Sneak a Peek at ICD-10-CM 2021

2021 ICD-10 CM Codes

There are a slew of changes and only a few months before you will need to start using the new codes.

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.

What’s New for 2021 Diagnosis Coding?

As is usually the case, most of the changes replace or expand non-specific codes with more specific codes. For example:

R74.0 Nonspecific elevation of levels of transaminase and lactic acid dehydrogenase [LDH] is expanded to include:

R74.01 Elevation of levels of liver transaminase levels
R74.02 Elevation of levels of lactic acid dehydrogenase [LDH]

Some of the changes to the 2021 code set are the result of stakeholder requests at the ICD-10-CM Coordination and Maintenance Committee Meeting, Sept. 10-11, 2019. Here’s a brief summary of the accepted code changes to the ICD-10-CM Tabular List of Diseases and Injuries that came out of the two-day meeting:

Day 1

Two new codes are added under E70.8 Other disorders of aromatic amino-acid metabolism:

E70.81 Aromatic L-amino acid decarboxylase deficiency [AADC deficiency]
E70.89 Other disorders of aromatic amino-acid metabolism

One new code is added under G40 Epilepsy and recurrent seizures:

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

Under T40 Poisoning by, adverse effect of and underdosing of narcotics and psychodysleptics [hallucinogens], the T40.4X codes are deleted and T40.41x, T40.2x, and T40.9x are added.

Under H55 Nystagmus and other irregular eye movements, H55.81 is revised, and one code is added:

H55.82 Deficient smooth pursuit eye movements

Two new codes are added under O34 Maternal care for abnormality of pelvic organs:

034.218 Maternal care for other type scar from previous cesarean delivery
034.22 Maternal care for cesarean scar defect (isthmocele)

Several additions, deletions, and revisions were made under M92 Other juvenile osteochondrosis based on a request made by the American Academy of Orthopedic Surgeons.

Under O99.89 Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium, three new codes are added to differentiate the affected stage:

099.891 Other specified diseases and conditions complicating pregnancy
099.892 Other specified diseases and conditions complicating childbirth
O99.893 Other specified diseases and conditions complicating puerperium

Two conditions (Louping ill and Powassan virus disease) are deleted from A84 Tick-borne viral encephalitis, and each condition is assigned a new code:

A84.81 Powassan virus disease
A84.89 Other tick-borne viral encephalitis [Louping ill]

Under K21.0 Gastro-esophageal reflux disease with esophagitis, the associated condition “reflux esophagitis” is deleted and two new codes are added to identify the condition more clearly as with or without bleeding:

K21.00 Gastro-esophageal reflux disease with esophagitis, without bleeding
K21.01 Gastro-esophageal reflux disease with esophagitis, with bleeding

The American Academy of Pediatrics is behind the addition of several new codes under S20 Superficial injury of thorax to identify thoracic injuries more clearly.

Day 2

New subcategory D89.83 Cytokine release syndrome is added, along with Code first and Use additional notes and six new codes (D89.831-D89.835, D89.839) to report the grade of the disease.

The new codes under V00.03 Pedestrian on foot injured in collision with standing micro-mobility pedestrian conveyance are a sign of the times. You wouldn’t need codes to report a collision with a person on a hoverboard or Segway in the good old days. There are several more codes added under V00 Pedestrian conveyance accident such as new code V01.131 Pedestrian on standing electric scooter injured in collision with pedal cycle in traffic accident.

Side note: I didn’t know what a “pedal cycle” was so I looked it up. According to Amazon, it’s one of those contraptions you use at your desk to keep your legs busy while sitting. I’m not sure how hard you have to peddle to make your desk mobile, but with all the COVID-19 coding changes this year, I suppose some of you may have enough nervous energy to make this a possibility. In that case, watch out for crazy drivers on electric scooters!

On a less humorous note, there are three new codes under category G11 Hereditary ataxia:

G11.10 Early-onset cerebellar ataxia, unspecified
G11.11 Friedreich ataxia
G11.19 Other early-onset cerebellar ataxia

Under category D84 Other immunodeficiencies, there are a few new codes to identify the cause of the immunodeficiency:

D84.81 Immunodeficiency due to condition classified elsewhere
D84.82 Immunodeficiency due to drugs and external causes
D84.821 Immunodeficiency due to drugs
D84.822 Immunodeficiency due to external causes
D84.89 Other immunodeficiencies

You’ll find several new codes under G96 Other disorders of central nervous system that will allow you to code certain conditions of the central nervous system, such as intracranial hypotension, perineural cyst, and cerebrospinal fluid leak, with more specificity.

Under J82 Pulmonary eosinophilia, not elsewhere classified, the associated conditions are deleted, and new codes are assigned to identify specific types of eosinophilia such as:

J82.81 Chronic eosinophilic pneumonia
J82.82 Acute eosinophilic pneumonia
J82.83 Eosinophilic asthma

In Chapter 3, category D57 Sickle-cell disorders, you are going to see many new codes and some revised codes to better identify patients without major complications but who are in crisis.

Under G71.2 Congenital myopathies, the associated conditions are deleted and assigned sub codes:

G71.20 Congenital myopathy, unspecified
G71.21 Nemaline myopathy
G71.22 Centronuclear myopathy

G71.220 X-linked myotubular myopathy
G71.228 Other centronuclear myopathy

G71.29 Other congenital myopathy

This is just a short list of new codes being added to the code set for 2021. There are extensive changes to the Index of Diseases, as well.

Get More Information on 2021 ICD-10-CM

The 2021 code descriptions in tabular order, addendum, and code tables and index are available for download on the CMS website.

Stay tuned to the AAPC Knowledge Center for a more in-depth look at the stories behind the new codes; and don’t miss the September issue of Healthcare Business Monthly, where we delve into all the diagnosis code changes for 2021.

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