Feeling energized for the last post in our ICD-10-CM 2020 update blog marathon? Today we’ll wrap up our overview of the main changes in each chapter of the diagnosis code set by covering symptoms, fractures, and more.
Chapter 18: Pick Up on New Code for Pyuria
In Part 1, you already read about R11.15 (Cyclical vomiting syndrome unrelated to migraine) being added to Chapter 18: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99). But you’ll also find new codes in commonly used category R82.- (Other and unspecified abnormal findings in urine):
- R82.81 (Pyuria), which includes sterile pyuria
- R82.89 (Other abnormal findings on cytological and histological examination of urine).
Chapter 19: Update Orbital Fracture, Poisoning, and Heatstroke Coding
A lot of different diagnoses fall under Chapter 19: Injury, poisoning and certain other consequences of external causes (S00-T88), and the new codes cover several different areas.
Orbital fracture: Three new ICD-10-CM fracture subcategories have separate codes for right, left, and unspecified side:
- S02.12- (Fracture of orbital roof)
- S02.83- (Fracture of medial orbital wall)
- S02.84- (Fracture of lateral orbital wall).
S02.85 (Fracture of orbit, unspecified) is reportable at five characters. Be sure to check for note changes that go along with these additions.
Multiple drugs: New subcategory T50.91- (Poisoning by, adverse effect of and underdosing of multiple unspecified drugs, medicaments and biological substances) offers a way to code multiple drug ingestion NOS, but ICD-10-CM additionally instructs to “Code also any specific drugs, medicaments and biological substances.”
Heatstroke: Three new codes expand T67.0 (Heatstroke and sunstroke):
- T67.01 (Heatstroke and sunstroke)
- T67.02 (Exertional heatstroke)
- T67.09 (Other heatstroke and sunstroke).
Chapter 20: Look for New Legal Intervention Codes
Chapter 20: External causes of morbidity (V00-Y99) has more than three pages of additions in the ICD-10-CM 2020 PDF addenda, and the PDF doesn’t even include the seventh character options, which could triple the length. There are two major areas of change.
Unspecified person: Most coders are unlikely to report a code for “unspecified person injured” on an average day, but ICD-10-CM 2020 is prepared in case you need those codes. Under Y35.- (Legal intervention) there will be dozens of new seven-character codes, such as Y35.049A (Legal intervention involving injury by rubber bullet, unspecified person injured, initial encounter).
Conducted energy device: Also under Y35 is new subcategory Y35.83- (Legal intervention involving a conducted energy device). Inclusion notes clarify that the codes apply to “Electroshock device (taser)” and “Stun gun.” You’ll base your code choice on whether the injured party is a law enforcement official, a bystander, a suspect, or an unspecified person, and also whether the encounter is initial, subsequent, or for sequela.
Chapter 21: Exams, Screenings, and Encounters, Oh My!
The last chapter of ICD-10-CM in 2020 is a worthy finale with numerous new codes and note changes to learn. Here are the highlights from Chapter 21: Factors influencing health status and contact with health services (Z00-Z99).
Eye exams: Add Z01.02- (Encounter for examination of eyes and vision following failed vision screen) to your options, with Z01.020 when there are not abnormal findings and Z01.021 when there are abnormal findings.
Tuberculosis: Check out these three codes if you see latent tuberculosis in the documentation:
- Z11.7 (Encounter for testing for latent tuberculosis infection)
- Z22.7 (Latent tuberculosis)
- Z86.15 (Personal history of latent tuberculosis infection).
BMI: In ICD-10-CM 2019, the notes with Z68.- (Body mass index [BMI]) state that you should use BMI pediatric codes for persons 2-20 years of age and BMI adult codes for persons 21 and older. In ICD-10-CM 2020, the age break changes. You’ll use pediatric BMI codes for patients 2-19 and adult BMI codes for patients 20 and older.
Travel: Expect to see new code Z71.84 (Encounter for health counseling related to travel), which covers health risk and safety counseling for travel. You’ll report Z23 separately for immunization.
In-situ neoplasm hx: The list of codes under Z86.00- (Personal history of in-situ neoplasm) is about to get significantly longer. Watch for these additions:
- Z86.002 (Personal history of in-situ neoplasm of other and unspecified genital organ)
- Z86.003 (Personal history of in-situ neoplasm of oral cavity, esophagus and stomach)
- Z86.004 (Personal history of in-situ neoplasm of other and unspecified digestive organs)
- Z86.005 (Personal history of in-situ neoplasm of middle ear and respiratory system)
- Z86.006 (Personal history of melanoma in-situ)
- Z86.007 (Personal history of in-situ neoplasm of skin).
Neurostimulator: Keep new code Z96.82 (Presence of neurostimulator) in mind when the patient has a neurostimulator. Notes indicate the code applies to brain, gastric, peripheral nerve, sacral nerve, spinal cord, or vagus nerve neurostimulators.
What About You?
Did we skip a change that will be important to you? Were you hoping to see a change in ICD-10-CM 2020 that didn’t happen?