ICD-10 coding changes that will impact radiologists in 2022

By Erin Stephens, AuntMinnie.com contributing writer

October 22, 2021 -- The annual changes to the International Classification of Diseases Clinical Modification (ICD-10-CM) coding system come in two forms. The coding and reporting guidelines describe how the codes are to be used, and then there is the list of available codes themselves.

Erin Stephens
Erin Stephens.

In all, 159 new codes became effective on October 1, 2021, and many codes have been revised or deleted. Not surprisingly there are a few revisions to the reporting of COVID-19 infections and related conditions.

Reporting COVID-19

In 2020 the new code U07.1 was introduced to code a confirmed diagnosis of COVID-19 as documented by the provider, or with documentation of a positive COVID-19 test result, whether the patient is symptomatic or asymptomatic.

Now we have the code U09.9, "Post-COVID-19 condition, unspecified," that has been added for reporting late effects of COVID-19. This new code should be used in place of B94.8, "Sequela of other specified infectious and parasitic diseases." U09.9 may be used in conjunction with U07.1 when a patient who has had a previous infection has been reinfected with another case of COVID-19, but it should not be used for manifestations of an active (current) COVID-19 infection.

Changes to the coding and reporting guidelines

Describing laterality is always important in radiology reporting. The guidelines now state that, "when laterality is not documented by the patient's provider, code assignment for the affected side may be based on medical record documentation from other clinicians." Such clinicians might include a dietitian, nurse, social worker, or emergency medical technician (EMT).

Specific diagnosis codes should be used when they are supported by the available medical record documentation and the physician's knowledge of the patient's health condition. When a definitive diagnosis has not been established by the physician, coding may be done using symptoms and signs.

The revised guidelines have highlighted this point by stating, "The importance of consistent, complete documentation in the medical record cannot be overemphasized. Without such documentation, accurate coding cannot be achieved. The entire record should be reviewed to determine the specific reason for the encounter and the conditions treated."

The ICD system includes a series of Z-codes that do not describe a patient's diagnosis but rather provide additional information relevant to the encounter. Radiologists might use such codes in emergency department cases to enhance the information in the medical record.

A new section titled Social Determinants of Health (SDOH) was added in the new release, indicating that these codes should be assigned when relevant information is documented. Documentation, in this case, can include patient self-reported information that is signed off by and incorporated into the medical record by a provider or a clinician such as a social worker, community health worker, case manager, or nurse. It can also include information provided directly by those clinicians that is included in the medical record.

SDOH codes are located primarily in these Z-code categories:

  • Z55 Problems related to education and literacy
  • Z56 Problems related to employment and unemployment
  • Z57 Occupational exposure to risk factors
  • Z58 Problems related to physical environment
  • Z59 Problems related to housing and economic circumstances
  • Z60 Problems related to social environment
  • Z62 Problems related to upbringing
  • Z63 Other problems related to primary support group, including family circumstances
  • Z64 Problems related to certain psychosocial circumstances
  • Z65 Problems related to other psychosocial circumstances

Coding revisions

Of the 159 new codes, relatively few would be important to radiology. In most cases, the new codes provide more specificity than the previous code assignment. Below is a selection of examples:

Low back pain
New Code Description Previous Codes
C56.3 Malignant neoplasm of bilateral ovaries C56.1, C56.2
C79.63 Secondary malignant neoplasm of bilateral ovaries C79.61, C79.62
Diseases of esophagus
K22.81 Esophageal polyp K22.8
K22.82 Esophagogastric junction polyp K22.8
K22.89 Other specified disease of esophagus K22.8
M54.50 Unspecified M54.5
M54.51 Vertebrogenic M54.5
M54.59 Other low back pain M54.5
R05.1 Acute cough R05
R05.2 Subacute cough R05
R05.3 Chronic cough R05
R05.4 Cough syncope R05
R05.8 Other specified cough R05
R05.9 Unspecified cough R05
Feeding difficulties
R63.30 Unspecified R63.3
R63.31 Pediatric, acute R63.3
R63.32 Pediatric, chronic R63.3
R63.39 Other feeding difficulties R63.3
Traumatic brain compression without herniation
S06.A0XA Initial encounter S06.890A-S06.899A
S06.A0XD Subsequent encounter S06.890D-S06.899D
S06.A0XS Sequela S06.890S-S06.899S
Traumatic brain compression with herniation
S06.A1XA Initial encounter S06.890A-S06.899A
S06.A1XD Subsequent encounter S06.890D-S06.899AD
S06.A1XS Sequela S06.890S-S06.899S

Action steps

This is just a brief overview of the many changes to ICD-10 coding that are effective now, as of October 1, 2021. Radiology practices should carefully review in detail those codes that will affect their practice and make appropriate adjustments to their templates and EHR systems.

Particular attention should be given to codes that have been deleted, as their use could cause claims to be rejected by payors. The reporting guidelines should also be thoroughly reviewed to determine where the practice's documentation might need to be modified.

The annual revision of the current procedural terminology (CPT) code set that takes effect at the beginning of each year is generally of greater impact than the ICD coding changes. Watch for our full coverage of the important coding changes for radiology.

Erin Stephens is senior client manager, education at Healthcare Administrative Partners.

The comments and observations expressed are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.

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