ICD-10 coding changes for 2021 that will impact radiologists

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There are 490 new clinical modification (CM) codes in the 10th revision of the International Classification of Diseases (ICD-10) that became effective on October 1, 2020, all of which are replacing existing codes. An additional 47 codes have been revised and 58 were deleted. Two new codes, U07.1 for COVID-19 and U07.0 for vaping-related disorders, took effect on April 1, 2020. They are contained in a new section of the guidelines, Chapter 22, "Codes for Special Purposes (U00 -- U85)."

Reporting COVID-19

The new code U07.1 for COVID-19 is to be used only 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. The type of test performed does not need to be documented.

Erin Stephens.Erin Stephens.

U07.1 should not be used if the provider documents "suspected," "possible," or "inconclusive." Instead, the signs and symptoms reported should be coded. When COVID-19 is the principal diagnosis, it should be sequenced first except when other guidelines (such as obstetrics, sepsis, or transplant complications) require that those guidelines be listed first.

When the reason for the encounter or admission is a respiratory or nonrespiratory manifestation of COVID-19, U07.1 should be the principal diagnosis with the respiratory manifestation(s) listed additionally. For example, a patient with pneumonia due to COVID-19 would have U07.1 listed first, followed by J12.89, "Other viral pneumonia." A patient with viral enteritis due to COVID-19 would be reported with U07.1 followed by the appropriate viral enteritis code.

The code Z20.828, "Contact with and (suspected) exposure to other viral communicable diseases," would be used for an asymptomatic patient who experienced actual or suspected exposure to COVID-19. When other signs or symptoms are present, they are listed first with Z20.828 listed additionally.

Z20.828 would be the primary diagnosis for symptomatic individuals with actual or suspected exposure to COVID-19 where the infection has been ruled out, or the test results are inconclusive or unknown. Since the use of screening codes is generally not appropriate during the current pandemic, encounters for COVID-19 testing, including preoperative testing, should be coded as described here for possible exposure.

Two codes are appropriately used when seeing patients who have recovered from COVID-19:

  • Z86.19, "Personal history of other infectious and parasitic diseases"
  • Z09, "Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm"

These rules change somewhat under certain circumstances. For example, radiologists performing obstetrical ultrasound exams should be aware of the proper coding for COVID-19 in pregnant patients.

  • When COVID-19 is the reason for the admission or encounter, a code from O98.5, "Other viral diseases complicating pregnancy, childbirth, and the puerperium," should be sequenced as the principal diagnosis, followed by U07.1 and the appropriate codes for any associated manifestations.
  • When the admission or encounter is not related to COVID-19 but the patient tests positive during the admission or encounter, the reason for the admission or encounter is sequenced first, followed by O98.5 and U07.1 and any other appropriate codes for associated manifestations.

The type of transmission is to be identified in newborns testing positive for COVID-19. When the infection was contracted in utero or during the birth process, code P35.8, "Other congenital viral diseases," is used along with U07.1. When the type of transmission is not known, U07.1 is used primarily along with the associated manifestations being reported in addition.

New and Revised Coding

The vast majority of new codes (253) are concerned with external causes of morbidity, poisoning, or injury. Of this group, the codes most relevant to radiologists will be related to thoracic injuries when evaluating x-ray and CT images.

Abrasion of front wall of thorax Bilateral Middle
Initial encounter S20.313A S20.314A
Subsequent encounter S20.313D S20.314D
Sequela S20.313S S20.314S
Blister (nonthermal) of front wall of thorax
Initial encounter S20.323A S20.324A
Subsequent encounter S20.323D S20.324D
Sequela S20.323S S20.324S
External constriction of front wall of thorax
Initial encounter S20.343A S20.344A
Subsequent encounter S20.343D S20.344D
Sequela S20.343S S20.344S
Superficial foreign body of front wall of thorax
Initial encounter S20.353A S20.354A
Subsequent encounter S20.353D S20.354D
Sequela S20.353S S20.354S
Insect bite (nonvenomous) of front wall of thorax
Initial encounter S20.363A S20.364A
Subsequent encounter S20.363D S20.364D
Sequela S20.363S S20.364S
Other superficial bite of front wall of thorax
Initial encounter S20.373A S20.374A
Subsequent encounter S20.373D S20.374D
Sequela S20.373S S20.374S

There are 57 new codes related to diseases of the musculoskeletal system and connective tissue that will be encountered by radiologists evaluating CT, MRI, and x-ray exams. They fall into the following categories:

  • Rheumatoid arthritis
  • Osteoarthritis
  • Arthritis and arthropathy of the temporomandibular joint
  • Juvenile osteochondrosis

Included in this section are 12 new codes related to osteoporosis that will be likely be encountered:

Osteoporosis with current pathological fracture, other site Age-related Other
Initial encounter for fracture M80.0AXA M80.8AXA
Subsequent encounter for fracture -- --
With routine healing M80.0AXD M80.8AXD
With delayed healing M80.0AXG M80.8AXG
With nonunion M80.0AXK M80.8AXK
With malunion M80.0AXP M80.8AXP
Sequela M80.0AXS M80.8AXS

New codes in other areas can be summarized as follows:

  • Sickle-cell diseases
  • Ataxia
  • Cerebrospinal fluid leaks
  • Intracranial hypotension
  • Eosinophilic pneumonia
  • Interstitial pulmonary diseases
  • Esophagitis
  • Gastroesophageal reflux disease
  • Functional intestinal disorders
  • Hepatic fibrosis
  • C3 glomerulonephritis
  • Chronic kidney disease
  • Granulomatous mastitis
  • Neonatal cerebral infarction
  • Headaches
  • Elevation of liver transaminase and lactate dehydrogenase levels

Revised codes (39) are found primarily in connection with factors influencing health status. Of those, only a few will be relevant to radiologists evaluating suspected foreign bodies.

Encounter for observation for suspected foreign body ruled out
Nonspecific Z03.82
Ingested Z03.821
Aspirated (inhaled) Z03.822
Inserted (injected) Z03.823

Action Steps

We have provided a brief overview of the many changes to ICD-10 coding that are effective now, as of October 1, 2020. Radiology practices should carefully review in detail those codes that will affect their practice and make appropriate adjustments to their templates and electronic health record systems. Particular attention should be given to codes that have been deleted, as their use could cause claims to be rejected by payers. The reporting guidelines have not changed very much this year, but nonetheless they should also be 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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