Laura Brink
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No matter where you may be coding from this year, one thing is certain: we medical coders and auditors have been shaking the “snow” from our brand new code books (or will be, when our books arrive) in preparation for the 2021 ICD-10-CM updates. It is hard to believe that it’s already that time of year again, when we get to review the annual additions, deletions, and revisions.
Nevertheless, we know there’s a lot in store this year, as the updates are in effect for discharges October 1st through September 30th, 2021. So, if you haven’t done so already, break those new books out, shake out the snow, and get ready to take a deep dive into the 490 new codes, 47 revised codes, and 58 deleted codes. (For the record, ICD-10-CM has now grown to a grand total of 72,616 codes and 544 new codes for ICD-10-PCS, bringing the total procedure codes to 78,103!)
With all those codes to remember, we thought we’d lend a helping hand by explaining some of the more notable changes made to the ICD-10-CM codes and guidelines for 2021:
Chapter One: Certain Infectious and Parasitic Diseases
The most noteworthy changes and revisions to Chapter One are the guidelines relating to COVID-19. As to be expected, many changes have been made since the initial coding and reporting guidelines, which require a thorough review of the COVID-19 infection (infection due to SARS-CoV-2) section. Additional guideline revisions to COVID-19 can be found for Chapter 15: Pregnancy, Childbirth, and the Puerperium and Chapter 16 Perinatal Period.
Chapter 3: Disease of the Blood and Blood-forming Organs and Certain Disorders Involving the Immune Mechanism
Forty-three (43) new codes have been added with a significant expansion of the sickle-cell category accounting. Further specification of complications of Hb-SS disease, Sickle-cell/Hb-C disease, Sickle-cell thalassemia, Sickle-cell thalassemia beta zero, Sickle-cell thalassemia beta plus, and other sickle-cell disorders can now be captured with the additional specifications of “cerebral vascular involvement” and “other specified complication”. Additional codes have been added for autoimmune hemolytic anemia, hypereosinophilic syndrome, and eosinophilia.
Chapter 4: Endocrine, Nutritional, and Metabolic Diseases
An update to guideline 1.C.4.a.3 was made to provide clarification on non-insulin injectable antidiabetic drugs. Coders are directed to code both Z79.4 Long-term (current) use of insulin and Z79.899 Other long-term (current) drug therapy when a patient is treated with both insulin and non-insulin injectable antidiabetic drugs. Code both Z79.84 Long-term (current) use of oral hypoglycemic drugs and Z79.899 when the patient is treated with both oral antidiabetic and non-insulin injectable antidiabetic drugs.
Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders
Twenty-one (21) new codes relating to substance abuse/use disorders with withdrawal have been added. A revision to guideline I.C.5.b.3. was also added to further clarify associated physical disorders as those “included in chapter 5 (such as sexual dysfunction and sleep disorder)” when reporting psychoactive substance use, unspecified codes.
Chapter 10: Diseases of the Respiratory System
A new guideline (1.C.9.a.3) for Vaping-related disorders was added directing us to code U07.0, Vaping-related disorder, as the principal diagnosis for those patients who are diagnosed with a vaping-related disorder. Code U07.0 should only be used for lung injury due to vaping. You should also assign any additional codes for manifestations as appropriate. The guideline includes instructions for signs and symptoms, stating that associated respiratory signs and symptoms due to vaping may not be coded with a definitive diagnosis, but gastrointestinal symptoms can be reported.
Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue
Fifty-seven (57) new codes were added, while 3 were deleted/ A substantial amount of these updates are related to our ability to capture greater specificity with “other specified site” or “other specified joint” to various arthritis diagnosis, disorders of ligament, contractures, ankylosis, instability, pain, etc. Additionally, specificity can be captured for diagnoses such as juvenile osteochondrosis and arthropathy of temporomandibular joints.
Chapter 14: Diseases of Genitourinary System
Most notably, code N18.3, Chronic kidney disease, Stage 3 (moderate), has been expanded and now requires a fifth character. For instance, N18.30, Chronic kidney disease, Stage 3 unspecified, will be replacing N18.3. Additional codes have been created to capture Stage 3a (GFR 45-59) with code N1.31, and Stage 3b (GFR 30-44) with code N18.32. This is a wonderful reminder for us coders how important it is to stay current with ICD-10-CM updates, to use the index and tabular, and not depend on memory for coding of common conditions.
Chapter 19 and 20: Injury, Poisoning, and Certain Other Consequences of External Causes/External Causes of Morbidity
One hundred and twenty-eight (128) new codes were added, while 23 codes were deleted in the Injury and Poisoning, and External Cause chapter. The External Cause of Morbidity chapter alone includes 125 new codes, including: Specificity for contusions of the thorax as middle or bilateral. External cause codes were updated to now include standing electric scooter, standing micro-mobility pedestrian conveyance, and other standing micro-mobility pedestrian conveyance. Other additions of note were poisoning/adverse effect/underdosing codes for fentanyl or fentanyl analogs, tramadol, and other synthetic narcotics.
ICD-10-PCS Guidelines
Two (2) revisions and two (2) new guidelines were added to section B3. The first revision is to B3.1b, in which the Exceptions Note was removed and the section revision to B3.10c’s parenthetical now states “containing bone graft or bone graft substitute.” Meanwhile, the new guideline B3.18 instructs us to report both procedures in order to capture each objective when an excision or resection of a body part is followed by replacement - unless it is integral and preparatory (e.g., a total joint replacement.) For the operative approach, a new guideline, B5.2b, instructs us to code for a percutaneous endoscopic approach when an incision, or an extension of an incision, is made to assist in removing all–or part–of a body or anastomosis during percutaneous endoscopic approach procedures.
ICD-10-PCS Code Updates
Most of this year’s new PCS codes are found in the Medical and Surgical (398), Imaging (38), Radiation Imaging (68), and New Technology (33) sections. The Medical and Surgical section has added the Root Operation, Fragmentation, to Additional Body Systems, including the Vascular System. Cesium 131 has been added to Brachytherapy tables, and a new device has been added, Radioactive Element, to the Root Operation Insertion tables for several body systems, including the Male Reproductive systems.
Transplantation is also now an available Root Operation for the Male Reproductive system. Additionally, External Fixation Device has been added for Removal from Lower Bones (0QP) and Internal Fixation Device, Sustained Compression was added to Upper and Lower Joints Fusion (0RG, 0SG). And finally, the technology section has added new codes for both devices and substances. The majority of those added involve drug therapy, 12 of which are specifically for COVID-19, when a drug is used to treat COVID-19.
With so many codes added, deleted, and revised, I highly recommend you thoroughly review them all, especially the tabular revisions of ICD-10-CM 2021. We know there’s a lot to digest, and so little time to digest it, that if you need additional help training your employees for all the new changes, our Audit Services Team is here to help.
Questions or Comments?