2019 ICD-10- CM Updates10/13/2020
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2021 ICD-10- CM Updates Ruby Woodward, BSN, CPC, CPMA, CPB, CPC-I, COSC, CSFAC, RCC
Coding and Compliance Consulting Radiologists
2015-2019 AAPC Chapter Association Board of Directors. 2018-2019 Chair
Agenda
Review code additions, revisions, deletions
Review code note changes effective October 1, 2020
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revisions in word order
No code changes Chapters 2, 8, 9,12
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• Infections in pregnancy
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the Patient’s Provider
Patient self-reported documentation may also be used to
assign codes for social determinants of health, as long as
the patient self-reported information is signed-off by and
incorporated into the health record by either a clinician or provider.
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Revision and additions from 04.01.2020
1.C.1.g.1.a. 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, or a presumptive 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 the type of test performed; the provider’s documentation that the individual has COVID-19 is sufficient.
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1.C.1.g.1.a. continued
Presumptive positive COVID-19 test results should be coded as confirmed. A presumptive positive test result means an individual has tested positive for the virus at a local or state level, but it has not yet been confirmed by the Centers for Disease Control and Prevention (CDC). CDC confirmation of local and state tests for COVID-19 is no longer required.
If the provider documents "suspected," "possible," "probable," or “inconclusive” COVID-19, do not assign code U07.1. Assign a code(s) explaining the reason for encounter (such as fever) or Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. Instead, code the signs and symptoms reported. See guideline I.C.1.g.1.g.
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Chapter 1 Guidelines COVID-19
1.C.1.g.1.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 in the case of obstetrics patients as indicated in Section . I.C.15.s. for COVID-19 in pregnancy, childbirth, and the puerperium. except when another guideline requires that certain codes be sequenced first, such as obstetrics, sepsis, or transplant complications.
See Section I.C.16.h. for COVID-19 infection in newborn
For a COVID-19 infection in a lung transplant patient, see Section I.C.19.g.3.a. Transplant complications other than kidney.
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COVID-19
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.
The following conditions are examples of common respiratory manifestations of
COVID-19.
(i) Pneumonia
For a patient with pneumonia case confirmed as due to the 2019 novel coronavirus
(COVID-19), assign codes U07.1, COVID-19, and J12.89, Other viral pneumonia.
(v) Acute respiratory failure
For acute respiratory failure due to COVID-19, assign code U07.1, and code J96.0-,
Acute respiratory failure.
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.
Chapter 1 Guidelines COVID-19
1.C.1.g.1.e. Exposure to COVID-19
For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation, assign code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out.
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 cases where there is an symptomatic individuals with actual or suspected exposure to someone who is confirmed or suspected (not ruled out) to have to COVID-19, and the exposed individual either tests negative or the test results are unknown, 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. If the exposed individual tests positive for the COVID- 19 virus, see guideline a). 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. 07/15/2020
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For asymptomatic individuals who are being screened for COVID-19 and
have no known exposure to the virus, and the test results are either
unknown or negative, assign code Z11.59, Encounter for screening for
other viral diseases. For individuals who are being screened due to a
possible or actual exposure to COVID-19, see guideline d).
If an asymptomatic individual is screened for COVID-19 and tests positive,
see guideline g).
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.
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1.C.1.g.1.g. Signs and symptoms without definitive diagnosis of COVID-19
If a patient with signs/symptoms associated with COVID-19 also has an actual or suspected contact with or exposure to someone who has COVID-19, assign Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, as an additional code. This is an exception to guideline I.C.21.c.1, Contact/Exposure.
2.C.1.g.1.h. Asymptomatic individuals who test positive for COVID-19
For asymptomatic individuals who test positive for COVID-19, assign code U07.1, COVID-19 see guideline 1.C.1.g.1.a. Although the individual is asymptomatic, the individual has tested positive and is considered to have the COVID-19 infection.
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Chapter 1 Guidelines COVID-19 New
1.C.1.g.1.g.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.
1.C.1.g.1.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.
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Chapter 1 Guidelines COVID-19 New
2.C.1.g.1.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.
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New Codes
• Rare but increasing
• Code first, if applicable, transfusion related infection (T80.22-)
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B60.09 Other Babesiosis
New Codes with multiple inclusion terms
B34.2 Coronavirus infection, unspecified
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Minor revisions to correct punctuation, grammar, description (adding “of”)
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AAPC Chapters
Chapter 3 Diseases of the Blood and Blood-Forming Organs and Certain Disorders
Involving the Immune Mechanism D50-D89
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43 new codes, 3 deleted (changed to subcategory), 3 revised
No guideline changes
D57.412 Sickle-cell thalassemia, unspecified, with splenic sequestration
D57.419 Sickle-cell thalassemia, unspecified. with crisis, unspecified
New codes to expand sickle-cell categorization
D57.413 Sickle-cell thalassemia, unspecified, with cerebral vascular involvement
D57.418 Sickle-cell thalassemia, unspecified, with crisis with other specified complication
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Chapter 3 Hematology/Immunology
21 New codes to expand sickle cell categorization D57.0 HB-SS disease with crisis
D57.03 Hb-SS disease with cerebral vascular involvement
• Code also, if applicable, cerebral infarction (I63.-)*
D57.09 Hb-SS disease with crisis with other specified complication
• Code also, if applicable, any associated manifestations*
D57.2 Sickle-cell/Hb-C disease
D57.218 Sickle-cell/Hb-C disease with crisis with other specified manifestations
D57.8 Other sickle-cell disorders
D57.818 Other sickle-cell disorders with crisis with other specified complication
* Code also instructional note added to all codes with the noted manifestations throughout the code set
Includes notes noted under nearly all code
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D57.4 Sickle-cell thalassemia
D57.431 Sickle-cell thalassemia beta zero with acute chest syndrome
D57.432 Sickle-cell thalassemia beta zero with splenic sequestration
D57.433 Sickle-cell thalassemia beta zero with cerebral vascular
involvement
specified complication
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D57.4 Sickle-cell thalassemia
D57.451 Sickle-cell thalassemia beta plus with acute chest syndrome
D57.452 Sickle-cell thalassemia beta plus with splenic sequestration
D57.453 Sickle-cell thalassemia beta plus with cerebral vascular
involvement
specified complication
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D59.1 Other autoimmune hemolytic anemias converted
to subcategory
Excludes 1 changed to Excludes 2
Numerous inclusion terms
D59.13 Mixed type autoimmune hemolytic anemia
D59.19 Other autoimmune hemolytic anemia
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D72.1 Eosinophilia converted to subcategory
Excludes 1 changed to Excludes 2
D72.10 Eosinophilia, unspecified
D72.111 Lymphocytic variant Hypereosinophilic Syndrome [LHES]
D72.118 Other hypereosinophilic syndrome
D72.12 Drug rash with eosinophilia and systemic symptoms syndrome
• Use additional code adverse effect to identify drug
D72.18 Eosinophilia in diseases classified elsewhere
• Code first underlying diseases
D84.8 Other specified immunodeficiencies converted to subcategory
D84.81 Immunodeficiency due to conditions classified elsewhere
• Code first underlying condition
HIV
D84.821 Immunodeficiency due to drugs
• Use additional code for adverse effect if applicable to identify drug
• Use additional code for long term current drug therapy
D84.822 Immunodeficiency due to external causes
• Code also radiological procedure and radiotherapy
• Use additional code for external cause
D84.89 Other immunodeficiencies
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D89.83 Cytokine release syndrome
• Use additional code to identify associated manifestations
D89.831 Cytokine release syndrome. Grade 1
D89.832 Cytokine release syndrome. Grade 2
D89.833 Cytokine release syndrome. Grade 3
D89.834 Cytokine release syndrome. Grade 4
D89.835 Cytokine release syndrome, grade 5
D89.838 Cytokine release syndrome, grade unspecified
Requires specific documentation of the grade by the provider, otherwise coded as unspecified.
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syndromes
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hypoglycemics, and injectable non-insulin drugs
…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.
Repeated in 2.C.4.a.6 Secondary diabetes mellitus
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E70.8 Disorders of aromatic amino-acid metabolism now
subcategory
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subcategory
• E74.810 Glucose transporter protein type 1 deficiency
• E74.818 Other disorders of glucose transport
• E74.819 Disorders of glucose transport, unspecified
E77.89 Other specified disorders of carbohydrate metabolism
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E88.0 Disorders of plasma-protein metabolism, not elsewhere
classified
Corrections to spelling, spacing, codes in inclusion notes
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1.C.5.b.3. Psychoactive Substance Use, Unspecified
As with all other unspecified diagnoses, the codes for unspecified psychoactive substance use (F10.9-, F11.9-, F12.9-, F13.9-, F14.9-, F15.9-, F16.9-, F18.9-, F19.9-) should only be assigned based on provider documentation and when they meet the definition of a reportable diagnosis (see Section III, Reporting Additional Diagnoses). These codes are to be used only when the psychoactive substance use is associated with a physical disorder
included in chapter 5 such as sexual dysfunction and sleep disorder),or a mental or behavioral disorder and such a relationship
is documented by the provider.
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All related to substance abuse/use disorders with withdrawal
Minor corrections in punctuation/code reference in inclusion terms
New
• F10.130 Alcohol abuse with withdrawal, uncomplicated
• F10.131 Alcohol abuse with withdrawal delirium
• F10.132 Alcohol abuse with withdrawal with perceptual disturbance
• F10.139 Alcohol abuse with withdrawal, unspecified
F10.93 Alcohol use, unspecified with withdrawal
• F10.930 Alcohol use, unspecified with withdrawal, uncomplicated
• F10.931 Alcohol use, unspecified with withdrawal delirium
• F10.932 Alcohol use, unspecified with withdrawal with perceptual disturbance
• F10.939 Alcohol use, unspecified with withdrawal, unspecified
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F13.13 Sedative, hypnotic or anxiolytic abuse with withdrawal
• F13.130 Sedative, hypnotic or anxiolytic with withdrawal, uncomplicated
• F13.131 Sedative, hypnotic or anxiolytic abuse with withdrawal delirium
• F13.132 Sedative, hypnotic or anxiolytic abuse with withdrawal with
perceptual disturbance
unspecified
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uncomplicated
perceptual disturbance
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Opioid abuse F11.13 XXXXX XXXXX XXXXX XXXXX
Cannabis abuse F12.13 XXXXX XXXXX XXXXX XXXXX
Sedative,
hypnotic,
Cocaine use
Other stimulant
Psychoactive
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G11.1 Early onset cerebellar ataxia made subcategory
Inclusion terms converted to codes
G11.10 Early-onset cerebellar ataxia
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G40.42 Cylin-Dependent Kinase-Like 5 Deficiency Disorder
• CDKL5
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inclusion terms converted to codes
Excludes 1 changed to Excludes 2
G71.20 Congenital myopathy, unspecified
Chapter 6 Nervous System
G96 Other disorders of central nervous system 11 new G96.0 Cerebrospinal fluid leak now subcategory
• Code also instructional note added for intracranial hypotension
• Codes defined by brain vs spine origin
• Numerous inclusion terms
o Otorrhea, rhinorrhea, skull base CSF leak
• * code also instructional note for head injury
o G96.00 Cerebrospinal fluid leak, unspecified*
o G96.01 Cranial cerebrospinal fluid leak, spontaneous
o G96.02 Spinal cerebrospinal fluid leak, spontaneous
o G96.08 Other cranial cerebrospinal fluid leak*
o G96.09 Other spinal cerebrospinal fluid leak*
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G96.1 Other disorders of meninges
• Code also intracranial hypotension G96.11
• G96.191 Perineural cyst
cyst
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G96.8 Other specified disorders of central nervous system
• G96.81 Intracranial hypotension new subcategory
Code also any associated diagnoses
o G96.810 Intracranial hypotension, unspecified
o G96.811 Intracranial hypotension, spontaneous
o G96.819 Other intracranial hypotension
• G96.88 Other specified disorders of central nervous system
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disorders of nervous system, not elsewhere classified
Addition of code also instructional note G97.0,G97.1,G97.2,G97.41 for
associated diagnoses or complications or associated headache
2 new codes
o Code also instructional note for any associated diagnoses or
complications
o Code also instructional note for accidental
puncture/laceration, CSF leak
G20 Parkinson’s disease
• Use additional instructional node added to identify dementia w/ or w/o behavioral disturbance
G44.8 Other specified headache syndromes
• a add headache w/orthostatic or positional component
G93.2 Benign intracranial hypertension
G93.4 Other and unspecified encephalopathy
• Excludes 1 toxic (metabolic) encephalopathy changed to Excludes 2
G97.41 Accidental puncture of laceration of dura during a procedure
o Code also any associated diagnoses or complications
Corrections to spelling, spacing, codes in inclusion notes
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Deletions all converted to subcategories
H18.5 Hereditary corneal dystrophies expanded to include
laterality
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H18.541
Revised H55.81 from Saccadic eye movements to Deficient
saccadic eye movements
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I.C.9.a.3 Hypertensive CKD and acute renal failure
For patients with both acute renal failure and chronic kidney disease, the an additional code for acute renal failure should also be coded. is required. Sequence according to the
circumstances of the admission encounter.
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Numerous revisions to the Tabular section for Excludes and Inclusion
notes
I46 Cardiac arrest
I63 Cerebral infarction
I70 Atherosclerosis
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For patients presenting with condition(s) related to vaping, assign code
U07.0, Vaping-related disorder, as the principal diagnosis. For lung
injury due to vaping, assign only code U07.0. Assign additional codes
for other manifestations, such as acute respiratory failure (subcategory J96.0-) or pneumonitis (code J68.0).
Associated respiratory signs and symptoms due to vaping, such as
cough, shortness of breath, etc., are not coded separately, when a
definitive diagnosis has been established. However, it would be
appropriate to code separately any gastrointestinal symptoms, such as
diarrhea and abdominal pain.
Converted to a subcategory, 4 new codes created
Inclusion terms now new codes or included in new codes
Excludes 1 changed to Excludes 2
J82.81 Chronic eosinophilic pneumonia
J82.82 Acute eosinophilic pneumonia
J82.89 Other pulmonary eosinophilia, not elsewhere classified
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diseases classified elsewhere
Inclusion terms now new codes or included in new codes
Code first moved to code level
J84.170 Interstitial lung disease with progressive fibrotic phenotype in
diseases classified elsewhere
• Code first: underlying disease
classified elsewhere
J00-J06 Acute upper respiratory infections
• Excludes 1 removed at category level added at code level
J04 Acute laryngitis and tracheitis
• Code also instructional note influenza, if present
J05 Acute obstructive laryngitis [croup] and epiglottitis
• Code also instructional note “code also if present, such as:”
J06 Acute upper respiratory infections of multiple and unspecified sites
• Excludes 1 influenza virus with other respiratory manifestations
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J43 Emphysema
J45 Asthma
• Excludes 1 changed to Excludes 2
• Code first: smoke inhalation
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No guideline changes
Deleted codes changed to subcategory, new codes created, 8 to reflect combination codes for bleeding
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K20.81 Other esophagitis with bleeding
K20.9 Esophagitis, unspecified converted to subcategory K20.90 Esophagitis, unspecified, without bleeding
K20.91 Esophagitis, unspecified, with bleeding
K21.0 Gastro-esophageal reflux disease with esophagitis converted to subcategory K21.00 Gastro-esophageal reflux disease with esophagitis without bleeding
K21.01 Gastro-esophageal reflux disease with esophagitis with bleeding
K20.9 Esophagitis, unspecified converted to subcategory K20.90 Esophagitis, unspecified without bleeding
K20.91 Esophagitis, unspecified, with bleeding
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subcategory
K59.81 Ogilvie syndrome
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Added Code first instructional note for underlying liver disease
K74.00 Hepatic fibrosis, unspecified
• Stage F1 or F2
• Stage F3
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Other tabular changes K56 Paralytic ileus and intestinal obstruction without hernia
• Excludes 1 stenosis of anus or rectum changed to Excludes 2
K56.60 Unspecified intestinal obstruction
• Added radiation therapy
K80.4 Calculus of bile duct with cholecystitis
• Added Code also : fistula of bile duct
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No guideline changes
Majority of revisions added for “other specified
joint/other site” in numerous joint disorder categories
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New Inflammatory Arthropathies
site without organ or systems involvement
M05.8A Other rheumatoid arthritis with rheumatoid factor of other
specified site
site
specified site
M08.9A Juvenile arthritis, unspecified, other specified site
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New osteoarthritis
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New other joint disorders M24.19 Other articular cartilage disorders, other specified site
M24.29 Disorder of ligament, other specified site
M24.39 Pathological dislocation of other specified joint, not elsewhere classified
M24.49 Recurrent dislocation, other specified joint
M24.59 Contracture, other specified joint
M24.69 Ankylosis, other specified joint
M24.89 Other specific joint derangement of other specified joint, not elsewhere classified
M25.39 Other instability, other specified joint
M25.59 Pain in other specified joint
M25.69 Stiffness of other specified joint, not elsewhere classified
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New TMJ
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New osteoporosis
fracture, other site
other site
each code from category M80.
A initial encounter
K subsequent encounter w/nonunion
M95.5- Juvenile osteochondrosis of tibia and fibula
descriptions revised, codes deleted and expanded
categories
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tibia
and fibula
Right leg
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Other tabular changes
M00 Pyogenic arthritis
• Added infection and inflammatory reaction due to internal joint prosthesis (T84.5-)
M00.0 Staphylococcal arthritis and polyarthritis
• Deleted Excludes 2 (since added to category level)
M22 Disorder of patella
M23 Internal derangement of knee
• Changed Excludes 1 to Excludes 2
o for current injury and recurrent dislocation/subluxation
Added inclusion terms M30.1 and M31.3
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Added Excludes 1 and inclusion terms to numerous codes
added reflecting conditions related to C3
glomerulonephritis to: N00.8, N01.5, N02.5, N03.5, N04.5, N05.5, N06.5,
N07.5
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N00.A Acute nephritis syndrome with C3 glomerulonephritis
N01.A Rapidly progressive nephritis syndrome with C3 glomerulonephritis
N02.A Recurrent and persistent hematuria with C3 glomerulonephritis
N03.A Chronic nephritic syndrome with C3 glomerulonephritis
N04.A Nephrotic syndrome with C3 glomerulonephritis
N05.A Unspecified nephritic syndrome with C3 glomerulonephritis
N06.A Isolated proteinuria with C3 glomerulonephritis
N07.A Hereditary nephropathy, not elsewhere classified with C3
glomerulonephritis
• All have notes related to conditions with dense deposit disease
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expanded to subcategory to expand stage
classification
N18.31 Chronic kidney disease, stage 3a
N18.32 Chronic kidney disease, stage 3b
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persistent albuminuria or known structural or hereditary renal
disease
• Stage 5: GFR < 15 mL/min/1.73 m2
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subcategory added
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Chapter 15 Guidelines
I.C.15.k. Puerperal sepsis
Code O85 should not be assigned for sepsis following an obstetrical
procedure (See section 1.C.1.d.5.b., Sepsis due to a postprocedural
infection).
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During pregnancy, childbirth or the puerperium, a patient admitted (or presenting for a
health care encounter) because of when COVID-19 is the reason for
admission/encounter, should receive a principal diagnosis code of O98.5-, Other viral
diseases complicating pregnancy, childbirth and the puerperium, should be sequenced
as the principal/first-listed diagnosis followed by and code U07.1, COVID-19, and the
appropriate codes for associated manifestation(s) should be assigned as additional
diagnoses. Codes from Chapter 15 always take sequencing priority.
If the reason for admission/encounter is unrelated to COVID-19 but the patient tests
positive for COVID-19 during the admission/encounter, the appropriate code for the
reason for admission/encounter should be sequenced as the principal/first-listed
diagnosis, and codes O98.5- and U07.1, as well as the appropriate codes for associated
COVID-19 manifestations, should be assigned as additional diagnoses.
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5 new, 1 deleted, 0 revised
New maternal care for abnormality of pelvic organ O34.218 Maternal care for other type scar from previous cesarean
delivery
O99.89 Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium converted to subcategory O99.891 Other specified diseases and conditions complicating
pregnancy
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Chapter 16 Certain Conditions Originating in the Perinatal Period P00-P96
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I.C.16.h. COVID-19 Infection in newborn
For a newborn that tests positive for COVID-19, assign code U07.1, COVID- 19, and the appropriate codes for associated manifestation(s) in
neonates/newborns in the absence of documentation indicating a specific type of transmission. For a newborn that tests positive for COVID- 19 and the provider documents the condition was contracted in utero or during the birth process, assign codes P35.8, Other congenital viral diseases, and U07.1, COVID-19. When coding the birth episode in a newborn record, the appropriate code from category Z38, Liveborn infants according to place of birth and type of delivery, should be assigned as the principal diagnosis.
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P00.89 Newborn affected by other maternal conditions
Use additional code to identify infectious agent added
P91.0 Neonatal cerebral ischemia
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P91.82 Neonatal cerebral infarction
P91.821 Neonatal cerebral infarction, right side of brain
P91.822 Neonatal cerebral infarction, left side of brain
P91.823 Neonatal cerebral infarction, bilateral
P91.829 Neonatal cerebral infarction, unspecified side
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Abnormalities Q00-Q99
Q51.20 Other doubling of uterus, unspecified deleted
Revised
Q51.28 Other and unspecified doubling of uterus, other specified
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Chapter 18 Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not
Elsewhere Classified R00-R99
Chapter 18 Guidelines
1.C.18.e. Coma scale
The coma scale codes (R40.2-) can be used in conjunction with traumatic brain injury codes, acute cerebrovascular disease or sequelae of cerebrovascular disease codes. These codes are primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma scale may also be used to assess the status of the central nervous system for other non-trauma conditions, such as monitoring patients in the intensive care unit regardless of medical condition. The coma scale codes should be sequenced after the diagnosis code(s).
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R51 Headache changed to subcategory
Excludes 1 changed to Excludes 2
R51.0 Headache with orthostatic component, not elsewhere classified
• Headache with positional component, not elsewhere classified
R51.9 Headache, unspecified
• Facial pain, NOS
R74.0 Nonspecific elevation of levels of transaminase and lactic acid dehydrogenase [LDH] changed to subcategory
R74.01 Elevation of levels of liver transaminase levels
• ALT and AST levels
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AAPC Chapters
Chapter 19 Injury, Poisoning and Certain Other Consequences of External Causes
S00-T88
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Chapter 19 Trauma/Poisoning
128 new, 23 deleted, 0 revised New affected by laterality, 7 character
Revisions in Excludes notes S06.3 Focal traumatic brain injury
• Excludes 1 focal cerebral edema changed to Excludes 2
S83 Dislocation and sprain of joints and ligaments of knee
• Excludes 1 changed to Excludes 2
Poisoning by, adverse effects of and underdosing of drugs, medicaments and biological substances T36-T50)
• Added to Excludes 2 immunodeficiency due to drugs
T79.7 Traumatic subcutaneous emphysema
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Chapter 19 Trauma/Poisoning
Superficial injuries to the thorax categories expanded for codes for bilateral and middle walls of thorax 22 codes plus 7th character (54 codes)
S20.2- Contusion
Contusion of front wall of thorax bilateral
S20.214- middle
bilateral
bilateral
bilateral
of thorax
wall of thorax
wall of thorax
front wall of thorax
wall of thorax
each code from category S20.
A initial encounter
NEW
T40.4X Poisoning by, adverse effect of and underdosing
of other synthetic narcotics
54 codes created with 3 new subcategories to more accurately
reflect the synthetic drugs
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T40.411-
T40.425- Adverse effect
T40.426- Underdosing The appropriate 7th character is to be added to each
code from category T40.
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T40.491-
The appropriate 7th character is to be added to each
code from category T40.
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converted to subcategory level and new codes created to
reflect laterality 1-right, 2-left, 3-bilateral, 9-unspecified
20 codes
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113
Majority related to pedestrian on mobility devices
Standing micro-mobility pedestrian conveyance =
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V00.03-Pedestrian on foot injured in collision with standing micro-mobility pedestrian conveyance
V00.031Pedestrian on foot injured in collision with rider of standing electric scooter
V00.038 Pedestrian on foot injured in collision with rider of other standing micro-mobility pedestrian conveyance
V00.84- Accident with standing micro-mobility pedestrian conveyance
V00.841 Fall from standing electric scooter
V00.842 Pedestrian on standing electric scooter colliding with stationary object
V00.848 Other accident with standing micro-mobility pedestrian conveyance
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The appropriate 7th character is to be added to each
code from category T40.
S sequela
Pedestrian on standing electric scooter injured in collision with (6th character 1)
Nontraffic
accident
Traffic
Accident
vehicle
Other nonmotor vehicle V06.031 V06.131 V06.931
The appropriate 7th character is to be added to each
code from category V01-V06.
New
10/13/2020
59
collision with (6th character 8)
Nontraffic
accident
Traffic
Accident
vehicle
Other nonmotor vehicle V06.038 V06.138 V06.938
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The appropriate 7th character is to be added to each
code from category V01-V06.
New
ophthalmic devices associated with adverse incidents
New
• Y77.19 Other therapeutic (nonsurgical) and rehabilitative
ophthalmic devices associated with adverse incidents
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118
• Excludes 1 changed to Excludes 2
W90 Exposure to other nonionizing radiation
• Excludes 1 changed to Excludes 2
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119
Chapter 21 Factors Influencing Health Status and Contact with Health Services
Z00-Z99
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exposure to, communicable diseases. These codes are for
patients who do not show any sign or symptom of a
disease but are suspected to have been exposed to it by
close personal contact with an infected individual or are in
an area where a disease is epidemic.
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1.C.21.c.3. Status
Z79 Codes from this category indicate a patient’s continuous use of a prescribed drug (including such things as aspirin therapy) for the long-term treatment of a condition or for prophylactic use. It is not for use for patients who have addictions to drugs. This subcategory is not for use of medications for detoxification or maintenance programs to prevent withdrawal symptoms in patients with drug dependence (e.g., methadone maintenance for opiate dependence). Assign the appropriate code for the drug dependence instead.
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I.C.21.c.6 Observation
The observation codes are primarily to be used as principal/first-listed diagnosis only. An observation code may be assigned as a secondary diagnosis code when the patient Is being observed for a condition that is ruled out and is unrelated to the principal/first-listed diagnosis (e.g., patient presents for treatment following injuries sustained in a motor vehicle accident and is also observed for suspected COVID-19 infection that is subsequently ruled out). The only exception to this is Also when the principal diagnosis is required to be a code from category Z38, Liveborn infants according to place of birth and type of delivery, then Then a code from category Z05, Encounter for observation and evaluation of newborn for suspected diseases and conditions ruled out, is sequenced after the Z38 code. Additional codes may be used in addition to the observation code, but only if they are unrelated to the suspected condition being observed.
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Z68 Body mass index
Entire code set adult and pediatric revised changing parenthesis around BMI to brackets
No change in code descriptor
Z88 Allergy status to drugs, medicaments and biological substances
Revised entire code set to remove redundant term
• Z88.1 Allergy status to other antibiotic agents status
Z78 Long term (current) drug therapy
Deleted Excludes 2 for oral antidiabetic drugs and oral hypoglycemic drugs
Moved as Excludes 1 to Z79.4 Long term (current) use of insulin
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ruled out
retained foreign body in eyelid (H02.81)
retained foreign body in soft tissues (M79.5)
confirmed foreign body ingestion or aspiration including:
foreign body in alimentary tract (T18)
foreign body in ear (T16)
foreign body in external eye (T15)
foreign body in respiratory tract (T17)
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New
• Z03.821 Encounter for observation for suspected ingested foreign body ruled out
• Z03.822 Encounter for observation for suspected aspirated (inhaled) foreign body ruled out
• Z03.823 Encounter for observation for suspected inserted (injected) foreign body ruled out
o Inclusion terms for eye, orifice, skin
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uncertain etiology or for emergency use
Became official April 1, 2020
Vaping-related disorders and Covid-19
07/15/2020 AAPC Chapters
Electronic cigarette related lung damage
Electronic cigarette related lung injury
Use additional code, to identify manifestations (abdominal pain, ARDS, diarrhea, drug-induced interstitial lung disorder, lipoid pneumonia, weight loss)
Note guidelines published by CMS 10/17/2019 were not incorporated in 10.01.2020 revision
07/15/2020 AAPC Chapters
Excludes 1:
• pneumonia due to SARS-associated Coronovirus (J12.81)
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Z20.822 Contact with and (suspected) exposure to COVID-19
Z86.16 Personal history of COVID-19
J12.82 Pneumonia due to coronavirus
M35.81 Multisystem Inflammatory Response Syndrome
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https://www.cdc.gov/nchs/icd/icd10cm_maintenance.htm
https://www.cdc.gov/nchs/icd/icd10cm.htm
Rarediseases.info.nih.gov
https://www.webmd.com/eye-health/corneal-dystrophies
https://www.aaaai.org/conditions-and-treatments/related- conditions/hypereosinophilic-syndrome