GET READY FOR ICD-10 CM 2021 CHANGES – PART 1

It’s now time to get prepared for the ICD10-CM changes 2021 which goes into effect October 1, 2020. The Centers for Medicare & Medicaid Services (CMS) released on July 1 the ICD-10-CM code descriptions, tables and index, and addendum for fiscal year 2021. There are 490 additions, 58 deletions, and 47 revisions — increasing the code set from 72,184 to 72,616 diagnoses. ICD-10-CM 2021 goes into effect Oct. 1, 2020.

Certain infectious and parasitic diseases: (A00-B99)

Other tick-borne viral encephalitis A84.8 – Deleted code

Code A84.8 denotes other tick-borne viral encephalitis which incorporates two diseases Louping ill and Powassan virus disease in its code description.

Per 2021 code changes, code A84.8 is deleted and two new codes are added to represent the two conditions separately as below:

New codes:

A84.81 Powassan virus disease

A84.89 Other tick-borne viral encephalitis

Louping ill

Babesiosis B60.0 – Deleted code

Babesiosis is a malaria-like parasitic disease caused by the parasite Babesia. Currently you have only one code B60.0 to denote the condition Babesiosis.

Per 2021 code changes, code B60.0 is deleted and five new codes are added to represent the different species causing babesiosis.

New codes:

B60.00 Babesiosis, unspecified

B60.01 Babesiosis due to Babesia microti

B60.02 Babesiosis due to Babesia duncani

B60.03 Babesiosis due to Babesia divergens

B60.09 Other babesiosis

Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89):

Other autoimmune haemolytic anemia D59.1 – Deleted code

Code D59.1 is deleted and five new codes are added to denote the type of haemolytic anemia as warm type, cold type, mixed type and other.

New codes:

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

Eosinophilia D72.1 – Deleted code

Eosinophilia refers to a condition of having an increased numbers of eosinophil in the peripheral blood. Currently you have only one code D72.1 to represent the condition “eosinophilia”. However there are several factors that trigger the eosinophilic condition which contributes to the formation of several new codes in 2021.

New codes:

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

D72.18 Eosinophilia in diseases classified elsewhere

D72.19 Other eosinophilia

Other immunodeficiencies D84.8 – Deleted code

Code D84.8 is deleted and new codes are added to identify the cause of the immunodeficiency:

D84.81 Immunodeficiency due to conditions classified elsewhere

D84.821 Immunodeficiency due to drugs

D84.822 Immunodeficiency due to external causes

D84.89 Other immunodeficiencies

Additional new codes for Sickle- cell disorders:

There are several new codes introduced in category D57 to identify the cerebral vascular complications and other complications. Currently you can see the codes for sickle cell disorders with acute chest syndrome, splenic sequestration and unspecified. In 2021 code changes, you can see additional new codes to represent the cerebral vascular involvement and other complications.

New codes:

D57.03 Hb-SS disease with cerebral vascular involvement

D57.09 Hb-SS disease with crisis with other specified complication

D57.213 Sickle-cell/Hb-C disease with cerebral vascular involvement

D57.218 Sickle-cell/Hb-C disease with crisis with other specified complication

D57.413 Sickle-cell thalassemia, unspecified, with cerebral vascular involvement

D57.418 Sickle-cell thalassemia, unspecified, with crisis with other specified complication

New codes for Sickle-cell thalassemia beta zero and beta plus type:

There are several new codes added to denote the form of sickle beta thalassemia as sickle beta plus thalassemia (HbS/β+) and sickle beta zero thalassemia (HbS/β0) and the patient’s crisis state with associated complications.

New codes:

Sickle-cell thalassemia beta zero:

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

Sickle-cell thalassemia beta plus:

D57.44 Sickle-cell thalassemia beta plus without crisis

D57451 Sickle-cell thalassemia beta plus with acute chest syndrome

D57452 Sickle-cell thalassemia beta plus with splenic sequestration

D57453 Sickle-cell thalassemia beta plus with cerebral vascular involvement

D57458 Sickle-cell thalassemia beta plus with crisis with other specified complication

D57459 Sickle-cell thalassemia beta plus with crisis, unspecified

D57813 other sickle-cell disorders with cerebral vascular involvement

D57818 other sickle-cell disorders with crisis with other specified complication

New subcategory for “Cytokine release syndrome”: D89.83

When we talk about this syndrome, it is also essential to know about the novel immunocellular therapy treatment “KYMRIAH (tisagenlecleucel)” which is the only approved therapy available in the market currently. Kymriah (tisagenlecleucel) is an immunotherapy medicine used to treat a certain type of acute lymphoblastic leukemia in people who are up to 25 years old. It is also used to treat certain adult patients with large B-cell lymphoma.

A serious side effect of Kymriah is called cytokine release syndrome, which causes fever, chills, trouble breathing, vomiting, and other symptoms. As there is no unique code to represent this syndrome in 2020, coders reported the adverse effect of antineoplastic medications and all of the associated symptoms. However it does not seem to accurately reflect the true severity of many of these patients. Therefore several proposals were made to the ICD-10 committee to bring new codes for Cytokine release syndrome.

A new subcategory D89.83 Cytokine release syndrome is added with instructional notes “code first” and “use additional notes”. Subcategory D89.83 is further expanded to six new codes to report the grade of the syndrome.

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

D89.839 Cytokine release syndrome, grade unspecified

Endocrine, nutritional and metabolic diseases (E00-E89)

Codes E70.8 and E74.8 denoting the disorders of amino acid and carbohydrate metabolism respectively are deleted and new codes are formed to further specify the deficiency.

Other disorders of aromatic amino-acid metabolism E70.8 – Deleted code

New codes:

E70.81 Aromatic L-amino acid decarboxylase deficiency

E70.89 other disorders of aromatic amino-acid metabolism

Other specified disorders of carbohydrate metabolism E74.8 – Deleted code

New codes:

E74.810 Glucose transporter protein type 1 deficiency

E74.818 other disorders of glucose transport

E74.819 Disorders of glucose transport, unspecified

E74.89 Other specified disorders of carbohydrate metabolism

Mental, Behavioural and Neurodevelopmental disorders (F01-F99)

Several new codes that describe the “withdrawal” from substances including alcohol, opioids, cannabis, sedatives, cocaine, other stimulants, other psychoactive substances are introduced in 2021. You can also check how the codes are categorized and the coding hierarchy of use, abuse and dependence in the below link:

https://medscorecoding.com/blogs/f/coding-hierarchy-of-use-abuse-and-dependence

New codes:

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

F11.13 Opioid abuse with withdrawal

F12.13 Cannabis abuse with withdrawal

F13.13 Sedative, hypnotic or anxiolytic abuse with withdrawal

F13.130 Sedative, hypnotic or anxiolytic abuse 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

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

Diseases of the nervous system (G00-G99):

There are five codes deleted and 24 new codes added in the nervous system.

Early-onset cerebellar ataxia: G11.1 – Deleted code

Code G11.1 is deleted and expanded into three new codes as below:

New codes:

G11.10 Early-onset cerebellar ataxia, unspecified

G11.11 Friedreich ataxia

G11.19 Other early-onset cerebellar ataxia

Congenital myopathy: G71.2 – Deleted code

Code G71.2 is deleted and expanded to five new codes as below:

New codes:

G71.20 Congenital myopathy, unspecifed

G71.21 Nemaline myopathy

G71.220 X-linked myotubular myopathy

G71.228 Other centronuclear myopathy

G71.29 Other congenital myopathy

Cerebrospinal fluid leak: G96.0 – Deleted code

Code G96.0 is deleted and expanded into the below five new codes:

New codes:

G96.00 Cerebrospinal fluid leak, unspecified

G96.01 Cranial cerebrospinal fluid leak, spontaneous

G96.02 Spinal cerebrospinal fluid leak, spontaneous

G96.08 Other cranial cerebrospinal fluid leak

G96.09 Other spinal cerebrospinal fluid leak

Other disorders of meninges, not elsewhere classified: G96.19 – Deleted code

Code G96.19 is deleted and expanded into two new codes:

New codes:

G96.191 Perineural cyst

G96.198 Other disorders of meninges, not elsewhere classified

Other specified disorders of central nervous system: G96.8 – Deleted code

Code G96.8 is deleted and expanded into new codes to specifically denote the intracranial hypotension. Currently, intracranial hypotension is captured in ICD-10-CM using a number of codes that are not specific, such as those related to CSF leaks, and headaches. But now, you have a separate new code to report intracranial hypotension.

New codes:

G96.810 Intracranial hypotension, unspecified

G96.811 Intracranial hypotension, spontaneous

G96.819 Other intracranial hypotension

G96.89 Other specified disorders of central nervous system

G97.83 Intracranial hypotension following lumbar cerebrospinal fluid shunting

G97.84 Intracranial hypotension following other procedure

New code for CDKL5:

One new code is added under G40 Epilepsy and recurrent seizuresto report CDKL5. Use additional code instructions are also provided to identify any associated manifestations such as cortical blindness or developmental delay.

G40.42 Cyclin-Dependent Kinase-Like 5 Deficiency Disorder [CDKL5

New codes for Dravet syndrome:

Dravet syndrome, previously known as severe myoclonic epilepsy in infancy (SMEI), is a genetic encephalopathy that presents in the first year of life. Currently there is no unique code for Dravet syndrome. It is currently being reported by code G40.8 Other epilepsy and recurrent seizures,which is a very broad description that does not encompass all of the symptoms of a patient with Dravet syndrome. Though it’s a rare disease, proposals were made by Dravet syndrome foundation to create a unique code which is required to track how many people have the disease and where they are located. With the proposals made, the following new codes were created for Dravet syndrome.

G40.833 Dravet syndrome, intractable, with status epilepticus

G40.834 Dravet syndrome, intractable, without status epilepticus

Stay connected for PART 2…..

Happy learning! Happy coding!

Resources:

cms.gov/medicare/acute-inpatient-pps/fy-2021-ipps-proposed-rule-home-page

https://pbn.decisionhealth.com/Blogs/Detail.aspx?id=200896

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