Primary Care Coding Alert

New CDC advice provides clear coding suggestions.

If you’ve been paying attention to recent news stories, you’ll know that the current vaping trend has resulted in serious, and in some cases fatal, health problems. As of Nov. 13, 2019, the Centers for Disease Control and Prevention (CDC) recorded 42 deaths throughout the US caused by e-cigarette or vaping product use and 2,172 cases of vitamin E acetate lung injury (EVALI) (Source:  www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html).

However, as the problem of vaping is so new, there are currently few guidelines to help you code any health problems associated with it. So, we’ve put together this three-step guide to help you if and when your provider has to deal with a patient coming in for e-cigarette-related issues and who wishes to quit the habit based on its current bad publicity.

Step 1: Code the Known Diagnosis

As you would do with practically any condition, “it makes sense that you code the known diagnosis followed by cause codes,” says Jan Rasmussen, PCS, CPC, ACS-GI, ACS-OB, owner/consultant of Professional Coding Solutions in Holcombe, Wisconsin.

Fortunately, “the Centers for Disease Control and Prevention’s [CDC’s] ICD-10-CM Coordination and Maintenance Committee has now released coding advice for reporting possible lung injuries for patients who are confirmed to be vaping,” according to Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico. It can be found at  www.cdc.gov/nchs/data/icd/Vapingcodingguidance2019_10_17_2019.pdf.

Of most use in a primary care setting might be the signs and symptoms codes that you could use when a patient initially presents with conditions associated with vaping. The guide lists 19 of them at the moment, including R06.00 (Dyspnea, unspecified), R06.02 (Shortness of breath), R06.2 (Wheezing), and R07.9 (Chest pain, unspecified). And there may be more coming. “The CDC guide also states that they will be considering new ICD-10 codes relating to vaping and e-cigarette use when their Coordination and Maintenance Committee meets again in March 2020,” Witt notes.

Step 2: Code the Cause

Here, again, the CDC’s guide identifies a number of possible codes that could come into play depending on the patient’s circumstances.

Most likely, you will be using a code from F17.- (Nicotine dependence) to document a patient’s vaping. However, the CDC’s guide follows previous advice found in the AHA Coding Clinic® for ICD-9-CM/ICD-10-CM (2017 Volume 4, Number 2), and reminds you that you cannot use F17.21- (Nicotine dependence, cigarettes) as the patient is not smoking cigarettes. Instead, you have to use F17.29- (Nicotine dependence, other tobacco product) if your physician has documented the patient’s use of e-cigarettes.

You will also add the appropriate sixth character to the code. As most patients will still be vaping at the time of the encounter, they will not be in remission or withdrawal. So, unless your provider has documented the patient has other nicotine-induced disorders, you would use F17.290 (Nicotine dependence, other tobacco product, uncomplicated) in this particular situation as the Coding Clinic article suggests.

Instead of vaping tobacco-derived products, you may encounter some patients that are inhaling products made with oil derived from tetrahydrocannabinol, or THC, which is the psychoactive ingredient in cannabis. In these cases, as ICD-10 does not use codes that distinguish between delivery methods, you will have to focus on whether your provider has documented that the patient is abusing the drug, dependent on it, or merely using it. This means choosing the correct code from F12.1- (Cannabis abuse), F12.2- (Cannabis dependence), or F12.9- (Cannabis use, unspecified).

Pro coding tip: If your provider documents use, abuse and/or dependence on nicotine or cannabis, make sure you follow ICD-10 guidelines outlined in the CDC guide and use only one code, applying the following rules:

• If both use and abuse are documented, assign only the code for abuse.
• If both abuse and dependence are documented, assign only the code for dependence.
• If use, abuse, and dependence are all documented, assign only the code for dependence.
• If both use and dependence are documented, assign only the code for dependence.

3) Code the Prevention

Vaping encounters also mean you will need to refresh your understanding of the preventive medicine and behavior change intervention codes.

For these services, you can use 99406-99407 (Smoking and tobacco use cessation counseling visit …) or 99408-99409 (Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services …) depending on the cause and if the patient’s vaping has created any of the conditions listed in the guide or above.

And if your provider is working with a patient who has yet to encounter health problems due to vaping, but who is contemplating quitting the use of e-cigarettes or similar products, you could turn to 99401-99404 (Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure)…) or 99411-99412 ( … provided to individuals in a group setting …), again depending on the context.