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CMS just released their updates to the ICD-10, which will apply to all services performed between October 1st, 2020, and September 30th, 2021.
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Table of Contents
CMS just released their updates to the ICD-10, which will apply to all services performed between October 1st, 2020, and September 30th, 2021. The changes this year include the following:
- 490 new diagnosis codes, including new codes for alcohol and narcotic use disorders, fentanyl poisoning, vaping use disorders, accidents involving electric scooters, and COVID-19.
- 58 deleted codes, including poisoning from synthetic narcotics. These deleted codes will be replaced by new ones. For example, code R51 (headache) has been deleted and replaced by newer and more specific codes.
- 47 revised codes, including updated descriptions for Z68.XX codes about adult body mass index (BMI) and Z88.X codes about allergies.
Some commonly used codes in hospitalized patients were updated include:
- Sickle-cell anemia,
- Substance abuse, use codes for (alcohol, cocaine, opioid, cannabis),
- Interstitial lung disease with fibrosis,
- Esophagitis and gastro-esophageal reflux disease with and without bleeding,
- Hepatic fibrosis specified as early or advanced,
- Rheumatoid arthritis to include other specified site,
- Other and unspecified osteoarthritis other specified site,
- Osteoporosis, age-related and other, to include other specified site,
- Chronic kidney disease stage 3 to include stage 3a and stage 3b,
- Headache to include an orthostatic component, and
- Osteoporosis, age-related and other, to include other specified site,
- Poisoning by, adverse effect of and underdosing of fentanyl, tramadol and other synthetic narcotics
HOW IT IMPACTS YOUR PRACTICE REVENUE
Since ICD codes are used across multiple healthcare fields, there’ll probably be a lot of codes in this update that don’t apply to your billing. But, you do want to review this list carefully. If you use a deleted code that’s no longer recognized, or try to use an old version of a code, the reimbursement for that service may be denied.
It also might be worth taking an extra careful look at the new codes surrounding COVID-19 diagnoses. Those codes will be new for everyone, and you’ll want to make sure you fully understand when you might need to use them in your own practice.
CHAPTER 1 : CERTAIN INFECTIOUS AND PARASITIC DISEASES (A00-B99)
The first new codes in ICD-10-CM 2021 are A84.81 Powassan virus disease and A84.89 Other tick-borne viral encephalitis. There are five more new codes under protozoal disease subcategory B60.0- Babesiosis.
CHAPTER 2 : NEOPLASMS (C00-D49)
Chapter 2 references a new code in a note under C93.1- Chronic myelomonocytic leukemia: “Code also, if applicable, eosinophilia (D72.18).”
CHAPTER 3 : DISEASES OF THE BLOOD AND BLOOD-FORMING ORGANS AND CERTAIN DISORDERS INVOLVING THE IMMUNE MECHANISM (D50-D89)
This chapter includes a longer list of updates than almost any other chapter. Many relate to D57.- Sickle-cell disorders, which features more than 20 new codes, from D57.03 Hb-SS disease with cerebral vascular involvement to D57.818 Other sickle-cell disorders with crisis with other specified complications.
New codes under D59.1- Other autoimmune hemolytic anemias provide choices for warm, cold, and mixed types. Subcategory D72.1- Eosinophilia also adds more specific options such as D72.11- Hypereosinophilic syndrome [HES] and (the code mentioned in the Chapter 2 note) D72.18 Eosinophilia in diseases classified elsewhere.
Other changes include new codes under D84.8- Other specified immunodeficiencies for immunodeficiencies due to other conditions, drugs, and external causes, and new codes under D89.83- Cytokine release syndrome that allow you to specify the grade (1 to 5).
CHAPTER 4 : ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES (E00-E89)
The biggest changes in Chapter 4 include new codes for rare inherited disorders: E70.81 Aromatic L-amino acid decarboxylase deficiency and E74.810 Glucose transporter protein type 1 deficiency.
CHAPTER 5 : MENTAL, BEHAVIORAL AND NEURODEVELOPMENTAL DISORDERS (F01-F99)
Chapter 5 adds many codes for substance use and abuse with withdrawal. Providers should document withdrawal delirium and withdrawal with perceptual disturbance, when present, to help with code selection. New codes range from F10.130 Alcohol abuse with withdrawal, uncomplicated to F19.139 Other psychoactive substance abuse with withdrawal, unspecified.
CHAPTER 6 : DISEASES OF THE NERVOUS SYSTEM (G00-G99)
The numerous changes in Chapter 6 relate primarily to new codes in these areas:
| G11.1 | Early-onset cerebellar ataxia, including a code for Friedreich ataxia |
| G40 | Epilepsy and recurrent seizures, with new codes for cyclin-dependent kinase-like 5 deficiency disorder and Dravet syndrome |
| G71.2 | Congenital myopathies, with more detailed options for nemaline and centronuclear myopathies |
| G96.0 | Cerebrospinal fluid leak, where the key terms are spontaneous, cranial, and spinal |
| G96.1 | Disorders of meninges, not elsewhere classified, including an option for perineural cyst |
| G96.81 | Intracranial hypotension, with coding based on unspecified, spontaneous, or other |
| G97.8 | Other intraoperative and postprocedural complications and disorders of nervous system, including two new codes for intracranial hypotension following procedures |
CHAPTER 7 : DISEASES OF THE EYE AND ADNEXA (H00-H59)
ICD-10-CM changes for eye care often involve adding codes for laterality, and the 2021 code set is no exception. There are 28 new codes allowing you to specify right, left, bilateral, or unspecified eye for various diagnoses under H18.5- Hereditary corneal dystrophies. Chapter 7 also adds H55.82 Deficient smooth pursuit eye movements.
CHAPTER 9 : DISEASES OF THE CIRCULATORY SYSTEM (I00-I99)
The bulk of the additions include notes for existing codes under I 70.- Atherosclerosis. The notes state the codes apply to chronic limb-threatening ischemia and critical limb ischemia. The ICD-10-CM Index to Diseases and Injuries has pages of updates related to these terms, as well.
CHAPTER 10 : DISEASES OF THE RESPIRATORY SYSTEM (J00-J99)
This chapter includes new subcategory J82.8- Pulmonary eosinophilia, not elsewhere classified. It includes separate codes for chronic and acute eosinophilic pneumonia and eosinophilic asthma. This chapter updates J84.17- Other interstitial pulmonary diseases with fibrosis in diseases classified elsewhere, as well, to add a unique code for the progressive fibrotic phenotype.
CHAPTER 11 : DISEASES OF THE DIGESTIVE SYSTEM (K00-K95)
New codes under K20.- Esophagitis and K21.0- Gastro-esophageal reflux disease with esophagitis, you need to check for documentation of bleeding.
Also added new codes under K74.0- Hepatic fibrosis with specific options for early (stage F1 or F2) and advanced (stage F3).
CHAPTER 12 : DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE (L00-L99)
| Under L57.- | Skin changes due to chronic exposure to nonionizing radiation, the 2021 code set adds the bolded language: Use Additional code to identify the source of the ultraviolet radiation (W89), or other non ionizing radiation (W90). |
| Under L98.4- | Non-pressure chronic ulcer of skin, not elsewhere classified, the Excludes2 note for varicose ulcer corrects the code range from I83.0-I82.2 to I83.0-I83.93. |
CHAPTER 13 : DISEASES OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE (M00-M99)
Unique codes are added for right, left, bilateral, and unspecified in these subcategories:
| M26.64- | Arthritis of temporomandibular joint |
| M26.65- | Arthropathy of temporomandibular joint |
| M92.5- | Juvenile osteochondrosis of tibia and fibula |
CHAPTER 14 : DISEASES OF THE GENITOURINARY SYSTEM (N00-N99)
Subcategory N18.3- Chronic kidney disease, stage 3 (moderate) is expanded with new options for stages 3a, 3b, and 3 unspecified. Subcategory N61.2- Granulomatous mastitis is also expanded with additions for unspecified, right, left, and bilateral breast involvement.
In the N00-N08 Glomerular diseases block, almost every category has a new, unique code for “with C3 glomerulonephritis.” An example is N00.A Acute nephritic syndrome with C3 glomerulonephritis.
CHAPTER 15 : PREGNANCY, CHILDBIRTH AND THE PUERPERIUM (O00-O9A)
There are five new codes in this chapter. Two of the codes (O34.218 and O34.22) relate to maternal care for cesarean scars. The other three result from expanding O99.89- Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium to offer one code each for pregnancy, childbirth, and the puerperium.
CHAPTER 16 : CERTAIN CONDITIONS ORIGINATING IN THE PERINATAL PERIOD (P00-P96)
The biggest update in this chapter is the addition of subcategory P91.82- Neonatal cerebral infarction. The subcategory includes four codes, allowing you to specify the side as right, left, bilateral, or unspecified.
CHAPTER 17 : CONGENITAL MALFORMATIONS, DEFORMATIONS AND CHROMOSOMAL ABNORMALITIES (Q00-Q99)
Revisions to Q51.2- Other doubling of uterus make up most of the changes to Chapter 17. For instance, ICD-10-CM 2021 deletes Q51.20 Other doubling of uterus, unspecified and revises Q51.28 from Other doubling of uterus, other specified to Other and unspecified doubling of uterus.
CHAPTER 18 : SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND LABORATORY FINDINGS, NOT ELSEWHERE CLASSIFIED (R00-R99)
Many coders probably have memorized R51 Headache, but R51 is not a reportable code in the 2021 code set. Instead, use one of these new four-character codes:
| R51.0 | Headache with orthostatic component, not elsewhere classified Headache with positional component, not elsewhere classified |
| R51.9 | Headache, unspecified Facial pain NOS |
This section also changes the Excludes1 note to Excludes2 for atypical face pain (G50.1), migraine and other headache syndromes (G43-G44), and trigeminal neuralgia (G50.0).
Another noteworthy change in this chapter is the expansion of R74.0- Nonspecific elevation of levels of transaminase and lactic acid dehydrogenase [LDH]. In 2021, there is one code for liver transaminase levels (R74.01) and another for LDH (R74.02).
CHAPTER 19 : INJURY, POISONING, AND CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES (S00-T88)
The first major change in this chapter is the addition of 18 six-character options under S20.- Superficial injury of thorax that allow you to identify bilateral front wall and middle front wall injuries. Keep in mind that each code in S20.- requires a 7th character (A, D, or S), so each six-character addition in the addenda translates to three new seven-character codes.
The next big change is more specific options under T40.4- Poisoning by, adverse effect of and underdosing of other synthetic narcotics. You have one set of options for fentanyl or fentanyl analogs and another set for tramadol. The codes for “other synthetic narcotics” moved from T40.4X- to T40.49-. Again, you need a 7th character to complete these codes.
The final large update for this chapter adds right, left, bilateral, and unspecified eye options for five subcategories under T86.84- Complications of corneal transplant.
CHAPTER 20 : EXTERNAL CAUSES OF MORBIDITY (V00-Y99)
You’ll find the longest list of changes in this chapter of ICD-10-CM 2021. Nearly all of them are in block V00-V09, Pedestrian injured in transport accident. There are now many codes for injuries involving the use of standing electric scooters and any “other standing micro-mobility pedestrian conveyance,” including hoverboards and Segways.
The chapter also includes new codes Y77.11 Contact lens associated with adverse incidents and Y77.19 Other therapeutic (nonsurgical) and rehabilitative ophthalmic devices associated with adverse incidents.
CHAPTER 21 : FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES (Z00-Z99)
Chapter 21 features new subcategory Z03.82- Encounter for observation for suspected foreign body ruled out with unique codes for encounters where ingestion, aspiration, or insertion of a foreign body has been ruled out.
CHAPTER 22 : CODES FOR SPECIAL PURPOSES (U00-U85)
It includes only U07.0 Vaping-related disorder and U07.1 COVID-19 with their notes, which are effective April 1, 2020.
Acknowledgement: www.aapc.com/blog/51606-see-whats-new-for-icd-10-cm-2021
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