Get the Latest Vaping Coding Guidance From ICD-10-CM Official Guidelines

Mon, Oct 28, 2019 --

ICD-10

You now have authoritative guidance on ICD-10-CM coding for e-cigarette, or vaping, product use associated lung injury (EVALI). One thing you’ll learn: There may be new codes on the way to provide additional detail.

Get the Scoop on the New Vaping Guidelines

The four Cooperating Parties for ICD-10-CM approved the new vaping coding guidance, with the posting date of Oct. 17, 2019. The Cooperating Parties are the National Center for Health Statistics (NCHS), the American Health Information Management Association (AHIMA), the American Hospital Association (AHA), and the Centers for Medicare & Medicaid Services (CMS).

The post states that the guidance is likely to change as new clinical information emerges. And, as mentioned in the introduction, you can expect the March 2020 ICD-10 Coordination and Maintenance Committee Meeting to include proposals for new codes that provide more detail related to vaping encounters.

For the scenarios in the guidance (below), the post warns that you may need additional codes for conditions unrelated to the vaping. Continue to apply the rules in the ICD-10-CM code set and Official Guidelines to ensure correct coding.

Assign These Codes for EVALI

When the documentation shows EVALI, assign the code for the specific condition diagnosed. Here are the examples provided by the post:

  • J68.0 (Bronchitis and pneumonitis due to chemicals, gases, fumes and vapors)
    • Includes chemical pneumonitis
  • J69.1 (Pneumonitis due to inhalation of oils and essences)
    • Includes lipoid pneumonia
  • J80 (Acute respiratory distress syndrome)
  • J82 (Pulmonary eosinophilia, not elsewhere classified)
  • J84.114 (Acute interstitial pneumonitis)
  • J84.89 (Other specified interstitial pulmonary disease)

If there’s a diagnosis of acute lung injury but the medical record does not identify a specific condition like pneumonitis or bronchitis, the post instructs you to report J68.9 (Unspecified respiratory condition due to chemicals, gases, fumes, and vapors).

Turn to These Codes for Toxic Effect and Poisoning

Acute nicotine exposure from swallowing, breathing in, or absorbing (through skin or eyes) e-cigarette liquid can be toxic. For patients who present under these circumstances, the post directs you to report a code from T65.291- (Toxic effect of other tobacco and nicotine, accidental (unintentional)).

This subcategory also applies to “Toxic effect of other tobacco and nicotine NOS,” which means that if the documentation doesn’t specify the cause (accidental, self-harm, assault, or undetermined), then a code from T65.291- is still correct. The post doesn’t mention this, but you’ll choose the 7th character based on the encounter type: initial, subsequent, or sequela.

If the patient instead has a diagnosis of acute tetrahydrocannabinol (THC) toxicity, you should report a code from T40.7X1- (Poisoning by cannabis (derivatives), accidental (unintentional)). The structure for this subcategory is a lot like T65.291-, with the 7th character based on the encounter type and the subcategory applying to both accidental and NOS cases.

Remember Existing Guidelines for Use, Abuse, and Dependence

When documentation indicates substance use, abuse, or dependence, the post reminds you to report an additional code to identify the substance. The post includes text from the 2020 ICD-10-CM Official Guidelines, Section I.C.5.b.2, which provides the hierarchy below for coding a single substance:

  • If both use and abuse are documented, assign only the code for abuse
  • If both abuse and dependence are documented, assign only the code for dependence
  • If use, abuse, and dependence are all documented, assign only the code for dependence
  • If both use and dependence are documented, assign only the code for dependence.

You may report more than one code if more than one substance is documented.

The post adds that for vaping of nicotine, you should report a code from F17.29- (Nicotine dependence, other tobacco product). The post states, “Electronic nicotine delivery systems (ENDS) are non-combustible tobacco products.”

As a coding tip, base the 6th character for F17.29- on whether the dependence is documented as uncomplicated, in remission, with withdrawal, with other nicotine-induced disorders, or with unspecified nicotine-induced disorders.

No Definite Diagnosis? See Signs and Symptoms

If documentation shows only signs or symptoms, and there’s no confirmed diagnosis for your office or outpatient encounter, the post reminds you to report the appropriate sign or symptom code. Among the roughly 20 examples listed are R06.02 (Shortness of breath), R07.9 (Chest pain, unspecified), R10.84 (Generalized abdominal pain), and R68.83 (Chills (without fever)).

What About You?

Do you code for encounters related to vaping? Does this new guidance answer the questions you’ve encountered?

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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