Primary Care Coding Alert

Temporary guidelines for COVID-19 and vaping are made permanent.

Like the 2021 ICD-10-CM addenda, the revisions to the 2021 ICD-10-CM guidelines are also very manageable. Not only that, but in most cases, you’ve already seen them. The Centers for Disease Control and Prevention (CDC) first established COVID-19 and vaping coding guidelines in April of this year, so they will be very familiar to you when they take effect on Oct. 1, 2020 and appear in your 2021 manual when you receive it.

Even so, they are worth reviewing to make sure you are on top of the most current regulations. But before we get to them, we should go over some brand new guidelines that may affect the way you document your type 2 and secondary diabetes patients who require long-term drug therapy.

But don’t worry. These guidelines are pretty manageable, too.

Note These Long-Term Insulin, Hypoglycemic Drug Use Guidelines

If you have 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), and who are on long-term insulin, an injectable non-insulin antidiabetic drug, or oral hypoglycemic drug therapy, you’ll want to take your highlighter to the following codes in your ICD-10 manual:

• Patients taking both insulin and an injectable [emphasis added] non-insulin antidiabetic drug should now be coded with Z79.4 (Long term (current) use of insulin) and Z79.899 (Other long term (current) drug therapy).
• Patients taking both oral hypoglycemic drugs and an injectable non-insulin antidiabetic drug should now be coded with Z79.84 (Long term (current) use of oral hypoglycemic drugs) and Z79.899 (Other long term (current) drug therapy).

U07.0 Guidelines Revisited

If you were paying attention to CDC announcements this April, you’ll know that they established guidelines surrounding the use of U07.0 (Vaping-related disorder). The guidelines, which now appear in section C.10.e., are significant, as the disorder “is an up-and-coming condition that requires accurate coding in order to track the frequency of respiratory conditions due to vaping,” explains Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico.

As with any condition, when a definitive diagnosis has not been established for the disorder, you should code for the presenting signs and symptoms such as cough (R05) or shortness of breath (R06.02).

However, for condition(s) related to vaping or for “lung injury due to vaping,” the guideline tells you to use U07.0. When you use U07.0 as the principal diagnosis, ICD-10-CM guidelines further instruct you to use an additional code to identify manifestations such as acute respiratory failure from subcategory J96.0- (Acute respiratory failure) or pneumonitis using code J68.0 (Bronchitis and pneumonitis due to chemicals, gases, fumes and vapors), when applicable.

Pay attention to the addenda: “Remember, in cases of a definitive diagnosis, you should follow the Use Additional Code instruction in the ICD-10 2021 addenda, which reminds you to code for additional manifestations such as abdominal pain [R10.84], diarrhea [R19.7], acute respiratory distress syndrome [J80], drug-induced interstitial lung disorder [J70.4], lipoid pneumonia [J69.1], and weight loss [R63.4], when applicable,” Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana, reminds coders.

COVID-19 Guidelines Finalized

Unsurprisingly, “the major changes to the guidelines for FY2021 involve the addition of rules with regard to COVID-19,” says Witt. Though they are not new, they appear in an entirely new section of the chapter-specific coding guidelines, section 1.C.1.g., which spells out in detail what you must do when coding for COVID-19.

As a refresher, the guidelines provide guidance for the following scenarios:

1. When U07.1 meets the definition of principal diagnosis, and the patient has respiratory manifestations: Sequence U07.1 as the principal/first-listed diagnosis, then code for associated 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.
2. When the reason for the encounter/admission is a non-respiratory manifestation: Sequence U07.1 as the principal/first-listed diagnosis, then code for any manifestations as additional diagnoses.
3. In cases of a “suspected,” “possible,” “probable,” or “inconclusive” COVID-19 diagnosis: Code for signs and symptoms.
4. “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”: Use Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases).
5. For COVID-19 screens: Use Z20.828.
6. 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”: Use 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).
7. “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”: Use Z01.84 (Encounter for antibody response examination).

Coding alert 1: ICD-10 2021 also offers specific guidelines for COVID-19 infection in pregnancy, childbirth, and the puerperium and guidelines for COVID-19 infection in newborns in chapter-specific guidelines C.15.s and C.16.h, respectively.

Coding alert 2: “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.

To download a pdf of the full 2021 ICD-10 guidelines, go to: https://www.cdc.gov/nchs/data/icd/10cmguidelines-FY2021.pdf.