ICD-10-CM changes take effect Oct. 1. What you should know

Pediatrics will see some important changes to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) that will take effect on Oct. 1. These include updates to both the tabular and the code set.

Tabular updates

An important clarification was made to the body mass index (Z68) introductory note. The age ranges were updated to align with the Centers for Disease Control and Prevention growth charts and now appears as:

Z68 Body mass index [BMI]

Note:

BMI adult codes are for use for persons 20 years of age or older.

BMI pediatric codes are for use for persons 2-19 years of age. These percentiles are based on the growth charts published by the Centers for Disease Control and Prevention (CDC).

At the respiratory distress of newborns (P22), an “excludes 1” note was removed.

P22 Respiratory distress of newborn

~~Excludes1:~~ ~~respiratory arrest of newborn (P28.81)~~

~~respiratory failure of newborn NOS (P28.5)~~

Within the P22 category, the excludes notes now appear as:

P22.0 Respiratory distress syndrome of newborn

Excludes2: respiratory arrest of newborn (P28.81)

respiratory failure of newborn NOS (P28.5)

P22.8 Other respiratory distress of newborn

Excludes1: respiratory arrest of newborn (P28.81)

respiratory failure of newborn NOS (P28.5)

P22.9 Respiratory distress of newborn, unspecified

Excludes1: respiratory arrest of newborn (P28.81)

respiratory failure of newborn NOS (P28.5)

There are no excludes notes at P22.1 (transient tachypnea of newborn).

New codes

The AAP sponsored several proposals for this ICD-10-CM update, including a code for when a patient presents for travel-related counseling. This was in response to AAP membership noting a gap for these types of encounters.

The AAP also requested a code to identify a patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency who is not anemic.

Table 1 lists pediatric conditions with new codes. Of note, there are new codes for congenital deformities of the feet, Ehlers-Danlos syndrome and Prader-Willi syndrome. Table 2 lists new codes that are less applicable to pediatrics.

Refer to the 2020 ICD-10-CM manual for all the rules and guidance as you implement these updates beginning on Oct. 1.

Table 1

Quick reference to 2020 ICD-10-CM pediatric code changes

Topic	2020ICD-10-CM codes
Adenosine deaminase [ADA] deficiency	D81.30 ADA deficiency, unspecified D81.31 Severe combined immunodeficiency due to ADA deficiency D81.32 ADA 2 deficiency D81.39 Other ADA deficiency
Congenital deformities of feet	Q66.9-* Congenital deformity of feet, unspecified Q66.7- Congenital pes cavus Q66.4- Congenital talipes calcaneovalgus Q66.1- Congenital talipes calcaneovarus Q66.0- Congenital talipes equinovarus Q66.3- Other congenital varus deformities of feet The appropriate 5^th character to be added to these codes: 0 unspecified foot 1 right foot 2 left foot Q66.21- Congenital metatarsus primus varus Q66.22- Congenital metatarsus adductus The appropriate 6^th character to be added to these codes: 1 right foot 2 left foot 9 unspecified foot
Cyclical vomiting	R11.15 Cyclical vomiting syndrome unrelated to migraine
Ehlers-Danlos	Q79.60 Ehlers-Danlos syndrome, unspecified Q79.61 Classical Ehlers-Danlos syndrome Q79.62 Hypermobile Ehlers-Danlos syndrome Q79.63 Vascular Ehlers-Danlos syndrome Q79.69 Other Ehlers-Danlos syndromes
Eye and vision exam	Z01.020 Encounter for examination of eyes and vision following failed vision screening without abnormal findings Z01.021 Encounter for examination of eyes and vision following failed vision screening with abnormal findings
Fracture of orbital wall	S02.12- Fracture of orbital roof, closed fracture S02.83- Fracture of medial orbital wall, closed fracture S02.84- Fracture of lateral orbital wall, closed fracture The appropriate 6^th character to be added to these codes: 1 right side 2 left side 9 unspecified side The appropriate 7th character to be added to these codes: A initial encounter for closed fracture B initial encounter for open fracture D subsequent encounter for fracture with routine healing G subsequent encounter for fracture with delayed healing K subsequent encounter for fracture with nonunion S sequela
Heatstroke	T67.01X- Heatstroke and sunstroke T67.02X- Exertional heatstroke T67.09X- Other heatstroke and sunstroke The appropriate 7th character to be added to these codes: A initial encounter D subsequent encounter with routine healing S sequela
G6PD	D75.A Glucose-6-phosphate dehydrogenase (G6PD) deficiency without anemia
Latent tuberculosis	Z11.7 Encounter for testing for latent tuberculosis infection Z22.7 Latent tuberculosis Z86.15 Personal history of latent tuberculosis infection
Poisonings	T50.911- Poisoning by multiple unspecified drugs, medicaments and biological substances The appropriate 6^th character to be added: accidental (unintentional) 2 intentional self-harm 3 assault 4 undetermined 5 adverse effect 6 underdosing The appropriate 7th character to be added: A initial encounter D subsequent encounter S sequela
Prader-Willi	Q87.11 Prader-Willi syndrome Q87.19 Other congenital malformation syndromes predominantly associated with short stature
Pyuria	R82.81 Pyuria R82.89 Other abnormal findings on cytological and histological examination of urine
Travel counseling	Z71.84 Encounter for health counseling related to travel

*- Indicates that more characters need to be added to complete the code

Table 2

Topic	Category/subcategory or code
Atrial fibrillation	I48-*
Breast lump	N63.15 Unspecified lump in the right breast, overlapping quadrants N63.25 Unspecified lump in the left breast, overlapping quadrants
Embolism/thrombophlebitis	I82.4- and I82.5-
Neurostimulator	Z96.82 Presence of neurostimulator
Personal history in-situ neoplasm	Z86.00-
Phlebitis and thrombophlebitis	I80.24-, I80.25-
Pressure induced deep tissue damage	L89.0-, L89.1-, L89.2-, L89.3-, L89.46, L89.5-, L89.6-, L89.8-, L89.96
Pulmonary embolism	I26.9-