ICD-10 annual update: what family physicians need to know

Getting paid is often as much about the diagnosis codes you use as it is about the service codes on your claims. The ICD-10-CM diagnosis code annual update will take effect Oct. 1, which means it’s time to prepare your practice if you haven’t already done so.

Here are some of the changes most important to family physicians.

F10-F19 Mental and behavioral disorders due to psychoactive substance use:

Family physicians are often the first contact for mental health issues, so they need to be aware of multiple new codes in this section. New codes have been added to further describe withdrawal symptoms — e.g., mental and behavioral disorders due to withdrawal from alcohol use (F10.930-F10.939) or abuse (F10.130-F10.139). Additionally, some codes in this section will now require the addition of an extra character (for example, to identify related symptoms).

M05-M14 Inflammatory polyarthropathies, M19 Other and unspecified osteoarthritis, and M92 Other juvenile osteochondrosis:

For the M05-M14 and M19 groups, ICD-10-CM is adding new codes for “other specified site,” which is not an option now. For M92, ICD-10-CM is breaking out some existing codes into new codes that allow more specificity with respect to laterality by the addition of a sixth character.

T40.- Poisoning by, adverse effect of, and underdosing of narcotics and psychodysleptics:

The existing code family T40.4X, which only cites “synthetic narcotics,” will be replaced by three code sets that allow coders to specify fentanyl, tramadol, or “other” synthetic narcotics.

U00-U85 Codes for special purposes:

The special purposes codes U07.0 (Vaping-related disorder) and U07.1 (COVID-19) are included in the annual update, although these codes were actually added to ICD-10-CM on an emergency basis earlier this year. On a related note, the addition of “Excludes1: COVID-19 (U07.1)” under code B34.2 (Coronavirus infection, unspecified) is important, because primary care physicians are often on the front line in diagnosing and treating COVID-19 and need to know that U07.1 (COVID-19) and B34.2 (Coronavirus infection, unspecified) are mutually exclusive.

F02.81 and F02.80 Dementia with and without behavioral disturbance:

There is a new instruction to use an additional code with G20 (Parkinson's disease) to identify dementia with behavioral disturbance (F02.81) or dementia without behavioral disturbance (F02.80). You will need to use an additional code when either of those circumstances applies, rather than relying on G20 alone.

J00-J06 Acute upper respiratory infections:

Under several of the codes for acute upper respiratory infections (J00-J06), ICD-10-CM has added a new “Excludes1” note about influenza: “Excludes1: influenza virus with other respiratory manifestations (J09.X2, J10.1, J11.1).” So, if the patient has influenza with respiratory manifestations, it would be inappropriate to also classify the patient as having a common cold (J00), because these conditions are mutually exclusive.

ICD-10-CM also added a "Code also influenza" note to certain codes in the J00-J06 family, which means you should add an influenza code when appropriate. Coders will have to exercise more caution when using codes for acute upper respiratory infections (J00-J06) if influenza is involved.

R51 Headache:

Coding “headache” (a common symptom in primary care) will now require a fourth digit: R51.0 (Headache with orthostatic component, not elsewhere classified) or R51.9 (Headache, unspecified). Also, the Excludes1 note has changed to an Excludes2 note, which means the listed conditions are no longer considered mutually exclusive to headache. Instead, they become separately reportable in addition to headache when applicable.

These are only a few of the changes. The full fiscal year 2021 ICD-10-CM diagnosis codes are available on the Centers for Medicare & Medicaid Services’ 2021 ICD-10-CM webpage.

— Kent Moore, Senior Strategist for Physician Payment, American Academy of Family Physicians