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ICD-10 Changes for 2021

The ICD-10-CM update for 2021 became effective on October 1, 2020. The 2021 edition contains 72,616 codes that includes 490 additions, 47 code revisions and 58 deletions. There are also 162 new headers along with 7 deletions and 5 revisions. The ICD-CM code set in the United States is maintained by the ICD Coordination and Maintenance Committee. This committee includes representatives from the National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS). This committee reviews all requests for changes or additions to the code set. The Director of NCHS and the Administrator of CMS make the final coding data set decisions.

New codes were added in Chapter 6 (Diseases of the Nervous System (G00-G99)) and Chapter 13 (Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)). Both chapters have revisions to inclusion codes, terminology and instructions. Although the codes will appear in your EHR, the changes in terms and instructions likely will not appear in your EHR code selection process. However, a digital copy of the ICD manual is available in most EHR systems.

The subcategory G96.0 (Cerebral spinal fluid leak) has been expanded to include the following new codes:

  • G96.00 Cerebrospinal fluid leak, unspecified
  • G96.01 Cranial cerebrospinal fluid leak, spontaneous
  • G96.02 Spinal cerebrospinal fluid leak, spontaneous
  • G96.08 Other cranial cerebrospinal fluid leak
  • G96.09 Other spinal cerebrospinal fluid leak

Additional codes were added to select subcategories in the following categories to indicate “other specified site”.

  • M05 Rheumatoid arthritis with rheumatoid factor
  • M06 ChangeM06 Other rheumatoid arthritis
  • M08 ChangeM08 Juvenile arthritis
  • M19 Other and unspecified osteoarthritis
  • M24 Other specific joint derangements
  • M25 Other joint disorder, not elsewhere classified

Two new subcategories were added to M26.6 (Temporomandibular joint disorders) and both include options for laterality. The new subcategories are:

  • M26.64 Arthritis of temporomandibular joint
  • M26.65 Arthropathy of temporomandibular joint​

Other ICD Chapters also contain changes. Those of most interest to Pain Management Physicians are noted here. ICD code R51 (Headache) was deleted in Chapter 18 (Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified) and replaced with two new codes:

  • R51.0 Headache with orthostatic component, not elsewhere classified
  • R51.9 Headache, unspecified

Changes in Chapter 19 (Injury, poisoning and certain other consequences of external causes) includes the addition of new codes and subcategories under T40.4 (Poisoning by, adverse effect of and underdosing of other synthetic narcotic). The new subcategories are T40.41 (fentanyl or fentanyl analogs) and T40.42 (tramadol). Each contains new codes that match the current code distinctions found within T40.4.

Multiple new codes were added to Chapter 5 (Mental, behavioral and neurodevelopmental disorders) related to substance abuse disorders. The changes primarily add new subcategories and codes related to withdrawal. Codes in categories F10 (Alcohol related disorders), F13 (Sedative, hypnotic, or anxiolytic related disorders) and F19 (Other psychoactive substance related disorders) have a 6th characters describing manifestations of withdrawal.

The new codes and instructions are effective October 1, 2020 through September 30, 2021.

AMA Releases New Code for Use During the Public Health Emergency

On September 8, the American Medical Association (AMA) released a new code to report the additional practice expenses incurred during a public health emergency (PHE) that is over and above those usually included in a medical visit or service. The code accounts for the additional supplies, materials, and clinical staff time associated with evaluation, management and procedural services provided during the current PHE. 

 Code 99072 is effective immediately and reads:

Additional supplies, materials, and preparation time required and provided by the physician or other qualified health care professional and/or clinical staff over and above those usually included in an office visit or other service(s), when performed during a nationally declared public health emergency due to respiratory transmitted infectious disease.

This new code is intended to capture the following practice expense activities:

  • Time over what is included in the primary service of clinical staff time (registered nurse [RN]/ licensed practical nurse [LPN]/ medical technical assistant [MTA]) to conduct a pre-visit phone call to screen the patient (symptom check), provide instructions on social distancing during the visit, check patients for symptoms upon arrival, apply and remove PPE, and perform additional cleaning of the examination/procedure/imaging rooms, equipment, and supplies
  • Three surgical masks
  • Cleaning supplies, including additional quantities of hand sanitizer and disinfecting wipes, sprays, and cleansers

The code should only be reported when the service is rendered in a non-facility place of service (POS) setting, such as a physician office, and in an area where the activities are required to lessen the transmission of the respiratory disease. The code should be reported only during a PHE due to a respiratory disease and only for additional items required to provide a safe in-person service. The code is to be reported once per in-person patient encounter regardless of the number of services provided at that encounter.

Currently, there are no relative value units (RVU) assigned to the code. The AMA has sent a request to the Centers for Medicare and Medicaid Services (CMS) to immediately implement the code and to assign practice expense RVUs based on input provided by the AMA. Practices can choose to assign a charge and submit the code to third-party payers however individual payer policies will dictate how the claim will be processed.

A special edition CPT Assistant article addressing this code and an additional COVID related laboratory code can be accessed here

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American Academy of Pain Medicine