Pathology/Lab Coding Alert

Kick off new diagnoses starting Oct. 1.

Your lab needs to review the broad sweep of ICD-10-CM changes every year, and now’s the time. Starting Oct. 1, you’re facing 490 code additions, 58 deletions, and 47 revisions to the code set.

Significance: Diagnostic testing impacts medical diagnosis in wide-ranging disease processes. Clinical labs must report current ICD-10-CM codes narrated by the ordering physician, and pathologists often assign diagnosis codes based on findings from cytology or histopathology exams. Add to that the fact that Medicare audits and quality reporting programs rely on proper diagnosis coding to demonstrate medical necessity for ordered tests, and you can see why ICD-10-CM updates are significant for your lab.

“Keeping abreast of [ICD-10-CM] changes can be important to the bottom line, and ensures that the most accurate information is being passed on to decision-makers of all types,” says Melanie Witt, RN, MA, an independent coding consultant from Guadalupita, New Mexico.

Read on for a quick overview of diagnosis code changes that could impact your lab.

Greet Infectious Agent Changes

Microbiology labs should be aware of expanded coding for certain tick-borne infections. ICD-10-CM 2021 converts A84.8 (Other tick-borne viral encephalitis) to a parent code and adds the following specific five-character codes:

• A84.81 (Powassan virus disease)
• A84.89 (Other tick-borne viral encephalitis)

Similarly, B60.0 (Babesiosis) becomes a parent code to the following 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)

COVID-19: You’ll find U07.1 (COVID-19) in the 2021 ICD-10-CM code book, although the code has been official since April due to the pressing need to monitor the spread of the pandemic.

“The new code, U07.1, was initially assigned by the World Health Organization. Usually it requires at least a one-year process to get a new code adopted, but this went through with exceptional speed,” said Betty Ann Price, BSN, RN, president and founder of Professional Reimbursement and Coding Strategies, and AHIMA-approved ICD-10-CM trainer.

The early adoption of U07.1 was necessary, to “fulfill the imperative need to track the diagnosis of this condition as well as its subsequent treatment,” explains Gregory Przybylski, MD, at New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey.

Review Blood and Immune Disorder Updates

ICD-10-CM 2021 provides many code revisions and additions in Chapter 3 relating to blood and immune-system conditions. You should be familiar with the following changes:

• Expand D57 (Sickle-cell disorders) with 26 new and revised codes that add specificity. For instance, 14 new codes in the range D57.42 to D57.45- distinguish forms of sickle-cell thalassemia beta, including specific manifestations such as cerebral vascular involvement or acute chest syndrome.
• Add five specific D59.1- (Other autoimmune hemolytic anemias) codes.
• Convert D72.1 (Eosinophilia) to a parent code for nine new codes distinguishing different forms of the condition, such as D72.111 (Lymphocytic Variant Hypereosinophilic Syndrome [LHES]) and D72.12 (Drug rash with eosinophilia and systemic symptoms syndrome).
• You’ll find related changes in Chapter 10 for pulmonary eosinophilia with the addition of five new codes J82.8- (Pulmonary eosinophilia, not elsewhere classified) for conditions such as chronic eosinophilic pneumonia or eosinophilic asthma.
• Convert D84.8 (Other specified immunodeficiencies) to a parent code for five new, more specific codes.
• Add six new D89.83- codes for cytokine release syndrome grades.

Learn New Drug-Use Diagnoses

Clinicians ordering drug testing from your lab may use new codes from the 2021 ICD-10-CM update that you should be familiar with.

Expect a makeover of codes for poisoning with synthetic narcotics. The updated code set deletes 24 codes under T40.4X- (Poisoning by, adverse effect of and underdosing of other synthetic narcotics) and adds specificity with three new code families:

• T40.41- (Poisoning by, adverse effect of and underdosing of fentanyl or fentanyl analogs)
• T40.42- (Poisoning by, adverse effect of and underdosing of tramadol)
• T40.49- (Poisoning by, adverse effect of and underdosing of other synthetic narcotics)

Each of the preceding parent codes has child codes with a sixth character to indicate, 1 (poisoning, accidental), 2 (poisoning, self-harm), 3 (poisoning, assault), 4 (poisoning, undetermined), 5 (adverse effect), or 6 (underdosing). The child codes also include a seventh character (A, D, or S) to indicate initial, subsequent, or sequela.

Chapter 5 provides many new codes in ICD-10-CM 2021 for specific substance use and abuse, such as the following:

• F10.13- (Alcohol abuse, with withdrawal)
• F10.93- (Alcohol use, unspecified with withdrawal)
• F11.13 (Opioid abuse with withdrawal)
• F12.13 (Cannabis abuse with withdrawal)
• F13.13- (Sedative, hypnotic or anxiolytic abuse with withdrawal)
• 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)

Many of the preceding codes encompass a sixth character: 0 (uncomplicated), 1 (delirium), 2 (with perceptual disturbance), or 9 (unspecified).

View Conditions Related to Molecular Tests

The 2021 ICD-10-CM update includes some new codes for conditions with a genetic component that your lab might encounter for molecular pathology procedures. Get familiar with the following diagnosis code additions:

• Expand G11.1- (Early-onset cerebellar ataxia) to distinguish Friedreich ataxia, other, or unspecified. Labs may perform tests such as 81284-81289 (FXN (frataxin) (eg, Friedreich ataxia) gene analysis …) related to these conditions.
• Add G40.42 (Cyclin-Dependent Kinase-Like 5 Deficiency Disorder). Relevant lab testing might include 81405 (…CDKL5 (cyclin-dependent kinase-like 5) (eg, early infantile epileptic encephalopathy), duplication/deletion analysis…).
• Expand G71.2- (Congenital myopathies) to distinguish nemaline myopathy, centronuclear myopathy, X-linked myopathy, other, or unspecified myopathies. Lab testing for these conditions might include 81400 (… NEB (nebulin) (eg, nemaline myopathy 2), exon 55 deletion variant…), 81408 (…NEB (nebulin) (eg, nemaline myopathy 2), full gene sequence…), 81405 (… MTM1 (myotubularin 1) (eg, X-linked centronuclear myopathy), duplication/deletion analysis…), or 81406 (… MTM1 (myotubularin 1) (eg, X-linked centronuclear myopathy), full gene sequence…).

Consider Changes Relevant to Anatomic Pathology

Pathologists should be aware of diagnosis code changes that could impact how they report findings from surgical-specimen exams.

For instance, ICD-10-CM 2021 provides new codes for osteoporosis-related pathological fracture of “other site,” adding to existing site-specific codes:

• New parent code M80.0A- (Age-related osteoporosis with current pathological fracture, other site)
• New parent code M80.8A- (Other osteoporosis with current pathological fracture, other site)

Each of the preceding parent codes have child codes with a sixth character placeholder X, and a seventh character, A, D, G, K, P, or S indicating the encounter, respectively: initial, subsequent with routine healing, subsequent with delayed healing, subsequent with nonunion, subsequent with malunion, or sequela.

Pathologists should also be aware of the new code family N61.2- (Granulomatous mastitis) that you should report to the fifth character 0 (unspecified breast), 1 (right breast), 2 (left breast), or 3 (bilateral breast).

Granulomatous mastitis is a “rare, chronic, inflammatory condition of the breast,” according to the ICD-10-CM proposal for these codes. The condition can clinically mimic carcinoma, so pathologists may receive breast tissue specimens with no signs of malignancy that display findings such as micro-abscess, suppuration, and granulomas. The findings may involve additional testing such as microbiology or molecular tests for mycobacterium infection to rule out tuberculosis. Pathologists may need to turn to the new codes for diagnosis in these cases.

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