It’s that time of year again — while summer temps rise, CMS looks towards fall with the release of the 2021 ICD-10-CM code changes. You’re up to your neck dealing with all things COVID, so you may have missed the release — but don’t let that catch you off guard come October 1st. Collecting every cent is of utmost importance as you rebuild your business, and complete, correct coding is your foundation. 2021 ICD-10 Code Updates.
ICD-10-CM code changes for 2021 include almost 600 code changes (490 new, 58 deleted, and 47 revised codes) – and you need to hone in on the ones you need to educate staff on, watch out for in your EMR, and monitor for payment processing. Remember: ICD-10-CM code changes for 2021 are effective Oct. 1, 2020.
Use this quick guide to spot the 2021 ICD-10 code updates that affect you and your practice’s compliance and cashflow.
21 New Codes Substance Abuse Codes
In 2021, you’ll have 21 new codes to choose from to more accurately describe withdrawal from use and abuse of substances like alcohol, cocaine, and opiates. For example:
- 130 − Alcohol abuse with withdrawal, uncomplicated
- 131 − Alcohol abuse with withdrawal delirium
- 132 − Alcohol abuse with withdrawal with perceptual disturbance
- 139 − Alcohol abuse with withdrawal, unspecified
- 13 − Cocaine abuse, unspecified with withdrawal
- 93 − Cocaine use, unspecified with withdrawal
- 13 − Other stimulant abuse with withdrawal
Tip: To choose the right code, be sure to know the differences between substance use, abuse, and dependence.
For codes that describe “poisoning with other synthetic narcotics,” CMS has replaced the X value with 9. For example, code T40.4X1A (Poisoning by other synthetic narcotics, accidental (unintentional), initial encounter) has been deleted and replaced by T40.491A (Poisoning by other synthetic narcotics, accidental (unintentional), initial encounter).
More New 2021 ICD-10 Code Updates for Headaches, Sickle Cell, Pedestrian Injuries, and More
It would be impossible to go over every single code update—but you don’t need to know them all anyways. Carefully check the official code lists for updates specific to your specialty. Other notable updates for 2021 include:
- Head Pain: Several new headache codes in Chapters 6 and 18. You’ll need to pin down added specifics to properly code the symptom of headache. When documentation indicate the headache has an orthostatic component – the patient has it when vertical and being horizontal relieves it, assign 0 (Headache with orthostatic component, not elsewhere classified). Otherwise select the unspecified code R51.9 (Headache, unspecified). There are also now five new codes to categorize the cerebral spinal fluid (CSF) leak circumstance associated with an orthostatic headache such as G97.83 (Intracranial hypotension following lumbar cerebrospinal fluid shunting).
- Anemia: Nearly 20 new codes in Chapter 3 to describe complications from sickle-cell anemia. New codes such as 213(Sickle-cell/Hb-C disease with cerebral vascular involvement) and D57.431 (Sickle-cell thalassemia beta zero with acute chest syndrome) specify complications related to the condition.
- Collisions: Over 100 new codes in Chapter 20 (V00-Y99, External Causes of Morbidity), including many codes for electric scooter and other micro-mobility pedestrian injuries.
Eye Coding Adds Increased Specificity
Coding to the highest level of specificity helps you to reduce under coding, prevent denials, and avoid audits. For 2020, here are some of the new eye codes that will more accurately represent the individual patient’s condition: 2021 ICD-10 Code Updates.
CMS has added laterality codes for certain types of corneal dystrophy. For example, CMS has deleted code H1851 (Endothelial corneal dystrophy) and replaced it with:
- 511 − Endothelial corneal dystrophy, right eye
- 512 − Endothelial corneal dystrophy, left eye
- 513 − Endothelial corneal dystrophy, bilateral
- 519 − Endothelial corneal dystrophy, unspecified eye
CMS has deleted code H1854 (Lattice corneal dystrophy) and replaced it with:
- 541 − Lattice corneal dystrophy, right eye
- 542 − Lattice corneal dystrophy, left eye
- 543 − Lattice corneal dystrophy, bilateral
- 549 − Lattice corneal dystrophy, unspecified eye
CMS has deleted code T86.840 (Corneal transplant rejection) and replaced it with:
- 8401 − Corneal transplant rejection, right eye
- 8402 − Corneal transplant rejection, left eye
- 8403 − Corneal transplant rejection, bilateral
- 8409 − Corneal transplant rejection, unspecified eye
Reminder: You should use unspecified codes as rarely as possible, especially when it refers to laterality. The examining physician should indicate the affected anatomy. 2021 ICD-10 Code Updates.
Inpatient Guidelines Update Resection, Incision Inclusions
CMS has added these two official coding guidelines for ICD-10-PCS procedure codes:
- Guideline B3.18: If an excision or resection of a body part is followed by replacement procedure, code both procedures to identify each distinct objective.
- Example: The surgeon performed a mastectomy followed by breast reconstruction. You would code the mastectomy and the reconstruction separately, to account for both distinct objectives (the breast removal and the breast reconstruction.
- Exception: When the excision or resection is considered integral and preparatory for the replacement procedure.
- Example: The surgeon performed a resection of a joint to prepare the patient for a joint replacement. The resection is in preparation for the replacement, so you would not code the resection separately (the surgeon would not remove a joint without replacing it).
- Guideline B5.2b: procedures performed using the percutaneous endoscopic approach, with an incision or extension of an incision to assist in the removal of all or a portion of a body part or to anastomose a tubular body part to complete the procedure, are coded to the approach value percutaneous endoscopic.
- Example: If the surgeon performs a laparoscopic nephrectomy with midline incision for removal of the kidney, you’d code it to the approach value of percutaneous endoscopic.
New Technology Codes Foreshadow Possible Add On Payments
CMS has added several new devices and drugs to the New Technology Section of ICD-10-PCS codes. If you use these codes, be sure to check the upcoming final IPPS rule for codes that have been approved for the New Technology Add on Payment (NTAP). The final rule (typically released in early August) has been delayed due to the COVID-19 pandemic. Examples of new technology additions include:
- Nerinitide (XWO3326, XWO4326)
- Durvalumab Anti-neoplastic (XWO3336, XWO4336)
- Lefamulin Anti-infective (XWO3366, XWO4366)
- Brexanalone (XWO4306, XWO3306)
- Brexucabtagene Autoleucel Immunotherapy (XW23346, XW24346)
- Lisocabtagene Maraleucel Immunotherapy (XW23376, XW24376)
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