Primary Care Coding Alert

More common primary care conditions get an ICD-10 update.

In addition to all the encounter code changes to the 2022 ICD-10 code set, you’ll find a number of revisions to a lot of your most-used codes.

Here’s a brief look at some of the new codes you’ll be able to use along with some accompanying instructions that you’ll be able to use once they take effect on Oct. 1, 2021.

COVID-19 Updates Continue

Unsurprisingly, there are a number of code changes related to COVID-19. “All of them are related to a new special purposes code, U09.9 [Post COVID-19 condition, unspecified], which has its own notes and Code First instructions that are also new,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. The changes include:

• Notes for new code U09.9 that explain the code “enables establishment of a link with COVID-19.” The notes go on to tell you that the code is to be used to document “post-acute sequela of COVID-19,” and not for “cases that are still presenting with active COVID-19,” though it can be used for “cases of re-infection with COVID-19, occurring with a condition related to prior COVID-19.”
• Code first instructions for U09.9 that tell you to code conditions related to COVID-19 “such as chronic respiratory failure (J96.1-), loss of smell (R43.8), loss of taste (R43.8), multisystem inflammatory syndrome (M35.81), pulmonary embolism (I26.-), and pulmonary fibrosis (J84.10).”
• A new Excludes2 note under B94.9 (Sequelae of unspecified infectious and parasitic disease) that allows you to code U09.9 in addition, if applicable.
• A change in the note under M35.81(Multisystem inflam­matory syndrome) that tells you to no longer use sequelae of COVID-19 (B94.8) but to use U09.9 if the condition is a result of COVID-19.
• And a new note under Z86.16 (Personal history of COVID-19) that tells you U09.9 is now an Excludes1 code.

Capture Cough With These New Codes

Another big change that will be sure to affect your coding when it takes effect involves the expansion of R05 (Cough) to six new codes:

• R05.1 (Acute cough)
• R05.2 (Subacute cough)
• R05.3 (Chronic cough)
• R05.4 (Cough syncope)
• R05.8 (Other specified cough)
• R05.9 (Cough, unspecified)

The codes now give you more specificity for this common symptom, giving you the choice of three levels of severity, from acute through subacute to chronic, the last of which also has three synonyms: persistent cough, refractory cough, and unexplained cough. You now also have R05.4 to document cough syncope, a condition where a patient loses consciousness after a coughing bout.

But even with this expanded range of R05 codes, “the unspecified code, R05.8, should be avoided whenever possible in favor of a code with greater specificity,” says Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana.

Code this first: R05.4 comes with a Code first note to add syncope and collapse (R55) as a the first-listed diagnosis when the two are documented together and when applicable.

But beware of this: All the R05 codes also come with changed Excludes1 instructions, which tell you that cough with hemorrhage (R04.2) in now an Excludes2 code rather than an Excludes1 code, while paroxysmal cough due to Bordetella pertussis (A37.0-) remains an Excludes1 code.

Feeding Difficulties

2022 also brings you a lot of new codes and instructions to document patients with feeding difficulties. The CDC has broken out R63.3 (Feeding difficulties) into four new codes:

• R63.30 (Feeding difficulties, unspecified)
• R63.31 (Pediatric feeding disorder, acute)
• R63.32 (Pediatric feeding disorder, chronic)
• R63.39 (Other feeding difficulties)

Additional changes to the new code group include moving the synonyms “feeding problem (elderly) (infant) NOS” and “picky eater” from parent code R63.3 to R63.39, and changing eating disorders (F50.-), feeding problems of newborn (P92.-), and infant feeding disorder of nonorganic origin (F98.2-) from Excludes1 codes for R63.3- to Excludes2 codes for the whole new code group.

Code these conditions also: The CDC has also added instructions for R63.31 and R63.32 to code also associated conditions such as aspiration pneumonia (J69.0), dysphagia (R13.1-), gastro-esophageal reflux disease (K21.-), and malnutrition (E40-E46) if applicable.

Lower Back Pain

Lastly, the CDC has expanded code choices for one of the most common conditions seen in primary care: lower back pain. When the changes take effect, you’ll be able to use M54.50 (Low back pain, unspecified) for documenting loin pain and lumbago NOS, synonyms that have moved from parent code M54.5 (Low back pain).

You will also have M54.51 (Vertebrogenic low back pain) at your disposal if your provider documents lower back pain emanating from the vertebral end plates in the patient’s lumbar spine, and M54.59 (Other low back pain) if your provider has specified the pain and there is no other specific code for you to use.

For the full list of added, revised, and deleted ICD-10 codes for 2022, go to www.cdc.gov/nchs/icd/icd10cm.htm, click on the ICD-10-CM FY 2022 Addenda PDF 2022 link, and download the Table and Index zip file.