Radiology Coding Alert

Get under the hood for a look changes affecting all parts of the ICD-10-CM book.

The further you dive into the 2021 changes within the ICD-10-CM manual, the more you realize that you’ve got to be extra proactive if you don’t want to get caught sleeping when implementation rolls around on Oct. 1, 2020. The list of changes is expansive, and sometimes exhaustive, and it extends well beyond additions, revisions, and deletions.

As you’ll see in this second part of a running series on ICD-10-CM changes, the parenthetical note changes carry just as much influence in your coding outcomes as the codes themselves.

Keep your foot on the pedal and home in on some more fundamental changes in store for 2021 ICD-10-CM.

Report U07.0 for Vaping-Related Respiratory Damage

While some of the most prevalent changes in 2021 come by way of ICD-10-CM code revisions, there are a few key code additions you should take note of.

While most of the new COVID-19 codes and guidelines dominated the headlines in the month of April, another code for vaping-related disorders was also implemented at the same time. For patients that present with various degrees of lung (or other specified organ) damage that are linked to vaping, you’ll report the following code:

• U07.0 (Vaping-related disorder)

“In fact, the addition of U07.0 and U07.1 [COVID-19] introduces an entirely new chapter to the ICD-10-CM code book,” says Lindsay Della Vella, COC, medical coding auditor at Precision Healthcare Management in Media, Pennsylvania. Code range U00-U85 (Codes for special purposes) is where you can expect to find new codes designated as “new diseases of uncertain etiology or emergency use.

The index will now include routes to reach this code via Damage ⇒ lung or Damage ⇒ organ. Sub terms that will yield code U07.1 include dabbing, electronic cigarette, and vaping. You can reach the same code following the route of Disease ⇒ lung, as well.

Note: Make sure to scour the list of “Use Additional” notes underneath U07.0 to include any accompanying diagnoses. For instance, if the patient presents with vaping-related damage to the lungs in addition to acute respiratory distress syndrome (ARDS), report code J80 (Acute respiratory distress syndrome) as a secondary diagnosis.

Stay Informed on New Osteoporosis Codes

With respect to bone scans, your osteoporosis with fracture coding will get a little more specific going forward. The current set of osteoporosis with fracture codes includes M80.0- (Age-related osteoporosis with current pathological fracture) and M80.8- (Other osteoporosis with current pathological fracture). Codes M80.0- and M80.8- currently extend out to include a variety of anatomic sites such as femur, hand, forearm, and vertebrae. However, the list fails to consider sites that are most commonly associated with osteoporosis. Previously, you’d have to resort to an unspecified code when coding osteoporosis diagnoses involving the wrist and hips (unless the diagnoses specifically state that the osteoporotic site exclusively involves the forearm or femur, respectively). As of Oct. 1, 2020, you’ll have the option to code these anatomic sites and others without a designated ICD-10-CM code using the following new codes:

• M80.0A (Age-related osteoporosis with current pathological fracture, other site)
• M80.8A (Other osteoporosis with current pathological fracture, other site)

Dive Deeper Than Just New ICD-10-CM Codes

If you want to get the most out of the ICD-10-CM updates, you’ve got to look beyond the mere addition of new codes. “Many coders think if they review their new ICD-10-CM book, focusing on ‘new code’ icons, they will be alerted to all the changes in the ICD for the year; nothing could be further from the truth,” says Sheri Poe Bernard, CPC, of Poe Bernard Consulting in Salt Lake City.

One set of changes that doesn’t fall into one of the new, revised, and deleted code categories has to do with the addition of index terms for existing codes. In some instances, you’ll now find rearranged sub-terms that lead to a given

existing code. Be sure to thoroughly scour the 2021 addenda to the alphabetic index to see what codes may have been “rerouted.”

Don’t Forget About Crucial Parenthetical Note Changes

To round out what you’ve learned, take a deeper dive into one set of important Excludes1 and Code Also note changes you’ll find in Chapter 10 (Diseases of the respiratory system (J00-J99)). Previously, code range J00-J06 had an all-encompassing Excludes1 note that stated the following:

• Excludes1: influenza virus with other respiratory manifestations (J09.X2, J10.1, J11.1)

Beginning in October, that parenthetical note will be deleted and parenthetical notes will instead be added to each respective category code. Category codes J00, J02, J03, and J06 will remain unchanged; meaning that the same Excludes1 note will be applied. However, ICD-10-CM is swapping out this Excludes1 note in category codes J04 and J05 for the following Code also note:

• Code also, if present, such as:

o influenza due to identified novel influenza A virus with other respiratory manifestations (J09.X2)

o influenza due to other identified influenza virus with other respiratory manifestations (J10.1)

o influenza due to unidentified influenza virus with other respiratory manifestations (J11.1).