Primary Care Coding Alert

New external cause codes, headache and influenza instructions take center stage.

The best thing about the 2021 ICD-10-CM addenda? “With 490 additions, 58 deletions, and 47 revisions, this year’s 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.

For primary care coders, however, there’s still a lot to unpack. So, in this first of two articles on the revisions, we’ll take a look at the changes that will affect you most when they go into effect on Oct. 1, 2020.

Micro-Mobility Pedestrian Conveyances Get Their Own Injury Codes …

“While 490 additions may sound overwhelming, coders and computer programming departments need to realize that 61 of these are V codes describing pedestrian status in an accident,” says Hays. They are dedicated external cause codes for accidents involving pedestrians on standing electric scooters, hoverboards, and segways, which ICD-10 refers to as micro-mobility conveyances.

Generally, the revisions consist of new fifth- and sixth-digit codes added to the existing V00-V09 (Pedestrian injured in transport accident) codes. So, V03.0- (Pedestrian injured in collision with car, pick-up or van in nontraffic accident) gets a new fifth-digit code — V03.03- (Pedestrian on standing micro-mobility pedestrian conveyance injured in collision with car, pick-up or van in nontraffic accident) — which, in turn, is broken out to V03.031- (Pedestrian on standing electric scooter injured in collision with car, pick-up or van in nontraffic accident) and V03.038- (Pedestrian on other standing micro-mobility pedestrian conveyance injured in collision with car, pick-up or van in nontraffic accident), which you would use for accidents involving hoverboards or segways.

Coding alert: You would use these additional codes as secondary codes after you document the appropriate injury code from the S00-T88 (Injury, Poisoning, and Certain Other Consequences of External Causes) codes in ICD-10. Like all of the V00-V09 codes, the new codes will also take seventh characters of A (Initial), D (Subsequent), and S (Sequela) to indicate the stage of care.

… While ICD-10 Adds Laterality Characters to Existing Musculoskeletal Codes.

“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.

Nowhere is this truer than the revisions to the M00-M99 (Diseases of the musculoskeletal system and connective tissue) codes. Here, “for the M05-M14 [Inflammatory polyarthropathies] and M19 [Other and unspecified osteoarthritis] groups, ICD-10 is adding new codes to accommodate ‘other specified site,’ which is otherwise not an option now,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. Examples of this include M06.0A (Rheumatoid arthritis without rheumatoid factor, other specified site), and M08.2A (Juvenile rheumatoid arthritis with systemic onset, other specified site).

Additionally, “for the M92 [Other juvenile osteochondrosis] codes, ICD-10 is breaking out some existing codes into new codes that allow more specificity with respect to laterality by the addition of a sixth character,” Moore points out.

So, ICD-10 has revised M92.51 (Juvenile osteochondrosis of tibia and fibula, right leg) and M92.52 (Juvenile osteochondrosis of tibia and fibula, left leg) to M92.51 (Juvenile osteochondrosis of proximal tibia) and M92.52 (Juvenile osteochondrosis of tibia tubercle) respectively, then provided for greater specificity by allowing sixth characters to be added to designate right leg (1), left leg (2), bilateral (3), and unspecified leg (9).

Headache Codes Get New Instructions and More Specificity …

One code you will have to unlearn on Oct. 1 will be R51 (Headache) because “coding this common symptom will now require a fourth digit,” cautions Moore. You’ll now have two choices if your provider records this common symptom: R51.0 (Headache with orthostatic component, not elsewhere classified), which describes headaches that occur while the patient is vertical and are relieved when the patient is horizontal, or R51.9 (Headache, unspecified).

Even more important, 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 Influenza Coding Changes, too

You’ll also have to adjust your acute upper respiratory infection reporting just in time for flu season and “exercise more caution when using codes in the ‘Acute upper respiratory infections’ family [J00-J06] if influenza is involved,” cautions Moore. In part, that’s because the note that previously appeared at the beginning of the J00-J06 code block has now been deleted and moved to three specific codes in the block.

In other words, the Excludes1 instruction not to report influenza virus with other 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], J11.1 [Influenza due to unidentified influenza virus with other respiratory manifestations]) has been moved to the following codes exclusively:

• J00 (Acute nasopharyngitis [common cold]),
• J02.9 (Acute pharyngitis, unspecified),
• J03.9 (Acute tonsillitis, unspecified), and
• J06 (Acute upper respiratory infections of multiple and unspecified sites).

“This means J09.X2, J10.1, J11.1 are mutually exclusive to the codes under which they are listed. So, if the patient has influenza with respiratory manifestations, it would be inappropriate to also classify them as having a common cold [J00],” notes Moore.

“On the other hand, the new instruction to ‘Code also’ influenza with J04 [Acute laryngitis and tracheitis] and J05 [Acute obstructive laryngitis [croup] and epiglottitis] means you should add an influenza code when appropriate,” says Moore.

Stay tuned to Primary Care Coding Alert next month for a roundup of more new ICD-10 codes that may affect your 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.