Pediatric Coding Alert

Here are just some of the codes you’ll need to become familiar with beginning Oct. 1.

Perhaps the biggest change in the 2021 ICD-10 isn’t really a change at all.

That’s because Chapter 22, Codes for special purposes (U00-U85) and the codes contained within it aren’t actually new. But there are a lot of new codes that will affect peds coding after they come into effect after Oct. 1, 2020. So many, in fact, that we could only tell about a few this month.

New/Old Chapter, New/Old Codes

“Chapter 22 and its two codes were actually added to ICD-10-CM on an emergency basis on April 1 this year,” Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians, reminds coders. “Oct. 1, 2020, marks the first time they’ll be reflected in the annual update. If coders aren’t already aware of these codes, they should be,” Moore adds.

Currently, the only two codes in the chapter are provisional codes for “new diseases of uncertain etiology or emergency use” as the introduction to the U00-U49 codes explains. “If you code in the primary pediatric office setting, you probably won’t get into U07.0 (Vaping-related disorder), though specialty pediatrics such as pulmonary, critical care, or hospitalists probably will,” says Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana.

“But the addendum does remind pediatric practices to code for additional manifestations,” Holle adds. These include such conditions as abdominal pain (R10.84), acute respiratory distress syndrome (J80), diarrhea (R19.7), drug-induced interstitial lung disorder (J70.4), lipoid pneumonia (J69.1), and weight loss (R63.4).

Again, there is nothing new here — these instructions are the same ones that came with the code when it was first introduced. But if you do go ahead and use the code, make sure you also read the new guidelines associated with it, which inform you of other signs and symptoms that you should not report with U07.0 (see the next article in this issue).

Clearing up COVID Confusion

You’ll also see one other code in this chapter: U07.1 (COVID-19). ICD-10 also introduced the code in April 2020, so it’s a code that you already know. But you also have to remember that there is a note to use an additional code “to identify pneumonia or other manifestations” and not to code coronavirus infection, unspecified (B34.2), coronavirus as the cause of diseases classified elsewhere (B97.2-), and pneumonia due to SARS-associated coronavirus (J12.81) with U07.1 as they are now Excludes1 codes for U07.1.

Don’t Let These New Codes Give You a Headache …

If, like most coders, you have R51 (Headache) burned into your brain, you’d better unlearn it come Oct. 1. That’s because “coding this common symptom will now require a fourth digit,” cautions Moore. You’ll now have two choices if your pediatrician records the symptom: R51.0 (Headache with orthostatic component, not elsewhere classified) or R51.9 (Headache, unspecified).

Terminology tip: Headaches are described as orthostatic if they occur while the patient is vertical and are relieved when the patient is horizontal.

The Excludes1 instructions for the R51.- codes have also changed to Excludes2 status. So, the listed conditions — atypical face pain (G50.1), migraine and other headache syndromes (G43-G44), and trigeminal neuralgia (G50.0) — “are no longer considered mutually exclusive to headache. Instead, they become separately reportable in addition to headache when applicable,” adds Moore.

… and Add Electric Scooters and Segways to Your Transport Accident Codes

ICD-10 has also added hoverboards, segways, and electric scooters to its growing list of transportation injury codes. Like many of the injury codes, the new codes take seventh characters of A (Initial), D (Subsequent), and S (Sequela) to indicate the stage of care.

Accidents involving hoverboards and segways — which ICD-10 refers to as micro-mobility conveyances — now have dedicated codes. So, you would add V03.038A (Pedestrian on other standing micro-mobility pedestrian conveyance injured in collision with car, pick-up or van in nontraffic accident, initial encounter) after the appropriate injury code(s) for a patient seeing your provider for an initial encounter after riding his or her hoverboard into a parked car.

Similarly, ICD-10 has introduced new codes for injuries involving electric scooters. “I think that all these codes will be used frequently, but remember that these will not be primary diagnoses but codes that describe how something happened. For example, if a patient reports for an initial encounter for a fracture of an unspecified phalanx of left thumb after colliding with a stationary object while standing on an electric scooter, you would record S62.502A as the primary diagnosis with V00.842A as the reason it happened,” Holle notes.

Stay tuned to Pediatric Coding Alert next month for a roundup of more new ICD-10 codes that may affect peds reporting on Oct. 1, 2020 and beyond. And 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.