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.