Pulmonology Coding Alert

Converted and added codes indicate how you’ll document cough diagnoses.

The Centers for Disease Control (CDC) has released the 2022 ICD-10-CM codes that take effect October 1, 2021, which means you and your pulmonology practice should take note of the upcoming changes. You have a variety of new and converted codes to choose from that apply to your specialty, as well as some key instructions that you’ll be able to use when the ICD-10-CM codes are enacted.

Read on to understand the new or converted ICD-10-CM codes for FY 2022.

Check for New COVID-19 Codes When Recording Chest X-rays

In the United States, the chance of contracting COVID-19 is diminishing due to COVID-19 vaccines, but that doesn’t mean the effects of the coronavirus are over. Many patients may experience long-haul symptoms that medical experts will be tracking and studying for years to come. That’s why it’s no surprise you will find two new COVID-19 codes for documentation — U09 (Post COVID-19 condition) and U09.9 (…, unspecified).

In Chapter 22: Codes for Special Purposes, the new post COVID-19 condition code set allows you to establish a patient link with COVID-19. The directions indicate that you will code the specific condition that is related to the presentation of COVID-19 if the symptom is known.

These symptoms include:

• J96.1- (Chronic respiratory failure)
• R43.0 (Anosmia)
• R43.8 (Other disturbances of smell and taste)
• M35.81 (Multisystem inflammatory syndrome)
• I26.- (Pulmonary embolism)
• J84.10 (Pulmonary fibrosis, unspecified)

Note: Code U09.9 should not be used in cases that are still presenting with active COVID-19. For patients experiencing re-infection with COVID-19 that occurs with a condition related to prior infection of COVID-19, you can make an exception.

New ICD-10-CM Guidelines: According to section I.C.1.g.1.m of the 2022 ICD-10-CM Official Guidelines for Coding and Reporting, code U09.9 “should not be assigned for manifestations of an active (current) COVID-19 infection.”

If the patient experiences sequela of COVID-19, or symptoms or conditions that develop from a previous COVID-19 infection, you’ll use code(s) for the specific symptom(s) related to the previous infection, if known, and code U09.9.

You’ll assign code U09.9 with code U07.1 (COVID-19) if the patient has conditions associated with a previous coronavirus infection and develops a new COVID-19 infection. By using these codes together, you’ll identify that the patient has conditions relating to a previous COVID-19 infection.

You’ll Need to Specify Diagnoses with Converted Parent Codes

You’ll find several ICD-10-CM codes in the 2022 manual that have been “converted to parents to help increase specificity,” says Kristen Taylor, CPC, CHC, CHIAP, Associate Partner at Pinnacle Enterprise Risk Consulting Services in Columbia, South Carolina, including R05 (Cough). Under this new parent code, you’ll find six new expanded codes that will help you specify the patient’s condition.

The added cough codes include:

• 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 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. For instance, you will be able to use 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.

Exclusion Notes: The new R05 codes come with instructions that smoker’s cough (J41.0) and paroxysmal cough due to Bordetella pertussis (A37.0-) are Excludes1 codes. However, R04.2 (Cough with hemorrhage) is now an Excludes2 code.

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.