ICD-10-CM diagnosis coding updates for 2022
Derm Coding Consult
By Faith C. M. McNicholas, RHIT, CPC, CPCD, PCS, CDC, manager, coding & reimbursement, September 1, 2021
Academy coding staff address important coding topics each month in Derm Coding Consult. Read more Derm Coding Consult articles.
The National Center for Health Statistics (NCHS) within the Centers for Disease Control and Prevention (CDC) has announced the 2022 International Classification of Diseases, Tenth Revision, Clinical Modifcation (ICD-10-CM) updates, that will be implemented on Oct. 1, 2021. The approved updates have 205 changes, of which very few will directly impact dermatology diagnoses coding. The overall changes include:
53 new diagnosis codes,
22 revised codes, and
30 invalidated codes.
The following list outlines new ICD-10-CM codes that are important to dermatology and will require inclusion in the practice management coding software, effective Oct. 1, 2021.
| ICD-10-CM code | Code descriptor |
|---|---|
L24.A0 |
Irritant contact dermatitis due to friction or contact with body fluids, unspecified |
L24.A1 |
Irritant contact dermatitis due to saliva |
L24.A2 |
Irritant contact dermatitis due to fecal, urinary, or dual incontinence |
L24.A9 |
Irritant contact dermatitis due to friction or contact with other specified body fluids |
L24.B0 |
Irritant contact dermatitis related to unspecified stoma or fistula |
L24.B1 |
Irritant contact dermatitis related to digestive stoma or fistula |
L24.B2 |
Irritant contact dermatitis related to respiratory stoma or fistula |
L24.B3 |
Irritant contact dermatitis related to fecal or urinary stoma or fistula |
M35.05 |
Sjögren syndrome with inflammatory arthritis |
M35.06 |
Sjögren syndrome with vasculitis |
M35.81 |
Multisystem inflammatory syndrome |
M35.89 |
Other specified system involvement of connective tissue |
M54.50 |
Low back pain, unspecified |
M54.51 |
Other low back pain |
R05.1 |
Acute cough |
R05.2 |
Subacute cough |
R05.3 |
Chronic cough |
R05.4 |
Cough syncopew |
R05.8 |
Other specified cough Persistent cough Refractory cough Unexplained cough |
R05.9 |
Cough, unspecified |
R79.83 |
Abnormal findings of blood amino-acid level |
Z11.52 |
Encounter for screening for COVID-19 |
Z20.822 |
Contact with and (suspected) exposure to COVID-19 |
Z71.85 |
Encounter for immunization safety counseling |
Z86.16 |
Personal history of COVID-19 |
Code sub-category M35.0 - Sicca syndrome (Sjögren) has been revised as follows.
| ICD-10-CM code | 2021 code descriptor | 2022 code descriptor |
|---|---|---|
M35.00 |
Sicca syndrome, unspecified |
Sjögren syndrome unspecified |
M35.01 |
Sicca syndrome with |
Sjögren syndrome with |
M35.03 |
Sicca syndrome with myopathy |
Sjögren syndrome with myopathy |
M35.09 |
Sicca syndrome with other organ |
Sjögren syndrome with other organ involvement |
Impact of diagnoses codes on the level of evaluation and management (E/M)
The number and complexity of the problem(s) addressed during an encounter is one of the elements used in selecting the level of office or other outpatient E/M services. As such, diagnosis coding is important during patient care because it can help define the complexity of the service and patient management to be provided by the dermatologist or non-physician clinician (NPC).
The American Medical Association (AMA) Current Procedural Terminology (CPT®) has clarified that patient conditions exhibited during an encounter can qualify under multiple categories, depending on presenting symptoms, disease severity, and the patient complexity of presenting problem and management options at the time of the encounter. Though symptoms may cluster around a specific diagnosis, an individual symptom is not necessarily a unique condition.
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However, the presence of comorbidities and/or underlying condition(s) as well as specific factors regarding the diagnosis may increase the amount and/or complexity of data to be reviewed and analyzed, as well as the risk of complications and/or morbidity or mortality of patient management. The patient’s comorbidities and underlying condition(s) may also impact the complexity of the problem(s) being addressed depending on its severity, duration, depending on whether the condition or comorbidity was newly or previously diagnosed, and its response to treatment.
Note: Comorbidities and/or underlying conditions, in and of themselves, are not considered in selecting the level of E/M service unless they are addressed.
For example, a 20-year-old male patient is seen for acne present around his chin and jawline since he started playing soccer a month ago (acute uncomplicated illness, low problem addressed). The dermatologist spends time discussing the treatment options and potential side effects of the recommended prescription (moderate risk of patient management) and may categorize this encounter under low-level complexity E/M level (992x3).
However, another patient is seen by the same dermatologist with the same diagnosis that has been present for more than a year with severe flaring. Although the acne is severely flaring (poor progression, uncontrolled) it is not to the extent that the patient requires hospital level of care as described by AMA under Chronic illness with severe exacerbation, progression, for side effects of treatment: The severe exacerbation or progression of a chronic illness or severe side effects of treatment that have significant risk of morbidity and may require hospital level of care.
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As such, the complexity of the problem addressed is categorized at moderate (chronic condition with exacerbation/progression, moderate problem addressed).
The second patient also has a family history of significant hyperlipidemia for which baseline lipid panel and liver function tests are ordered and the results are discussed with the primary care physician (two unique tests ordered and management options discussed with an external physician, moderate data reviewed and analyzed).
A prescription drug is ordered (isotretinoin) (moderate risk of patient management) and monthly monitoring of blood lipids and liver function through lab testing to monitor for drug-induced lipid and triglyceride elevations is planned (high-risk drug therapy requiring intensive monitoring).
Although the drug monitoring, in this example, is categorized as high risk (992x5), the number and complexity of problems addressed as well as the complexity of data to be reviewed are both categorized at moderate level (992x4).
Therefore, the overall E/M level of complexity may be categorized as moderate level (992x4) because we do not meet two of the three elements required at high-level to report the service as 992x5.
* The duration that the acne has been present and the severe flare makes this a chronic condition with exacerbation. The family history of hyperlipidemia (comorbidity) complicates the management options to be selected. Even though hyperlipidemia is not being managed during this encounter, there is a risk of the prescription drug therapy (isotretinoin) causing a significant elevation of triglyceride levels including pancreatitis due to its use.
The Academy’s "Definitions for the MDM Elements Terminology" should be used as a reference tool to determine appropriate categorization for diagnosis coding. More coding examples are available in Derm Coding Consult — see "Application of 2021 E/M Coding Concepts."
Visit the Coding Resource Center at staging.aad.org/coding for more guidance and additional coding resources.
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