A Brief summary on 2021 Coding Guidelines

In this article, we will discuss about the new guidelines for each chapter briefly.

Certain Infectious and Parasitic Diseases (A00-B99), U07.1

A new subsection stating the guidelines for coronavirus infection is introduced in 2021 official coding guidelines of Infectious and parasitic disease chapter. For a detailed review on these guidelines refer the below link:


Endocrine, Nutritional, and Metabolic Diseases (E00-E89)

There is a new guideline added to report the use of “injectable non-insulin drugs”. Many medications for type 2 diabetes, besides insulin, are available in the form of injections. The new guidelines direct the coders to use the appropriate Z codes when a diabetic patient uses both the insulin/oral hypoglycemic drugs and an injectable non-insulin anti-diabetic drug.

As per the new guidelines 2021, when a patient is treated with both insulin and an injectable non-insulin antidiabetic drug, then you need to assign the codes as below:

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 the codes as below:

Z79.84, Long-term (current) use of oral hypoglycemic drugs, and

Z79.899, Other long-term (current) drug therapy

Diseases of the Respiratory System (J00-J99), U07.0

Vaping-related disorders:

In response to recent occurrences of vaping related disorders, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) implemented a new diagnosis code, U07.0, Vaping-related disorder, effective April 1, 2020. The new guidelines to report vaping related disorder is introduced in the 2021 official coding guidelines.

  • Assign code U07.0, Vaping-related disorder, as the principal diagnosis when patients present with conditions related to vaping. Additional codes for other manifestations, such as acute respiratory failure (subcategory J96.0-) or pneumonitis (code J68.0) can also be coded.
  • For lung injury due to vaping, assign only code U07.0
  • 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.

Pregnancy, Childbirth, and the Puerperium (O00-O9A):

Encounters related to COVID-19:

During pregnancy, childbirth or the puerperium, if the reason for admission/encounter is COVID-19, then you need to assign the codes as below:

Primary diagnosis: O98.5-, other viral diseases complicating pregnancy, childbirth and the puerperium

Secondary diagnosis: U07.1, COVID-19

Additional diagnoses: codes for any associated manifestations.

It is important to note that codes from chapter 15 always take sequencing priority.

Encounters unrelated to COVID-19:.

If the reason for admission/encounter is unrelated to COVID-19 but the patient tests positive for COVID-19 during the admission/encounter, then you need to assign the below codes:

Primary diagnosis: Appropriate code for the reason for the admission/encounter.

Secondary diagnosis: Codes O98.5 and U07.1

Additional diagnoses: Codes for associated COVID-19 manifestation.

COVID-19 Infection in Newborn:

If a newborn tests positive for COVID-19 and a specific method of transmission such as contracted in utero or birth process, is not documented, then you need to assign the below codes:

Primary diagnosis: U07.1, COVID-19

Secondary diagnosis: Codes for associated manifestations,

If a newborn tests positive for COVID-19 and the provider documents that the newborn contracted the disease in utero or during birth process, then you need to assign the below codes:

Primary diagnosis: P35.8 (other congenital viral diseases)

Secondary diagnosis: U07.1, COVID-19

The guidance also clarifies that Z38 (live born infants according to place of birth and type of delivery) is the principal diagnosis when coding the birth episode in a newborn record.

Observation guidelines:

The new guideline in observation section instructs the coders to use observation code as a secondary diagnosis code along with an example.

As per the guidelines, the observation codes are primarily used as first-listed diagnosis. However it 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).

Happy learning! Happy coding!



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