2021 ICD-10- CM Updates

Full text

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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 guideline changes effective October 1, 2020

Review code additions, revisions, deletions

Review code note changes effective October 1, 2020

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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

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General Changes

Again many revisions due to spelling, punctuation, minor

revisions in word order

Laterality, 7

th

character affects numbers

No code changes Chapters 2, 8, 9,12

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Guideline 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

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General Guidelines

ICD-10-CM October 1, 2021 07/15/2020 6 AAPC Chapters

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Documentation 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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Chapter 1

Certain Infections and Parasitic Diseases A00-B99

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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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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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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

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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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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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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.

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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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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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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

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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 Chapters

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Chapter 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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Chapter 3

Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism D50-D89

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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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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

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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

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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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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

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Chapter 4

Endocrine, Nutritional and Metabolic Diseases (E00-E89)

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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

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Chapter 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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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

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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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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

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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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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

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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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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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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

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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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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

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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

(29)

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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

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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

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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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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.

(33)

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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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

(35)

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

(37)

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

76

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Chapter 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

(41)

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

(43)

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

(45)

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 89

Chapter 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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AAPC Chapters

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).

(47)

Chapter 15 Guidelines

I

.C.15.s. COVID-19 infection in pregnancy, childbirth, and the puerperium

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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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.

(49)

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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Excludes 1

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

(50)

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

(51)

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).

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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

(53)

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

th

character (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

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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

(55)

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

(56)

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

th

character

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 112

(57)

Chapter 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

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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

(59)

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 2

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Chapter 21

Factors Influencing Health Status and Contact with Health Services Z00-Z99

(61)

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.

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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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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

(63)

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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Figure

Updating...

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