ED Coding and Reimbursement Alert

Plus: You’ll also find new codes for headaches.

When patients arrive at the ED with symptoms of withdrawal, physicians must determine what substances the patients were using and whether their conditions are life threatening. And effective October 1, 2020, you’ll have more specific codes for reporting these services.

Background: On July 1, CMS released the new ICD-10-CM codes and descriptors, with a total of 490 additions, 58 code deletions, and 47 revisions that will go into effect on October 1. Although there aren’t hundreds of code changes impacting emergency departments this year, the ones that are debuting will allow you to get much more specific on your claims.

Look for Updates to the F10-F19 Range

Many of the changes to the 2021 code set involve additions to the F10 to F19 range, which involve substance use and/or abuse with withdrawal. These codes will offer new specificity to EDs when patients are withdrawing from such substances as alcohol, cocaine, stimulants, and more.

For example, the new section F10.13 (Alcohol abuse, with withdrawal) has the following four codes under it:

• 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)

These codes differ from the existing series, F10.23 (Alcohol dependence with withdrawal), by specifically denoting when abuse is present versus dependence.

You’ll also find new codes for alcohol use with withdrawal (F10.93-F10.939), opioid use with withdrawal (F11.13), cannabis use with withdrawal (F12.13), cocaine abuse with withdrawal (F14.13), and more codes for such substances as stimulants and psychoactive substances.

You’ll also find dozens of new codes for poisoning, such as the T40.49 (Poisoning by, adverse effect of and underdosing of other synthetic narcotics) series, which describes a variety of conditions that can result from overuse of synthetic narcotics, from self harm (T40.492) to assault (T40.493) and beyond.

Bleeding Now Specified for These Conditions

Some of the changes to the 2021 code set are the result of stakeholder requests made at last year’s ICD-10-CM Coordination and Maintenance Committee (ICMC) Meeting, during which the ICMC’s Shannon McConnell-Lamptey offered some insight into the following new code additions:

• K20.80 (Other esophagitis without bleeding)
• K20.81 (… with bleeding)
• K21.00 (Gastro-esophageal reflux disease with esophagitis, without bleeding).
• K21.01 (…with bleeding)

The new codes rectify the problem of ICD-10 not including combination codes that reflect bleeding with these conditions. “In ICD-9-CM, there was a unique code for esophageal hemorrhage,” she said when requesting these new code additions. Now the ICD-10 code listings will follow that lead, creating additional specificity for providers.

Look for Headache Code Expansion

Most ED coders have the headache code (R51) committed to memory, but in a major adjustment to the code set, you’ll now find that R51 has become the parent code, and two additional codes will follow it:

• R51.0 (Headache with orthostatic component, not elsewhere classified)
• R51.9 (Headache, unspecified)

An orthostatic headache is one in which a patient has a headache while standing upright, but the headache goes away when the patient lies down or is otherwise horizontal. In the future, if the headache isn’t specified, you’ll use R51.9.

Other new codes now official: As part of the update to the ICD-10 codes, you’ll also find both U07.0 (Vaping-related disorder) and U07.1 (COVID-19) on the list of new diagnoses. These both took effect earlier in 2020, but the new code set indicates that they will be listed in ICD-10-CM code books for the coming year.

Resource: To read the entire new ICD-10 code set, visit the CMS website at https://www.cms.gov/medicare/icd-10/2021-icd-10-cm.