星空入口

鈥淎ccording to the Centers for Disease Control and Prevention [CDC], sickle cell disorder is a common inherited blood disorder in the United States, affecting an estimated 70,000 to 100,000 Americans,鈥� notes Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. So, it should come as no surprise that 鈥渢here are multiple new codes in this family [D57], which will allow greater specificity but also require more granular coding in the process,鈥� Moore adds.

The 24 new codes in the group, along with numerous Code Also and Use Additional code instructions, add specificity to parent codes by describing various medical crises that occur when red blood cells stick together and block small blood vessels. As an example, existing code D57.21- (Sickle-cell/ Hb-C disease with crisis), which previously had three code options, has two additional options as of Oct. 1, 2021: D57.213 (Sickle-cell/Hb-C disease with cerebral vascular involvement), which has an instruction to code also, if applicable, cerebral infarction (I63.-), and D57.218 (Sickle-cell/Hb-C disease with crisis with other specified complication), which contains instructions to use an additional code to identify complications, such as cholelithiasis (K80.-) and priapism (N48.32).

New Codes Added to the F10-F19 Group

Many of the changes to the F10-F19 (Mental and behavioral disorders due to psychoactive substance use) group involve 鈥渢he addition of a sixth character to a code previously used to identify when substance use or abuse turns into withdrawal,鈥� explains Moore. The characters are:

• 0 鈥� with withdrawal, uncomplicated
• 1 鈥� with withdrawal delirium
• 2 鈥� with withdrawal with perceptual disturbance
• 9 鈥� with withdrawal, unspecified

鈥淧rimary care physicians are often the first contact for mental health issues, so they will need to be aware of the multiple new codes in this section,鈥� says Moore.

New Additional Code Instruction for Use With Parkinson鈥檚

This small but significant change to ICD-10 asks you to 鈥淯se Additional code to identify dementia with behavioral disturbance (F02.81) and/or dementia without behavioral disturbance (F02.80).鈥� So, 鈥渨hen either of those circumstances applies, primary care providers [PCPs] will need to use an additional code rather than relying on G20 alone,鈥� Moore notes.

New Codes for the K20, K21 Group

Like the F10-F19 codes, the K20 (Esophagitis) and K21 (Gastro-esophageal reflux disease) codes also get additional characters to specify whether the conditions are without bleeding, indicated by fifth digit 0, or with bleeding, indicated by fifth digit 1.

T40 Codes Get Major Makeover

鈥淭he existing T40.4X [Poisoning by, adverse effect of and underdosing of other synthetic narcotics] code family, which only specifies 鈥榮ynthetic narcotics,鈥� has been deleted and will be replaced by three code sets that allow coders to specify fentanyl or fentanyl analogs [T40.41-], tramadol [T40.42-], and 鈥榦ther鈥� synthetic narcotics [T40.49-]. Given the attention being paid to fentanyl these days, this does not seem a surprise,鈥� notes Moore.

Fortunately, ICD-10 has retained the structure of the codes, so you鈥檒l still be able to document whether the poisoning was accidental, intentional self-harm, assault, or undetermined, or whether the patient is suffering from adverse effects or underdosing using sixth characters 1-6, respectively. And you鈥檒l still need to add seventh characters of A, D, or S to indicate the stage of care.

Don鈥檛 Rule Out These New Foreign Body Codes

The expansion of the Z03.82- (Encounter for observation for suspected foreign body ruled out) codes will come as a welcome addition to any primary care coder who is used to dealing with children.

鈥淜ids are known for putting objects into their nose, ears and other places, so new codes for ruling out suspected ingestion [Z03.821], aspiration [Z03.822], or insertion [Z03.823] of a foreign body will probably get a lot of use!鈥� notes Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana.

New Chapter Gets Formal Introduction

Lastly, you鈥檒l find a new chapter in your 2021 ICD-10 manual, though you have already seen it and the codes it contains. 鈥淐hapter 22 and its two codes were actually added to ICD-10-CM on an emergency basis on April 1 this year. Oct. 1, 2020, marks the first time they鈥檒l be reflected in the annual update. If coders aren鈥檛 already aware of these codes, they should be,鈥� Moore adds.

In the chapter you will see two codes for 鈥渘ew diseases of uncertain etiology or emergency use鈥� as the introduction to the U00-U49 explains. The first is U07.0 (Vaping-related disorder), which comes with the instruction 鈥渢o code for additional manifestations such as abdominal pain [R10.84], acute respiratory distress syndrome [J80], diarrhea [R19.7], drug-induced interstitial lung disorder [J70.4], lipoid pneumonia [J69.1], and weight loss [R63.4],鈥� notes Holle.

The other is U07.1 (COVID-19), also introduced in April 2020. Just remember to observe the note telling you to use an additional code 鈥渢o identify pneumonia or other manifestations鈥� and not to code coronavirus infection, unspecified (B34.2), coronavirus as the cause of diseases classified elsewhere (B97.2-), and pneumonia due to SARS-associated coronavirus (J12.81) with U07.1, as they are now Excludes1 codes for U07.1.

For the full 2021 ICD-10 addenda, go to: and download the zip file labeled 2021 Addendum.