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 guideline changes effective October 1, 2020
Review code additions, revisions, deletions
Review code note changes effective October 1, 2020
07/15/2020
2
ICD-10 How many?
New Guidelines
revisions
2020: 72,184
595 Code changes (323)
Additions + 490 (273) Revisions 47 (30) Deletions -58 (21)
2021: 72,616
07/15/2020 AAPC Chapters 3General Changes
Again many revisions due to spelling, punctuation, minor
revisions in word order
Laterality, 7
thcharacter affects numbers
No code changes Chapters 2, 8, 9,12
4Guideline Changes
New Guidelines
Covid-19
•
Incorporated guidelines established 04.01.2020
with some revisions and expansion
•
Infections in pregnancy
•
Infections in the newborn
Vaping related disorders
07/15/2020 5 AAPC Chapters
General Guidelines
ICD-10-CM October 1, 2021 07/15/2020 6 AAPC ChaptersDocumentation by Clinicians Other than
the Patient’s Provider
I. B.14
For social determinants of health…..
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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AAPC Chapters
Chapter 1
Certain Infections and Parasitic Diseases A00-B99
Chapter 1 Guidelines
1.C.1.g Coronavirus infections
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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AAPC Chapters
Chapter 1 Guidelines COVID-19
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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AAPC Chapters
Chapter 1 Guidelines COVID-19
1.C.1.g.1.c
Acute respiratory illness due to manifestations of
COVID-19
When the reason for the encounter/admission is a respiratory manifestation of COVID-19, assign code U07.1, COVID-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 12
Chapter 1 Guidelines COVID-19 New
1.C.1.g.1.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.
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AAPC Chapters
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.
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Chapter 1 Guidelines COVID-19
1.C.1.g.1.f. Screening for COVID-19
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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AAPC Chapters
Chapter 1 Guidelines COVID-19
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.
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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AAPC Chapters
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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Chapter 1 Infections
7 new codes, 2 deleted codes, 0 revised codes
A84.8 Other tick-borne viral encephalitis changed to a subcategory
New Codes
A84.81 Powassan virus disease
• Long incubation period
• Can be transmitted by blood transfusion • Rare but increasing
• Northeastern and Great Lakes
A84.89 Other tick-borne viral encephalitis
• Code first, if applicable, transfusion related infection (T80.22-)
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AAPC Chapters
Chapter 1 Infections
B60.0 Babesiosis changed to a subcategory
B60.01 Babesiosis due to Babesi microti
B60.02 Babesiosis due to Babesi duncani
B60.03 Babesiosis due to Babesi divergens
B60.09 Other Babesiosis
• Inclusion terms for each 20
Chapter 1 Infections
Tabular changes
Inclusion terms added to Rikettsioses (A75-A79) code set
New Codes with multiple inclusion terms
B34.2 Coronavirus infection, unspecified
Added Excludes 1: COVID-19 (U07.1)
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Chapter 2
Neoplasms C00-D49 07/15/2020 22 AAPC ChaptersChapter 2 Neoplasms
0 code changes
No guideline changes
Revisions to instructional notes
C93.1 Chronic myelomonocytic leukemia• Code also, if applicable, eosinophilia (D72.18)
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
Chapter 3 Hematology/Immunology
43 new codes, 3 deleted (changed to subcategory), 3 revised
No guideline changes
Revised
codes
D57.411 Sickle-cell thalassemia, unspecified, with acute chest syndrome
D57.412 Sickle-cell thalassemia, unspecified, with splenic sequestration
D57.419Sickle-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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AAPC Chapters
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
D57.213 Sickle-cell/Hb-C disease with cerebral vascular involvement
D57.218 Sickle-cell/Hb-C disease with crisis with other specified manifestations D57.8 Other sickle-cell disorders
D57.813 Other sickle-cell disorders with cerebral vascular involvement
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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Chapter 3 Hematology/Immunology
New codes to expand sickle cell category
D57.4 Sickle-cell thalassemia
D57.42 Sickle-cell thalassemia beta zero without crisis
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
D57.438 Sickle-cell thalassemia beta zero with crisis with other specified complication
D57.439 Sickle-cell thalassemia beta zero with crisis, unspecified
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Chapter 3 Hematology/Immunology
New codes to expand sickle cell category
D57.4 Sickle-cell thalassemia
D57.44 Sickle-cell thalassemia beta plus without crisis
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
D57.458 Sickle-cell thalassemia beta plus with crisis with other specified complication
D57.459 Sickle-cell thalassemia beta plus with crisis, unspecified 28
Chapter 3 Hematology/Immunology
5 New codes to expand autoimmune hemolytic anemias
D59.1 Other autoimmune hemolytic anemias converted
to subcategory
Inclusion terms converted to codes
Excludes 1 changed to Excludes 2
Numerous inclusion terms
D59.10 Autoimmune hemolytic anemia, unspecified D59.11 Warm autoimmune hemolytic anemia D59.12 Cold autoimmune hemolytic anemia D59.13 Mixed type autoimmune hemolytic anemia D59.19 Other autoimmune hemolytic anemia
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Chapter 3 Hematology/Immunology
8
New
codes to expand eosinophilia
D72.1 Eosinophilia converted to subcategory
Excludes 1 changed to Excludes 2
D72.10 Eosinophilia, unspecified
D72.110 Idiopathic hypereosinophilic syndrome [IHES]
D72.111 Lymphocytic variant Hypereosinophilic Syndrome [LHES] D72.118 Other hypereosinophilic syndrome
D72.119 Hypereosinophilic syndrome [HES], unspecified
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 firstunderlying diseases
D72.19 Other eosinophilia
07/15/2020 AAPC Chapters
Chapter 3 Hematology/Immunology
4
New
codes to expand other specified immunodeficiencies
D84.8 Other specified immunodeficiencies converted to subcategory
D84.81 Immunodeficiency due to conditions classified elsewhere
• Code first underlying condition
• Certain disorders involving the immune mechanism 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 07/15/2020 AAPC Chapters 31 Excludes 1
Chapter 3 Hematology/Immunology
New
code subcategory and codes
D89.83 Cytokine release syndrome
• Code first underlying causes such as complications following infusion, transfusion, therapeutic injection, transplanted organ
• 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
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33
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003181/
Chapter 3 Hematology/Immunology
Other tabular changes
D61 Other aplastic anemias and other bone marrow failure syndromes
• Excludes 1 changed to Excludes 2
07/15/2020 AAPC Chapters
Chapter 4
Endocrine, Nutritional and Metabolic Diseases (E00-E89)
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AAPC Chapters
Chapter 4 Guidelines
1.C.4.a.3.
Diabetes mellitus and the use of insulin, oral
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
36Chapter 4 Endocrine
6 new, 0 revised, 2 deleted (converted to subcategory)
E70.8 Disorders of aromatic amino-acid metabolism now
subcategory
E70.81 Aromatic L-amino acid decarboxylase deficiency (AADC) E70.89 Other disorders of aromatic amino-acid metabolism
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AAPC Chapters
Chapter 4 Endocrine
E74.8 Other specified disorders of carbohydrate metabolism now
subcategory
E74.81 Disorders of glucose transport, not elsewhere classified
• 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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Chapter 4 Endocrine
Other tabular changes
E86 Volume depletion
• Excludes 1 changed to Excludes 2
E88.0 Disorders of plasma-protein metabolism, not elsewhere classified
• Excludes 1 changed to Excludes 2
Corrections to spelling, spacing, codes in inclusion notes
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Chapter 5
Mental, Behavioral and Neurodevelopmental Disorders F00-F99
Chapter 5 Guidelines
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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Chapter 5 Psych
21 New, 0 Revised, 0 Deleted
All related to substance abuse/use disorders with withdrawal
Minor corrections in punctuation/code reference in inclusion terms
New
F10.13 Alcohol abuse, with withdrawal
• 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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Chapter 5 Psych
F11.13 Opioid abuse with withdrawal
F12.13 Cannabis abuse with withdrawal
F13.13 Sedative, hypnotic or anxiolytic abuse with withdraw
al• 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
• F13.139 Sedative, hypnotic or anxiolytic abuse with withdrawal, unspecified
F14.13 Cocaine abuse, unspecified with withdrawal
F14.93 Cocaine use, unspecified with withdrawal
F15.13 Other stimulant abuse with withdrawal
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AAPC Chapters
Chapter 5 Psych
F19.13 Other psychoactive substance abuse with withdrawal
• F19.130 Other psychoactive substance abuse with withdrawal, uncomplicated
• F19.131 Other psychoactive substance abuse with withdrawal delirium
• F19.132 Other psychoactive substance abuse with withdrawal with perceptual disturbance
• F19.139 Other psychoactive substance abuse with withdrawal, unspecified
With withdrawal
Uncomplicated Delirium Perceptual disturbance Unspecified Alcohol abuse F10.130 F10.131 F10.132 F10.139 Alcohol use F10.930 F10.931 F10.932 F10.939 Opioid abuse F11.13 XXXXX XXXXX XXXXX XXXXX Cannabis abuse F12.13 XXXXX XXXXX XXXXX XXXXX Sedative, hypnotic, anxiolytic abuse F13.130 F13.131 F13.132 F13.139 Cocaine abuse unspecified F14.13 XXXXX XXXXX XXXXX XXXXX Cocaine use unspecified F14.93 XXXXX XXXXX XXXXX XXXXX Other stimulant abuse F15.13 XXXXXX XXXXXX XXXXXX XXXXXX Psychoactive substance abuse F19.130 F19.131 F19.132 F19.139 07/15/2020 AAPC Chapters 45
Chapter 6
Diseases of the Nervous System G00-G09
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Chapter 6 Nervous System
No guideline changes
24 new, 0 revised , 5 deleted (converted to subcategories)
G11.1 Early onset cerebellar ataxia made subcategory
Inclusion terms converted to codes
G11.10 Early-onset cerebellar ataxia G11.11 Friedreich ataxia
G11.19 Other early-onset cerebellar ataxia
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AAPC Chapters
Chapter 6 Nervous System
G40 Epilepsy and recurrent seizures 2 new codes
G40.42 Cylin-Dependent Kinase-Like 5 Deficiency Disorder
• CDKL5
• Use additional instructional note to identify manifestations
G40.833 Dravet syndrome, intractable, with status epilepticus G40.834 Dravet syndrome, intractable, without status epilepticus
Chapter 6 Nervous System
G71.2 Congenital myopathies converted to subcategory
inclusion terms converted to codes
Excludes 1 changed to Excludes 2
G71.20 Congenital myopathy, unspecified G71.21 Nemaline myopathy
G71.22 Centronuclear myopathy
• G71.220 X-linked myotubular myopathy • G71.228 Other centronuclear myopathy
G71.29 Other congenital myopathy
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AAPC Chapters
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 Postoperative, traumatic included here 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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Chapter 6 Nervous System
G96 Other disorders of central nervous system 11 new
G96.1 Other disorders of meninges
• Code also intracranial hypotension G96.11
•
G96.191 Perineural cyst
o Cervical, thoracic, lumbar, sacral nerve root cyst, Tarlov
cyst
•
G96.198 Other disorders of meninges, not elsewhere
classified
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AAPC Chapters
Chapter 6 Nervous System
G96 Other disorders of central nervous system 11 new
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
Chapter 6 Nervous System
G97 Intraoperative and postprocedural complications and
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
•
G97.83 Intracranial hypotension following lumbar
cerebrospinal fluid shunting
o Code also instructional note for any associated diagnoses or
complications
•
G97.84 Intracranial hypotension following other procedure
o Code also instructional note for accidental
puncture/laceration, CSF leak
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AAPC Chapters
Chapter 6 Nervous System
Other tabular changes 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
• Added inclusion term and 1 obstructive hydrocephalus
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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Excludes 2
Chapter 7
Diseases of the Eye and Adnexa H00-H59
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AAPC Chapters
Chapter 7 Eye
No guidelines
29 new, 7 deleted , 1 revised
Deletions all converted to subcategories
H18.5 Hereditary corneal dystrophies expanded to include laterality
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H18.5 Hereditary corneal dystrophies
H18.501
Unspecified hereditary corneal dystrophies right eye H18.502 left eye H18.503 bilateral H18.509 Unspecified eye H18.511
Endothelial corneal dystrophy
right eye
H18.512 left eye
H18.513 bilateral
H18.519 Unspecified eye
H18.521
Epithelial (juvenile) corneal dystrophy right eye H18.522 left eye H18.523 bilateral H18.529 Unspecified eye H18.531
Granular corneal dystrophy
right eye H18.532 left eye H18.533 bilateral H18.539 Unspecified eye 07/15/2020 AAPC Chapters 58
H18.5 Hereditary corneal dystrophies
H18.541
Lattice corneal dystrophy
right eye
H18.542 left eye
H18.543 bilateral
H18.549 Unspecified eye
H18.551
Macular corneal dystrophy
right eye
H18.552 left eye
H18.553 bilateral
H18.559 Unspecified eye
H18.591
Other hereditary corneal dystrophies
right eye
H18.592 left eye
H18.593 bilateral
Chapter 7 Eye
H55.8 Other irregular eye movements
Revised H55.81 from Saccadic eye movements to Deficient
saccadic eye movements
New code H55.82 Deficient smooth pursuit eye movements
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Chapter 9
Diseases of the Circulatory System I00-I99
Chapter 9 Guidelines
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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AAPC Chapters
Chapter 9 Circulatory System
0 new, 0 deleted, 0 revised
Numerous revisions to the Tabular section for Excludes and Inclusion
notes
Revisions in punctuation, spacing not affecting code
I46 Cardiac arrest
Excludes 1 changed to Excludes 2
I63 Cerebral infarction
Added Excludes 1 neonatal cerebral infarction
I70 Atherosclerosis
Inclusion terms added
• Chronic limb-threatening ischemia • Critical limb ischemia
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Chapter 10
Diseases of the Respiratory System J00-J99
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AAPC Chapters
Chapter 10 Guidelines
I.C.10.e. Vaping-related disorders
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.
Chapter 10 Respiratory System
6 new, 2 deleted, 0 revised
J82 Pulmonary eosinophilia, not elsewhere classified
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 J82.83 Eosinophilic asthma
• Code first asthma by type
J82.89 Other pulmonary eosinophilia, not elsewhere classified
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AAPC Chapters
Chapter 10 Respiratory System
J84.1 Other interstitial pulmonary diseases with fibrosis in
diseases classified elsewhere
Converted to a subcategory, 2 new codes created
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
• Inclusion term progressive fibrotic interstitial lung disease • Code first: underlying disease
J84.178 Other interstitial lung disease with fibrosis in diseases classified elsewhere
• Multiple inclusion terms • Code first : underlying disease
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Chapter 10 Respiratory System
Other tabular changes
Addition of Excludes 1, instructional notes multiple codes
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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Chapter 10 Respiratory System
Other tabular changes
J10 Influenza due to other identified influenza virus
• Added includes note influenza A (non-novel), B, C
J43 Emphysema
• Excludes 1 changed to Excludes 2
J45 Asthma
• Use additional instructional note for eosinophilic asthma
J70.5 Respiratory conditions due to smoke inhalation
• Excludes 1 changed to Excludes 2 68
Chapter 11
Diseases of the Digestive System K00-K95
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Chapter 11 Digestive
11 new, 5 deleted, 0 revised
No guideline changes
Deleted codes changed to subcategory, new codes created, 8 to
reflect combination codes for bleeding
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Chapter 11 Digestive
K20.8 Other esophagitis converted to subcategory
K20.80 Other esophagitis without bleeding 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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Chapter 11 Digestive
K59.8 Other specified functional intestinal disorders converted to
subcategory
Inclusion terms deleted and moved to code level
K59.81 Ogilvie syndrome
K59.89 Other specified functional intestinal disorders
Chapter 11 Digestive
K74.0 Hepatic fibrosis converted to subcategory
Added Code first instructional note for underlying liver disease
K74.00 Hepatic fibrosis, unspecified
K74.01 Hepatic fibrosis,
early
fibrosis
• Stage F1 or F2
K74.02 Hepatic fibrosis,
advanced
fibrosis
• Stage F3
• cirrhosis and stage 4 fibrosis
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Excludes 1
Chapter 11 Digestive
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
• Excludes 1 deleted K57 Diverticular disease
• Deleted inclusion terms K62.7 Radiation proctitis
• Corrected Use additional W code for type of radiation
• Added radiation therapy
K75.81 Nonalcoholic steatohepatitis (NASH)
• Added Use additional instructional note for hepatic fibrosis K80.4 Calculus of bile duct with cholecystitis
• Added Code also : fistula of bile duct
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Chapter 13
Diseases of the Musculoskeletal System M00-M99
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Chapter 13 Musculoskeletal and Connective Tissue
No guideline changes
57 new, 3 deleted, 0 revised
Majority of revisions added for “other specified
joint/other site” in numerous joint disorder categories
76Chapter 13 Musculoskeletal and Connective Tissue
New
Inflammatory Arthropathies
M05.7A Rheumatoid arthritis with rheumatoid factor of other specified site without organ or systems involvement
M05.8A Other rheumatoid arthritis with rheumatoid factor of other specified site
M06.0A Rheumatoid arthritis without rheumatoid factor, other specified site
M08.0A Unspecified juvenile rheumatoid arthritis, other specified site M08.2A Juvenile rheumatoid arthritis with systemic onset, other
specified site
M08.4A Pauciarticular juvenile rheumatoid arthritis, other specified site M08.9A Juvenile arthritis, unspecified, other specified site
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Chapter 13 Musculoskeletal and Connective Tissue
New osteoarthritis
M19.09 Primary osteoarthritis, other specified site
M19.19 Post-traumatic osteoarthritis, other specified site M19.29 Secondary osteoarthritis, other specified site
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Chapter 13 Musculoskeletal and Connective Tissue
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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Chapter 13 Musculoskeletal and Connective Tissue
New TMJ
M26.641 Arthritis of right temporomandibular joint M26.642 Arthritis of left temporomandibular joint M26.643 Arthritis of bilateral temporomandibular joint M26.649 Arthritis of unspecified temporomandibular joint M26.651 Arthropathy of right temporomandibular joint M26.652 Arthropathy of left temporomandibular joint M26.653 Arthropathy of bilateral temporomandibular joint M26.659 Arthropathy of unspecified temporomandibular joint
Chapter 13 Musculoskeletal and Connective Tissue
New osteoporosis
M80.0AX- Age-related osteoporosis with current pathological fracture, other site
M80.8AX- Other osteoporosis with current pathological fracture, other site
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The appropriate 7th character is to be added to each code from category M80.
A initial encounter
D subsequent encounter w/routine healing G subsequent encounter w/delayed healing K subsequent encounter w/nonunion P subsequent encounter w/malunion S sequela
Chapter 13 Musculoskeletal and Connective Tissue
M95.5- Juvenile osteochondrosis of tibia and fibula
descriptions revised, codes deleted and expanded
categories
Removed terms Blount Disease and Osgood Schlatter
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M92.501
Unspecified juvenile osteochondrosis
Right leg
M92.502 Left leg
M92.503 Bilateral leg
M92.509 Unspecified leg
M92.511
Juvenile osteochondrosis of proximal tibia (Blount disease) (Tibia vara) Right leg M92.512 Left leg M95.513 Bilateral leg M92.519 Unspecified leg M92.521
Juvenile osteochondrosis of tibia tubercle (Osgood-Schlatter disease) Right leg M92.522 Left leg M92.523 Bilateral leg M92.529 Unspecified leg M92.591
Other juvenile osteochondrosis of tibia and fibula
Right leg
M92.592 Left leg
M92.593 Bilateral leg
M92.599 AAPC Chapters Unspecified leg 07/15/2020
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Chapter 13 Musculoskeletal and Connective Tissue
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
• Changed Excludes 1 to Excludes 2
M23 Internal derangement of knee
• Changed Excludes 1 to Excludes 2
o for current injury and recurrent dislocation/subluxation 84
Chapter 14
Diseases of the Genitourinary System N00-N99
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Chapter 14 GU
No guideline changes
15 new, 1 deleted, 0 revised
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
N20.1 Calculus of ureter
• Added inclusion term to include ureteropelvic junction
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Chapter 14 GU
New all related to C3 glomerulonephritis
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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Excludes 1
Chapter 14 GU
N18.3 Chronic kidney disease, stage 3 moderate
expanded to subcategory to expand stage
classification
N18.30 Chronic kidney disease, stage 3 unspecified N18.31 Chronic kidney disease, stage 3a
N18.32 Chronic kidney disease, stage 3b
Stages of CKD
•
Stage 1: Normal GFR (≥ 90 mL/min/1.73 m
2) plus either
persistent albuminuria or known structural or hereditary renal
disease
•
Stage 2: GFR 60 to 89 mL/min/1.73 m
2•
Stage 3a: GFR 45 to 59 mL/min/1.73 m
2•
Stage 3b: GFR 30 to 44 mL/min/1.73 m
2•
Stage 4: GFR 15 to 29 mL/min/1.73 m
2•
Stage 5: GFR < 15 mL/min/1.73 m
2 07/15/2020 AAPC Chapters 89Chapter 14 GU
N61 Inflammatory disorders of breast 4 new codes and
subcategory added
N61.2 Granulomatous mastitis
•
N61.20 Granulomatous mastitis, unspecified breast
•
N61.21 Granulomatous mastitis, right breast
•
N61.22 Granulomatous mastitis, left breast
•
N61.23 Granulomatous mastitis, bilateral breast
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Chapter 15
Pregnancy, Childbirth and the Puerperium O00-O99
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Chapter 15 Guidelines
I
.C.15.k. Puerperal sepsisCode 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).
Chapter 15 Guidelines
I
.C.15.s. COVID-19 infection in pregnancy, childbirth, and the puerperiumDuring 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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Chapter 15 Obstetrics
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
O34.22 Maternal care for cesarean scar defect (isthmocele)
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
O99.892 Other specified diseases and conditions complicating childbirth
O99.893 Other specified diseases and conditions complicating
puerperium
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Chapter 16
Certain Conditions Originating in the Perinatal Period P00-P96
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Chapter 16 Guidelines
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.
Chapter 16 Perinatal
4 new, 0 deleted, 0 revised
P00.89 Newborn affected by other maternal conditions
Use additional code to identify infectious agent
added
P91.0 Neonatal cerebral ischemia
added for new neonatal cerebral infarction codes
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Chapter 16 Perinatal
New subcategory and code set for neonatal cerebral
infarction
P91.82 Neonatal cerebral infarction
• Inclusion terms
• cerebral infarction I63.-
• intracranial hemorrhage of newborn P52.-
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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Excludes 1 Excludes 2
Chapter 17
Congenital Malformations, Deformations and Chromosomal Abnormalities Q00-Q99
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Chapter 17 Congenital
0 new, 1 deleted, 3 revised
Cleft lip and cleft palate (Q35-Q37)
Excludes 1 changed to Excludes 2
Q51.20 Other doubling of uterus, unspecified
deleted
Revised
Q51.21 Other complete doubling of uterus
Q51.22 Other partial doubling of uterus
Q51.28 Other
and unspecified
doubling of uterus, other
specified
Chapter 18
Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified R00-R99
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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).
07/15/2020 AAPC Chapters
Chapter 18 Signs & Symptoms
No guideline changes
4
new
, 2 deleted, 0 revised
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
R74.02 Elevation of levels of lactic acid dehydrogenase [LDH]
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Chapter 19
Injury, Poisoning and Certain Other Consequences of External Causes S00-T88
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
• Excludes 1 changed to Excludes 2
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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
7
thcharacter (54 codes)
S20.2- Contusion
S20.30- Unspecified superficial injury
S20.31- Abrasion
S20.32- Blister
S20.34- External constriction
S20.35- Superficial foreign body
S20.36- Insect bite
S20.37- Other superficial bite
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S20.213- Contusion of front wall of thorax bilateral
S20.214- middle
S20.223 Contusion of back wall of thorax bilateral
S20.224- middle
S20.303- Unspecified superficial injuries of front wall of thorax
bilateral
S20.304- middle
S20.313- Abrasion of front wall of thorax bilateral
S20.314- middle
S20.323- Blister (nonthermal) of front wall of thorax
bilateral
S20.324- middle
S20.343- External constriction of front wall of thorax
bilateral
S20.344- middle
S20.353- Superficial foreign body of front wall of thorax
bilateral
S20.354- middle
S20.363- Insect bite (nonvenomous of front wall of thorax
bilateral
S20.364- middle
S20.373- Other superficial bite of front wall of thorax
bilateral
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The appropriate 7th character is to be added to each code from category S20.
A initial encounter
D subsequent encounter w/routine healing S sequela
NEW
Chapter 19 Injuries and Poisoning
T40.4X Poisoning by, adverse effect of and underdosing
of other synthetic narcotics
Code set deleted
54 codes created with 3 new subcategories to more accurately reflect the synthetic drugs
• Fentanyl, Tramadol, Other
• Numbers affected by 7th character and causation 108
Poisoning by, adverse effect of and underdosing of
T40.411-
Fentanyl or fentanyl analogs
Accidental T40.412- Intentional T40.413- Assault T40.414- Undetermined T40.415- Adverse effect T40.416- Underdosing T40.421- Tramadol Accidental T40.422- Intentional T40.423- Assault T40.424- Undetermined T40.425- Adverse effect
T40.426- The appropriate 7th character is to be added to each Underdosing
code from category T40. A initial encounter D subsequent encounter S sequela 07/15/2020 AAPC Chapters 109 New
Poisoning by, adverse effect of and underdosing of
T40.491-
Other synthetic narcotics
Accidental T40.492- Intentional T40.493- Assault T40.494- Undetermined T40.495- Adverse effect T40.496- Underdosing
The appropriate 7th character is to be added to each code from category T40.
A initial encounter D subsequent encounter S sequela 07/15/2020 AAPC Chapters 110 New
Chapter 19 Trauma/Poisoning
T86.84- Complications of corneal transplant codes
converted to subcategory level and new codes created to
reflect laterality 1-right, 2-left, 3-bilateral, 9-unspecified
20 codes
No 7
thcharacter
07/15/2020 AAPC Chapters 111 Corneal Transplant T86.8401 Rejection Right eye Other complications T86.8481 T86.8402 Left eye T86.8482 T86.8403 Bilateral T86.8483 T86.8409 Unspecified eye T86.8489 T86.8411 Failure Right eye Unspecified complications T86.8491 T86.8412 Left eye T86.8492 T86.8413 Bilateral T86.8493 T86.8419 Unspecified eye T86.8499 T86.8421 Infection Right eye T86.8422 Left eye T86.8423 Bilateral T86.8429 Unspecified eye 112Chapter 20
External Causes of Morbidity V00-V99
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Chapter 20 External Cause
No guideline changes
125 New, 1 Deleted, 1 Revised
Majority related to pedestrian on mobility devices
Standing micro-mobility pedestrian conveyance =
standing electric scooter, hoverboard or Segway
07/15/2020 AAPC Chapters
Chapter 20 External Cause New
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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116
The appropriate 7th character is to be added to each
code from category T40.
A initial encounter
D subsequent encounter
S sequela
Pedestrian on standing electric scooter injured in collision with (6th character 1)
Nontraffic accident Traffic Accident Unspecified whether traffic or nontraffic accident Pedal cycle V01.031 V01.131 V01.931 Two or three wheeled motor
vehicle
V02.031 V02.131 V02.931 Car, pick-up truck or van V03.031 V03.131 V03.931 Heavy transport vehicle or bus V04.031 V04.131 V04.931 Railway train or railway vehicle V05.031 V05.131 V05.931 Other nonmotor vehicle V06.031 V06.131 V06.931
The appropriate 7th character is to be added to each code from category V01-V06.
A initial encounter
Pedestrian on other standing micro-mobility pedestrian conveyance injured in collision with (6th character 8)
Nontraffic
accident Traffic Accident Unspecified whether traffic or nontraffic accident
Pedal cycle V01.038 V01.138 V01.938 Two or three wheeled motor
vehicle V02.038 V02.138 V02.938 Car, pick-up truck or van V03.038 V03.138 V03.938 Heavy transport vehicle or bus V04.038 V04.138 V04.938 Railway train or railway vehicle V05.038 V05.138 V05.938 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.
A initial encounter D subsequent encounter S sequela
New
Chapter 20 External Causes
Y77.1 Therapeutic (nonsurgical) and rehabilitative
ophthalmic devices associated with adverse incidents
New
• Y77.11 Contact lens associated with adverse incidents • Y77.19 Other therapeutic (nonsurgical) and rehabilitative
ophthalmic devices associated with adverse incidents
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Chapter 20 External Cause
Other tabular changes
W89 Exposure to man-made visible and ultraviolet light
• Excludes 1 changed to Excludes 2
W90 Exposure to other nonionizing radiation
• Excludes 1 changed to Excludes 207/15/2020 AAPC Chapters
119
Chapter 21
Factors Influencing Health Status and Contact with Health Services Z00-Z99
Chapter 21 Guidelines
1.C.21.c.1. Contact/Exposure
Category Z20 indicates contact with, and suspected
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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Chapter 21 Guidelines
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.
07/15/2020 AAPC Chapters
Chapter 21 Guidelines
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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AAPC Chapters
Chapter 21 Z codes
3 new, 0 deleted, 39 revised
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
Chapter 21 Z codes
New
Z03.82 Encounter for observation for suspected foreign body
ruled out
o
retained foreign body (Z18.1-)
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)
07/15/2020 125 AAPC Chapters Excludes 1 Excludes 2
Chapter 21 Z codes
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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Chapter 22
Codes for Special Purposes U00-U85
07/15/2020
127
AAPC Chapters
Chapter 22
Added for the provisional assignment of new diseases of
uncertain etiology or for emergency use
Became official April 1, 2020
Vaping-related disorders and Covid-19
2 “new”
“New” code category U07 Emergency use of U07
Chapter 22 Vaping
U07.0 Vaping-related disorder
Dabbing related lung damage
Dabbing related lung injury
E-cigarette, or vaping, product use associated lung injury
[EVALI]
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 129
Chapter 22 COVID-19
U07.1 COVID-19
Use additional code to identify pneumonia or other manifestations
Excludes 1:
• coronavirus infection, unspecified (B34.2)
• coronavirus as the cause of diseases classified elsewhere (B97.2-)) • pneumonia due to SARS-associated Coronovirus (J12.81)
07/15/2020 AAPC Chapters
More to Come
Code proposals to be implemented 01.01.2021
Z11.52 Encounter for screening for COVID-19
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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131
132
07/15/2020 AAPC Chapters 133 07/15/2020 134 https://www.cdc.gov/nchs/icd/icd10cm.htm AAPC Chapters https://www.cdc.gov/nchs/icd/icd10cm.htm
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07/15/2020 AAPC Chapters 137 07/15/2020 AAPC Chapters 138
07/15/2020 AAPC Chapters
139
07/15/2020 AAPC Chapters 141 07/15/2020 AAPC Chapters 142
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