Our medical billing and coding company reports on the new ICD-10 codes that come into effect each year starting October 1. Proposals for the fiscal year 2021 include 490 new, 47 revised, and 58 invalidated ICD-10 codes.

While the FY 2019 ICD code set included 473 code changes, the finalized code set for 2020 features over 500 changes and is for use from October 1, 2020 through September 30, 2021. One of the highlights of the FY 2021 ICD-10 code set is the addition of Chapter 22 – Codes for Special Purposes (U00-U85). Here is an overview of the key ICD-10 code changes and new guidelines for FY 2021:

  • 128 additions in Chapter 19, Injury, poisoning & certain other consequences, including new codes for adverse effects and poisoning by fentanyl and tramadol as well as other synthetic narcotics.
  • 125 additions in Chapter 20, External causes of morbidity (V00-Y99), with more specific codes for collisions involving electric scooters and other nonmotor vehicle accidents.
  • Chapter 21, Factors influencing health status and contact with health services: There is a notable change to observation code Z03.818 Encounter for observation for suspected exposure to other biological agents ruled out. The new guidelines state that while the observation codes are primarily to be used as a principal/first-listed diagnosis, “an observation code may be assigned as a secondary diagnosis code when the patient is being observed for a condition that is ruled out and is unrelated to the principal/first-listed diagnosis (e.g., patient presents for treatment following injuries sustained in a motor vehicle accident and is also observed for suspected COVID-19 infection that is subsequently ruled out)”.
  • Chapter 22, Codes for Special Purposes (U00-U85) includes two codes: U07.0 Vaping- related disorder and U07.1 COVID-19. These codes came into effect in April 2020.
  • Coronavirus infections: There are detailed instructions on reporting coronavirus infections in FY ICD-10, which came into effect on April 1, 2020.
  • 21 codes to report withdrawal from substances including alcohol, cocaine, and opioids.
  • 18 detailed codes for sickle cell anemia. There are new codes to specify complications related to the condition, such as D57.213 (sickle-cell/Hb-C disease with cerebral vascular involvement) and D57.431 (sickle-cell thalassemia beta zero with acute chest syndrome).
  • 12 new codes for other pathological fractures (M80.8AX- and M80.0AX-). Updates in Chapter 13: Musculoskeletal System include additional codes for rheumatoid arthritis, primary and secondary arthritis, and arthritis caused by trauma. In the M24 category, there are new codes for other articular cartilage disorders, disorders of ligament, pathological dislocation, recurrent dislocation, contracture and ankylosis.
  • 3 codes to capture stage 3 chronic kidney disease (CKD) in two new sub-stages: N18.30 (CKD, stage 3 unspecified), N18.31 (CKD, stage 3a), and N18.32 (CKD, stage 3b).
  • For social determinants of health, such as in categories Z55-Z65, ICD-10 general guidelines state that for reporting a patient’s potential health hazards related to socioeconomic and psychosocial circumstances, code assignment may be based on medical record documentation from clinicians involved in the care of the patient who are not the patient’s provider as this information represents social information, rather than medical diagnoses. The FY 2021 ICD-10 guidelines clarify that patient self-reported documentation may also be used to assign codes for social determinants of health, “as long as the patient self-reported information is signed-off by and incorporated into the health record by either a clinician or provider”.
  • New coding guidelines for reporting diabetic patients treated with insulin, oral hypoglycemics and injectable non-insulin drugs in Chapter 4: Endocrine, Nutritional & Metabolic Disease. For e.g., if the patient is taking both insulin and an injectable non-insulin antidiabetic drug, both Z79.4 (Long term [current] use of insulin) and Z79.899 (Other long term [current] drug therapy) should be reported. If the patient is taking oral hypoglycemic drugs and an injectable non-insulin antidiabetic drug, code Z79.84 (Long term [current] use of oral hypoglycemic drugs) should be assigned in addition to code Z79.899.

Deletions: The following ICD codes have been deleted in 2021:

  • Q51.20 (other doubling of uterus, unspecified)
  • All codes within subcategory T40.4X- (poisoning by adverse effect of and underdosing of other synthetic narcotics)

Partnering with an experienced provider of medical billing and coding services can ease the task of adapting to the hundreds of ICD-10 code changes in FY 2020-2021. Certified coders in a reliable medical billing company keep track of these changes and can help physicians ensure accurate assignment of codes on claims.