Pediatric Coding Alert
Stay Current With the 2020 ICD-10 Addenda (Part 2)
Note new influenza instructions, extensive juvenile arthritis and osteochondrosis revisions. “This year’s ICD-10-CM updates seem very manageable,” says Barbara Hays, CPC, CPCO, CPMA, CRC, CPC-I, CEMC, CFPC, medical review supervisor, Special Investigations, at GEHA in Lee’s Summit, Missouri. “Coders and computer programming departments have to deal with just 490 additions, 58 deletions, and 47 revisions,” Hays notes. Even so, there are more changes that peds coders need to know about than we could fit into our previous issue. That’s why we’ve put together this second article highlighting more changes that may come into play for your coding on Oct. 1, 2020 and moving forward. Don’t Rule Out This New Foreign Body Code … As a peds coder, you’ve probably seen it all, but you may not have had the codes to document it. So, the expansion of the Z03.82- (Encounter for observation for suspected foreign body ruled out) codes will come as a welcome addition. You will now have to add a sixth character when a child is suspected of ingesting (Z03.821), aspirating (Z03.822), or inserting (Z03.823) a foreign body [FB], and the pediatrician ruled it out. “Kids are known for putting objects into their nose, ears and other places, so these codes will probably get a lot of use!” notes Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana. … But Take Note of This Influenza Instruction Just in time for flu season comes three instruction changes affecting the Acute upper respiratory infections (J00-J06) codes, which means you will have to exercise more caution in your reporting after October 1. First, ICD-10 has deleted the “Excludes1” note for J00-J06 stating that the influenza virus is mutually exclusive to respiratory manifestations J09.X2 (Influenza due to identified novel influenza A virus with other respiratory manifestations), J10.1 (Influenza due to other identified influenza virus with other respiratory manifestations), and J11.1 (Influenza due to unidentified influenza virus with other respiratory manifestations). Instead, you will now find the note under three specific conditions: J00 (Acute nasopharyngitis [common cold]), J02.- (Acute pharyngitis), and J03.- (Acute tonsillitis). This means “these codes now exclude the diagnosis of influenza virus with other respiratory manifestations, including acute pharyngitis and acute tonsillitis,” notes Holle. Next, ICD-10 has added a “Code also” note to J04 (Acute laryngitis and tracheitis) and J05 (Acute obstructive laryngitis [croup] and epiglottitis), which instructs you to code influenza codes J09.X2, J10.1, or J11.1 “if present” along with the laryngitis. Last, “J10 [Influenza due to other identified influenza virus] now has an ‘Includes’ note that incorporates all of the influenza codes — A (non-novel), B, and C — so practices need to be aware that they should only use this code when they have a positive flu test. Otherwise using signs and symptoms would be a better option,” advises Holle. Juvenile Arthritis, Osteochondrosis Codes Get Revamped … “Another area of great importance involves instances where codes are altered to add a fifth or sixth digit to reflect specific body areas and laterality. These should certainly be reviewed, especially if you need to code for anatomical reference,” says Hays. This is especially true for M08.- (Juvenile arthritis), where you’ll now be able to add a fifth character, A, for anatomic sites your pediatrician has specified but that currently do not have a specific code: Coding caution: The two other M08.- codes — M08.1 (Juvenile ankylosing spondylitis) and M08.8 (Other juvenile arthritis) — are not affected by this change. Meanwhile, the juvenile osteochondrosis of tibia and fibula codes (M92.5) also get more specific. ICD-10 has added a new code, M92.59 (Other juvenile osteochondrosis of tibia and fibula) to the group, and renamed the existing codes: will now be able to add a sixth character to specify whether the osteochondrosis affects the patient’s right (1) or left leg (2), is bilateral (3), or affects an unspecified leg (9). … While T40 Codes Get Major Makeover Lastly, ICD-10 2021 has deleted T40.4X (Poisoning by, adverse effect of and underdosing of other synthetic narcotics) and resequenced it to T40.49. In addition, you will now be able to choose specific codes for fentanyl or fentanyl analogs (T40.41-) and tramadol (T40.42). Fortunately, ICD-10 has retained the structure of the codes, so you’ll still be able to document whether the poisoning was accidental, intentional self-harm, assault, or undetermined, or whether the patient is suffering from adverse effects or underdosing using sixth characters 1-6, respectively. And you’ll still need to add seventh characters of A, D, or S to indicate the stage of care. For the full 2021 ICD-10 addenda, go to: www.cms.gov/medicare/icd-10/2021-icd-10-cm and download the zip file labeled 2021 Addendum.
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