CMS unveiled the 2021 changes for ICD-10-CM, which include 490 new codes, 47 revised codes and 58 codes that were deleted or invalidated. With some notable exceptions in a handful of commonly used categories, we believe the modifications affect mostly coders and specialty physicians.
Some of these changes include: Epilepsy and recurrent seizures which now contain new codes for specific seizure disorders that are usually diagnosed by neurologists; many of the musculoskeletal codes that have been amended to include “other specified site” or “other specified joint” so the number of changes can be misleading; and Atherosclerosis of the extremities (I70.-) codes, which now feature an “includes” statement with information about chronic limb-threatening ischemia, and no code changes in this section.
The complete list of changes and coding guidelines can be found here, but below is a summary of the most important differences, especially as they affect primary care physicians.
- A big change for PCPs is found in Chapter 14, Diseases of the Genitourinary System for Chronic Kidney Disease (CKD). Since the initial inclusion of CKD in the International Classification of Diseases, six stages have been coded, each with only one code. For 2021, CKD stage 3 has been expanded to three codes:
- N18.30 for CKD stage 3, unspecified
- N18.31 for CKD stage 3a
- N18.32 for CKD stage 3b
- Another big change for PCPs is coding Headaches. The familiar code R51 for Headache, unspecified has been replaced with two codes:
- R51.0 Headache with orthostatic component, not elsewhere classified
- R51.9 Headache, unspecified
In addition, the Excludes1 for atypical face pain, migraine and trigeminal neuralgia has been changed to an Excludes2, so these conditions can be coded together.
- Under Diseases of the Respiratory System, the Excludes1 prohibition that existed for codes J00 through J06 has been modified. The exclusion prohibiting the coding of these conditions with COPD with acute lower respiratory infection or with influenza virus with other respiratory manifestations now only applies to these codes:
- J00 Acute nasopharyngitis (common cold)
- J02 Acute pharyngitis
- J03 Acute tonsillitis
- In Chapter 11 for Diseases of the Digestive System, the code for GERD with esophagitis was expanded to include with or without bleeding. Otherwise, the general code for GERD unspecified (K21.9) remains the same.
- ICD-10-CM now include a code for Vaping-related disorder (U07.0). This code is used for any lung damage or lung injury resulting from dabbing, e-cigarettes, electronic cigarettes or vaping. All synonyms are included to be sure the code is correctly assigned regardless of the specific words are documented. The code also contains a reminder to use additional codes to report any manifestations of the damage or injury.
The CMS-HCC model that includes 2021 ICD-10-CM codes has not been released as of this writing. Check back on our blogs, leave a comment or email us and we’ll notify you when it is released.