Breaking News: Codes to add specificity to pathological fractures, CKD & COVID-19 finalized in 2021 ICD-10-CM update

by: DecisionHealth Editors 

Nearly 500 codes – including the two new U codes for COVID-19 and vaping-related disorders – were finalized to be added to the ICD-10 code set.

In addition to the 490 new codes, this update also includes 47 revised codes and 58 codes deemed invalid. Final changes were issued today by the ICD-10-CM Coordination and Maintenance Committee. They take effect Oct. 1.

As included among the proposed codes in May, 12 new codes were finalized to capture other pathological fractures (M80.8AX- and M80.0AX-). Industry experts noted that these codes will be helpful as there were currently no codes to capture a pathological fracture of a rib, which happens often in the Medicare demographic.

Also of note  are the codes to capture stage 3 chronic kidney disease (CKD) in two new sub-stages. The new codes are: N18.30 (Chronic kidney disease, stage 3 unspecified), N18.31 (Chronic kidney disease, stage 3a) and N18.32 (Chronic kidney disease, stage 3b).

The final code update also contains 18 new, detailed codes for sickle cell anemia. The new codes specify complications related to the condition such as D57.213 (Sickle-cell/Hb-C disease with cerebral vascular involvement) and D57.431 (Sickle-cell thalassemia beta zero with acute chest syndrome).

Coders will also find 21 new codes that describe withdrawal from substances including alcohol, cocaine and opioids. For example, F10.932 (Alcohol use, unspecified with withdrawal with perceptual disturbance).

The new Chapter 22: Codes for Special Purposes (U00-U85) so far includes just two codes: U07.0 Vaping-related disorder and U07.1 COVID-19, which took effect in the early part of this year.

Make note that the following codes are true deletions – with no replacements –  from the 2021 ICD-10-CM code set: Q51.20 (Other doubling of uterus, unspecified), and the entire code family of T40.4X- (Poisoning by adverse effect of and underdosing of other synthetic narcotics).

In addition to hundreds of code changes, the ICD-10-CM manual also includes 193 revisions within the Tabular instructions for current codes. Among the tabular changes:

The trend of converting Excludes1 notes to Excludes2 continues. Excludes1 notes indicate that the excluded code should never be used with the code above it. Excludes2 notes indicate that “the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time,” according to the ICD-10-CM Official Guidelines for Coding and Reporting (Section I.,A.,12). As an example, under category M22 (Disorder of patella), an Excludes1 note is deleted for traumatic dislocation of patella (S83.0-) and an Excludes2 note is added.

  • Updates to Chapter 3: Diseases of th Blood and Blood-Forming Organs include additional codes to describe complications associated with sickle-cell and hemoglobin-C (Hb-C) diseases. For example, a note for new sickle-cell thalassemia code D57.418 (Sickle-cell thalassemia, unspecified, with crisis with other specified complication) instructs the coder to code any identified complications such as cholelithiasis (K80.-) or priapism (N48.32).
  • In Chapter 6: Diseases of the Nervous System, “pseudotumor” has been added as a clarifying term to G93.2 (Benign intracranial hypertension) and coders are instructed to code G98.81- (intracranial hypotension) with G96.0 (Cerebrospinal fluid leak) when applicable.
  • In Chapter 9: Diseases of the Circulatory System, though no actual codes changed, you’ll find numerous revisions to includes and excludes notes for existing codes. For example: Atherosclerosis of native arteries of the legs with ulceration (I70.2-) now include both critical and chronic ischemia of native arteries with ulceration.

In addition, the list of diagnoses included in hypertensive heart disease (I11) has been revised to exclude Takotsubo Syndrome (I51.81), also known as “broken heart” syndrome.

  • In Chapter 10: Diseases of the Respiratory System, you’ll find that for cases of acute laryngitis and tracheitis (J04) and acute obstructive laryngitis (croup) and epiglottitis (J05) you now are to code also influenza if present, including influenza due to identified novel influenza A virus with other respiratory manifestations (J10.1).

You’ll find several headache-induced changes in Chapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified, including a note to code facial pain NOS using new headache code R51.9 (Headache, unspecified).

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