The new codes for Covid-19 — including three new Z codes, one new J code and one new M code — were proposed for a January 2021 implementation during a Sept. 9 virtual ICD-10 Coordination and Maintenance Committee Meeting. This was one of more than 30 proposals discussed during the meeting.
Three of the suggested codes were proposed to improve specificity when capturing COVID-19 screening, exposure and personal history. These new codes are:
- For screening — Z11.52 (Encounter for screening for COVID-19)
- For exposure — Z20.822 (Contact with and (suspected) exposure to COVID-19) which includes the inclusion term “Contact with and (suspected) exposure to SARS-CoV-2”
- For personal history — Z86.16 (Personal history of COVID-19)
“COVID-19 caused by the virus SARS-CoV-2 is a significant public health issue, and multiple requests for related codes have been received,”
– the proposal states.
The addition of an instruction note under “infections” in the index is also proposed to include, “Contact with and (suspected) exposure to SARS-CoV-2”
A new J code was proposed that would allow coders to report COVID-caused pneumonia with one code instead of two. This new code would be:
J12.82 (Pneumonia due to coronavirus disease 2019), which includes the inclusion terms, “Pneumonia due to COVID-19” and “Pneumonia due to 2019 novel coronavirus (SARS-CoV-2).”
The committee proposed the new combined coronavirus pneumonia code to improve coding specificity for pneumonia due to coronavirus disease.
Existing coding guidance for COVID-related pneumonia instructs coders to report two diagnosis codes for the condition: U07.1 (COVID-19) and J20.89 (Other viral pneumonia).
However, the committee said it needed to draft the combined code J12.82 after an investigation of CMS data showed that using two codes “may substantially under-record pneumonia-related COVID-19, with more than 50% of recorded COVID-19 cases having had ‘other viral pneumonia’ recorded.”
Multisystem Inflammatory Syndrome
A new M code would report multisystem inflammatory syndrome that has been associated with COVID-19, particularly in children. This new code would be: M35.81 (Multisystem inflammatory syndrome).
The code, proposed by researchers at the Centers for Disease Control and Prevention (CDC), would apply in cases that involve “fever, laboratory markers of inflammation, severe illness requiring hospitalization with at least two organ systems involved and laboratory evidence of SARS-CoV-2 infection (by RT-PCR, serology or antigen test) or a history of known exposure to a suspected or confirmed COVID-19 case within four weeks prior to symptom onset,” according to the current CDC definition.
Other Notable Proposals
F32.A (Depression, unspecified) was proposed as a new code by the Division of Health Care Statistics (DHCS) of the National Center for Health Statistics (NCHS) to capture Depression NOS. “ICD-9-CM had a unique code for unspecified depression (311). Though this is an unspecified term, it is frequently seen in medical records and needed to allow for data comparability across years,” they state in the proposal. They go on to state that in 2014 and 2015, the ICD-9-CM code 311 was found on 662 records, or 1.5% of the total records, from the NCHS’ National Ambulatory Medical Care Survey (NAMCS). The current default for depression NOS in ICD-10-CM is F32.9 (Major depressive disorder, single episode, unspecified). However, the proposal states that this has been determined by subject matter experts to be clinically incorrect and will incorrectly increase the incidence of major depression in statistical data.
Moisture associated skin damage. A proposal from the Wound Ostomy and Continence Nurses Society that was originally presented at the March 2020 C&M meeting was updated to include two new subcategories and eight new codes to capture Moisture associated skin damage. The proposed new subcategories would be L24.A (Irritant contact dermatitis due to friction or contact with body fluids) and L24.B (Irritant contact dermatitis related to stoma or fistula). The new proposed codes would include L24.A0 (Irritant contact dermatitis due to friction or contact with body fluids, unspecified), L24.A1 (Irritant contact dermatitis due to saliva), L24.B0 (Irritant contact dermatitis related to unspecified stoma or fistula) and L24.B1 (Irritant contact dermatitis related to digestive stoma or fistula).
The following were proposed for implementation.
Under B97.4 (Respiratory syncytial virus as the cause of diseases classified elsewhere) — Delete the “Excludes 2” note and add an “Excludes 1” note for “acute bronchiolitis due to respiratory syncytial virus (RSV) (J21.0), acute bronchitis due to respiratory syncytial virus (RSV) (J20.5) and respiratory syncytial virus (RSV) pneumonia (J12.1).”
Under Ischemic heart diseases (I20-I25) Ñ Delete the “use additional code to identify presence of hypertension (I10-I16)” note and add a “Code also to identify presence of hypertension (I10-I16)” note instead.
From Home Health Line—
Comments on this proposal are due by Oct. 9 and should be sent to: nchsicd10CM@cdc.gov
To view the proposals, visit: https://bit.ly/3bIlDPV