New diagnosis codes effective Oct. 1. Here are some family physicians should know

Though it may not feel like it yet in all parts of the country, fall is here, bringing with it changes to diagnosis codes that occur each Oct. 1. The Centers for Disease Control and Prevention has released this year’s changes, and reviewing them can ensure your claims will continue to be paid smoothly.

Here’s a look at some of the changes most relevant to family physicians:

There is a new code related to COVID-19. U09.9 (Post COVID-19 condition, unspecified) is a special purposes code with its own notes and Code First instructions. It is used to document post-acute sequela of COVID-19 after infection (aka "long COVID") rather than active cases, although it can be used for re-infected patients who are still suffering sequela from a previous infection. You should code first conditions related to COVID-19 such as chronic respiratory failure (J96.1-), loss of smell (R43.8), loss of taste (R43.8), multisystem inflammatory syndrome (M35.81), pulmonary embolism (I26.-), and pulmonary fibrosis (J84.10).

There are also new code choices for low back pain, a condition family physicians commonly see. The current code, M54.5 (Low back pain), will be expanded into three more specific codes:

• M54.50 (Low back pain, unspecified)
• M54.51 (Vertebrogenic low back pain)
• M54.59 (Other low back pain)

Similarly, you will no longer be able to simply report a patient has a cough with R05 (Cough). Instead, you’ll have to choose from among six new, more specific codes:

• R05.1 (Acute cough)
• R05.2 (Subacute cough)
• R05.3 (Chronic cough)
• R05.4 (Cough syncope)
• R05.8 (Other specified cough)
• R05.9 (Cough, unspecified)

Finally, beginning in October you’ll have an expanded array of codes for recording various social determinants of health. For instance, code Z59.0 (Homelessness) is now broken out to three codes:

• Z59.00 (Homelessness unspecified)
• Z59.01 (Sheltered homelessness)
• Z59.02 (Unsheltered homelessness)

Code Z59.81- (Housing instability, housed) will also require more specificity, as follows:

• Z59.811 (Housing instability, housed, with risk of homelessness)
• Z59.812 (Housing instability, housed, homelessness in past 12 months)
• Z59.819 (Housing instability, housed unspecified)

There will also be new codes for food insecurity (Z59.41), other specified lack of adequate food (Z59.48), and inadequate drinking water (Z58.6).

As always, this is just a sample of the changes. For the full list, go to www.cdc.gov/nchs/icd/icd10cm.htm, click on the ICD-10-CM FY 2022 Addenda PDF 2022 link, and download the Table and Index zip file.

— Kent Moore, Senior Strategist for Physician Payment