HAP Radiology Billing and Coding Blog

ICD-10 Coding Changes For 2021 That Will Impact Radiologists

Posted: By Erin Stephens on November 13, 2020

ICD-10 Coding Changes For 2021 That Will Impact Radiologists1There are 490 new ICD-10-CM[i] codes that became effective on October 1, 2020, all of which are replacing existing codes. An additional 47 codes have been revised and 58 were deleted. Two new codes, U07.1 for COVID-19 and U07.0 for vaping-related disorders, took effect on April 1, 2020. They are contained in a new section of the guidelines, Chapter 22 “Codes for Special Purposes (U00 – U85)”.

Reporting COVID-19

The new code U07.1 for COVID-19 is to be used only to code a confirmed diagnosis of COVID-19 as documented by the provider, or with documentation of a positive COVID-19 test result, whether the patient is symptomatic or asymptomatic. The type of test performed does not need to be documented. U07.1 should not be used if the provider documents “suspected,” “possible,” or “inconclusive,” but instead the signs and symptoms reported should be coded. When COVID-19 is the principal diagnosis, it should be sequenced first except when other guidelines (such as obstetrics, sepsis, or transplant complications) require that those guidelines be listed first.

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When the reason for the encounter or admission is a respiratory or non-respiratory manifestation of COVID-19, U07.1 should be the principal diagnosis with the respiratory manifestation(s) listed additionally. For example, a patient with pneumonia due to COVID-19 would have U07.1 listed first, followed by J12.89 Other viral pneumonia. A patient with viral enteritis due to COVID-19 would be reported with U07.1 followed by the appropriate viral enteritis code.

 

The code Z20.828 Contact with and (suspected) exposure to other viral communicable diseases would be used for an asymptomatic patient who experienced actual or suspected exposure to COVID-19.   When other signs or symptoms are present, they are listed first with Z20.828 listed additionally. Z20.828 would be the primary diagnosis for symptomatic individuals with actual or suspected exposure to COVID-19 where the infection has been ruled out, or the test results are inconclusive or unknown. Since the use of screening codes is generally not appropriate during the current pandemic, encounters for COVID-19 testing, including preoperative testing, should be coded as described here for possible exposure.

 

Two codes are appropriately used when seeing patients who have recovered from COVID-19:

  • 19 Personal history of other infectious and parasitic diseases, and
  • Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm.

These rules change somewhat under certain circumstances. For example, radiologists performing obstetrical ultrasound exams should be aware of the proper coding for COVID-19 in pregnant patients.

  • When COVID-19 is the reason for the admission or encounter, then a code from O98.5- Other viral diseases complicating pregnancy, childbirth and the puerperium should be sequenced as the principal diagnosis, followed by U07.1 and the appropriate codes for any associated manifestations.

  • When the admission or encounter is not related to COVID-19 but the patient tests positive during the admission or encounter, then the reason for the admission or encounter is sequenced first, followed by O98.5- and U07.1 and any other appropriate codes for associated manifestations.

The type of transmission is to be identified in newborns testing positive for COVID-19. When the infection was contracted in utero or during the birth process, code P35.8 Other congenital viral diseases is used along with U07.1. When the type of transmission is not known, then U07.1 is used primarily along with the associated manifestations being reported in addition.

New and Revised Coding

The vast majority of new codes (253) are concerned with external causes of morbidity, poisoning, or injury. Of this group, the codes most relevant to radiologists will be related to thoracic injuries when evaluating x-ray and CT images.

 

Abrasion of front wall of thorax

Bilateral

Middle

Initial encounter

S20.313A

S20.314A

Subsequent encounter

S20.313D

S20.314D

Sequela

S20.313S

S20.314S

Blister (nonthermal) of front wall of thorax

Bilateral

Middle

Initial encounter

S20.323A

S20.324A

Subsequent encounter

S20.323D

S20.324D

Sequela

S20.323S

S20.324S

External constriction of front wall of thorax

Bilateral

Middle

Initial encounter

S20.343A

S20.344A

Subsequent encounter

S20.343D

S20.344D

Sequela

S20.343S

S20.344S

Superficial foreign body of front wall of thorax

Bilateral

Middle

Initial encounter

S20.353A

S20.354A

Subsequent encounter

S20.353D

S20.354D

Sequela

S20.353S

S20.354S

Insect bite (nonvenomous) of front wall of thorax

Bilateral

Middle

Initial encounter

S20.363A

S20.364A

Subsequent encounter

S20.363D

S20.364D

Sequela

S20.363S

S20.364S

Other superficial bite of front wall of thorax

Bilateral

Middle

Initial encounter

S20.373A

S20.374A

Subsequent encounter

S20.373D

S20.374D

Sequela

S20.373S

S20.374S

 

There are 57 new codes related to diseases of the musculoskeletal system and connective tissue that will be encountered by radiologists evaluating CT, MRI and x-ray exams. They fall into the following categories:

  • Rheumatoid arthritis
  • Osteoarthritis
  • Arthritis and arthropathy of the temporomandibular joint
  • Juvenile osteochondrosis

Included in this section are 12 new codes related to osteoporosis that will be likely be encountered:

Osteoporosis with current pathological fracture, other site

Age-related

Other

Initial encounter for fracture

M80.0AXA

M80.8AXA

Subsequent encounter for fracture

 

 

With routine healing

M80.0AXD

M80.8AXD

With delayed healing

M80.0AXG

M80.8AXG

With nonunion

M80.0AXK

M80.8AXK

With malunion

M80.0AXP

M80.8AXP

Sequela

M80.0AXS

M80.8AXS

 

New codes in other areas can be summarized as follows:

  • Sickle-cell diseases
  • Ataxia
  • CSF leaks
  • Intracranial hypotension
  • Eosinophilic pneumonia
  • Interstitial pulmonary diseases
  • Esophagitis
  • Gastro-esophageal reflux disease
  • Functional intestinal disorders
  • Hepatic fibrosis
  • C3 glomerulonephritis
  • Chronic kidney disease
  • Granulomatous mastitis
  • Neonatal cerebral infarction
  • Headaches
  • Elevation of liver transaminase and LDH levels

Revised codes (39) are found primarily in connection with factors influencing health status. Of those, only a few will be relevant to radiologists evaluating suspected foreign bodies.

 

Encounter for observation for suspected foreign body ruled out

 

Nonspecific

Z03.82

Ingested

Z03.821

Aspirated (inhaled)

Z03.822

Inserted (injected)

Z03.823


Action Steps

We have provided a brief overview of the many changes to ICD-10 coding that are effective now, as of October 1, 2020. Radiology practices should carefully review in detail those codes that will affect their practice and make appropriate adjustments to their templates and EHR systems. Particular attention should be given to codes that have been deleted, as their use could cause claims to be rejected by payers. The reporting guidelines have not changed very much this year, but nonetheless they should also be reviewed to determine where the practice’s documentation might need to be modified.

Contact HAP

The annual revision of the CPT®[ii] (Current Procedural Terminology) code set that takes effect at the beginning of each year is generally of greater impact than the ICD coding changes. Watch for our full coverage of the important coding changes for radiology. Subscribe to this blog to keep abreast of these issues and other news that affects your practice.

 

[i] ICD stands for International Classification of Diseases, the system owned and copyrighted by the World Health Organization that is used to report diagnoses when submitting claims for reimbursement of physician services, among many other purposes. ICD-10 is the 10th edition of this coding system.  CM stands for the Clinical Modification of the classification system.

[ii] CPT® is a registered trademark of the American Medical Association.

 

Erin Stephens, CPC, CIRCC  is the Sr. Client Manager, Education at Healthcare Administrative Partners. 

 

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