Information regarding coding, coverage, and payment is provided as a service to our readers. Every effort has been made to ensure accuracy. However, HMP and the author do not represent, guarantee, or warranty that coding, coverage, and payment information is error-free and/or that payment will be received.
As a service to our readers, this author provides a summary of the new/revised wound care diagnosis code updates that will go into effect on October 1 every year when they are released by the National Center for Health Statistics. The new 2021 ICD-10-CM codes and guidelines are to be used from October 1, 2020 through September 30, 2021. The full addenda can be found at this link: https://tinyurl.com/yyvrvcll.
Now is an excellent time to take a moment and review both the guidelines and the new ICD-10-CM codes for fiscal year 2021 with your staff. In addition, it is essential to ensure that all forms, superbills, electronic medical records (EMRs), etc., have been updated to reflect any of the new codes and coding guidelines.
The Acute Inpatient Prospective Payment Final Rule has not been published as of this writing but should be out shortly. This information will be referenced in the form of addenda to the final rule when it is published.
Review of Coding Guidelines
One of the largest new set of guidelines is for the coronavirus infection. There was a previous article on COVID-19 by this author in the April issue.1 Everyone should review the new COVID-19 Infection Guidelines that were effective April 1, 2020. Below is an excerpt from the Official Coding Guidelines for 2021 ICD-10-CM from the National Center for Health Statistics Web site at this link: https://tinyurl.com/yybvt5u5.
g. Coronavirus infections
1) COVID-19 infection (infection due to SARS-CoV-2)
(a) Code only confirmed cases. Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider or documentation of a positive COVID-19 test result. For a confirmed diagnosis, assign code U07.1, COVID-19. This is an exception to the hospital inpatient guideline Section II, H. In this context, “confirmation” does not require documentation of a positive test result for COVID-19; the provider’s documentation that the individual has COVID-19 is sufficient. If the provider documents “suspected,” “possible,” “probable,” or “inconclusive” COVID-19, do not assign code U07.1. Instead, code the signs and symptoms reported. See guideline I.C.1.g.1.g.
(b) Sequencing of codes. When COVID-19 meets the definition of principal diagnosis, code U07.1, COVID-19, should be sequenced first, followed by the appropriate codes for associated manifestations, except when another guideline requires that certain codes be sequenced first, such as obstetrics, sepsis, or transplant complications.
For a COVID-19 infection that progresses to sepsis, see Section I.C.1.d. Sepsis, Severe Sepsis, and Septic Shock.
(c) Acute respiratory manifestations of COVID-19.
(i) When the reason for the encounter/admission is a respiratory manifestation of COVID-19, assign code U07.1, COVID-19, as the principal/first-listed diagnosis and assign code(s) for the respiratory manifestation(s) as additional diagnoses. For a patient with pneumonia confirmed as due to COVID-19, assign codes U07.1, COVID-19, and J12.89, Other viral pneumonia.
(ii) Acute bronchitis. For a patient with acute bronchitis confirmed as due to COVID-19, assign codes U07.1, and J20.8, Acute bronchitis due to other specified organisms. Bronchitis not otherwise specified (NOS) due to COVID-19 should be coded using code U07.1 and J40, Bronchitis, not specified as acute or chronic.
(iii) Lower respiratory infection. If the COVID-19 is documented as being associated with a lower respiratory infection, NOS, or an acute respiratory infection, NOS, codes U07.1 and J22, Unspecified acute lower respiratory infection, should be assigned. If the COVID-19 is documented as being associated with a respiratory infection, NOS, codes U07.1 and J98.8, Other specified respiratory disorders, should be assigned.
(iv) Acute respiratory distress syndrome. For acute respiratory distress syndrome (ARDS) due to COVID-19, assign codes U07.1, and J80, Acute respiratory distress syndrome.
(v) Acute respiratory failure. For acute respiratory failure due to COVID-19, assign code U07.1, and code J96.0-, Acute respiratory failure.
(d) Non-respiratory manifestations of COVID-19. When the reason for the encounter/admission is a non-respiratory manifestation (e.g., viral enteritis) of COVID-19, assign code U07.1, COVID-19, as the principal/first-listed diagnosis and assign code(s) for the manifestation(s) as additional diagnoses.
(e) Exposure to COVID-19. For asymptomatic individuals with actual or suspected exposure to COVID-19, assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. For symptomatic individuals with actual or suspected exposure to COVID-19 and the infection has been ruled out, or test results are inconclusive or unknown, assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. See guideline I.C.21.c.1, Contact/Exposure, for additional guidance regarding the use of category Z20 codes. If COVID-19 is confirmed, see guideline I.C.1.g.1.a.
(f) Screening for COVID-19. During the COVID-19 pandemic, a screening code is generally not appropriate. For encounters for COVID-19 testing, including preoperative testing, code as exposure to COVID-19 (guideline I.C.1.g.1.e). Coding guidance will be updated as new information concerning any changes in the pandemic status becomes available.
(g) Signs and symptoms without definitive diagnosis of COVID-19. For patients presenting with any signs/symptoms associated with COVID-19 (such as fever, etc.) but a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as:
• R05 Cough
• R06.02 Shortness of breath
• R50.9 Fever, unspecified
If a patient with signs/symptoms associated with COVID-19 also has an actual or suspected contact with or exposure to COVID-19, assign Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, as an additional code.
(h) Asymptomatic individuals who test positive for COVID-19. For asymptomatic individuals who test positive for COVID-19, see guideline I.C.1.g.1.a. Although the individual is asymptomatic, the individual has tested positive and is considered to have the COVID-19 infection.
(i) Personal history of COVID-19. For patients with a history of COVID-19, assign code Z86.19, Personal history of other infectious and parasitic diseases.
(j) Follow-up visits after COVID-19 infection has resolved. For individuals who previously had COVID-19 and are being seen for follow-up evaluation, and COVID-19 test results are negative, assign codes Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm, and Z86.19, Personal history of other infectious and parasitic diseases.
(k) Encounter for antibody testing. For an encounter for antibody testing that is not being performed to confirm a current COVID-19 infection, nor is a follow-up test after resolution of COVID-19, assign Z01.84, Encounter for antibody response examination. Follow the applicable guidelines above if the individual is being tested to confirm a current COVID-19 infection. For follow-up testing after a COVID-19 infection, see guideline I.C.1.g.1.j.
These guidelines should be reviewed with the team to be sure that all are familiar with the codes to be used for any COVID-19 related encounter.
New Diabetes Guideline for Long-Term insulin or Oral Hypoglycemic Drugs
In addition, there were also some changes to the guidelines for reporting long term use of insulin and oral hypoglycemic medications provided below for your convenience:
“If the patient is treated with both insulin and an injectable non-insulin antidiabetic drug, assign codes Z79.4, Long-term (current) use of insulin, and Z79.899, Other long term (current) drug therapy. If the patient is treated with both oral hypoglycemic drugs and an injectable non-insulin antidiabetic drug, assign codes Z79.84, Long-term (current) use of oral hypoglycemic drugs, and Z79.899, Other long-term (current) drug therapy. Code Z79.4 should not be assigned if insulin is given temporarily to bring a type 2 patient’s blood sugar under control during an encounter.”
New ICD-10-CM Codes
Now that we have reviewed the pertinent changes in coding guidelines, let’s turn our attention to some of the new ICD-10-CM codes that go into effect on October 1, 2020. There were not many changes this year, but I have summarized the changes into 4 groups. The first group (Table 1) is trauma related code changes, the second group (Table 2) is minor revisions to the obesity codes, the third group (Table 3) includes new chronic kidney disease codes. The fourth group (Table 4) of codes includes codes regarding pathological fractures. The fifth group (Table 5) contains new codes for glucose transporter deficiencies, immunodeficiency due to drugs and drug rash with eosinophilia.
As noted in the beginning of the article there is a link to the entire addenda for the full list of 2021 New Codes and Changes. Please be sure to review the addenda in their entirety to ensure you are aware of other diagnoses that may be present in your practice. As suggested, now is a great time to review these new and revised coding guidelines and new codes (especially COVID-19 if you have not done so already). Knowing the new guidelines and codes will be prescriptive of how documentation needs to appear in the medical records to support the use of these new codes and guidelines. It has been a challenging 2020 thus far, and the challenge will continue throughout 2021. Stay healthy and safe!
Donna Cartwright is senior director of health policy and reimbursement at Integra LifeSciences Corp., Plainsboro, NJ. She is approved as an AHIMA-approved ICD-10-CM/PCS trainer and she has been designated as a fellow of the American Health Information Management Association.
1. Cartwright DJ. ICD-10-CM coding guidelines for COVID-19. Today’s Wound Clinic. https://www.todayswoundclinic.com/articles/icd-10-cm-coding-guidelines-covid-19 . April 2020.