you may use codes such as R10.84 (Generalized abdominal pain) or R19.7 (Diarrhea, unspecified) when applicable.

… and Type 2 and Secondary Diabetes Guidelines Established

Lastly, ICD-10 has issued new guidelines for coding insulin, injectable non-insulin antidiabetic drugs, or oral hypoglycemic drug use for patients diagnosed with diabetes mellitus due to underlying condition (E08), drug or chemical induced diabetes mellitus (E09), type 2 diabetes (E11), and other specified diabetes mellitus (E13).

For patients taking both insulin and an injectable non-insulin antidiabetic drug: Use Z79.4 (Long term (current) use of insulin), and Z79.899 (Other long term (current) drug therapy).

For patients taking both oral hypoglycemic drugs and an injectable non-insulin antidiabetic drug: Use Z79.84 (Long term (current) use of oral hypoglycemic drugs) and Z79.899 (Other long term (current) drug therapy).

To download a pdf of the full 2021 ICD-10 guidelines, go to: https://www.cdc.gov/nchs/data/icd/10cmguidelines-FY2021.pdf. And remember: these guidelines are effective Oct. 1, 2020 through Sept. 30, 2021.