A Quarterly Publication of The Central Office On ICD-10-CM/PCS

A quarterly publication of the
Central Office on ICD-10-CM/PCS

Volume 8 Fourth Quarter
Number 4 2021
In This Issue Immune Effector Cell-Associated
Changes to the ICD-10-CM Neurotoxicity Syndrome 12
Official Guidelines for Coding Irritant Contact Dermatitis 16
and Reporting 81 Malignant Neoplasm of Bilateral
Changes to the ICD-10-PCS Ovaries 6
Official Guidelines for Coding Neimann-Pick Disease Type A/B 8
and Reporting 97 Newborn Affected by Maternal
Explanation of the Revised Group B Streptococcus
Guideline for Control 99 Colonization 23
New/Revised Frequently Asked Nocturnal Polyuria 26
Questions Regarding Coding Non-Ischemic Myocardial Injury 14
for COVID-19 101 Non-Radiographic Axial
Spondyloarthritis 21
New/Revised ICD-10-CM Codes Non-Suicidal Self-Harm 26
Abnormal Findings of Blood Other Intellectual Disabilities 10
Amino- Acid Level 28 Pediatric Feeding Disorder 27
Abnormal Findings on Neonatal Post COVID-19 Condition 31
Screening 24 Sjögren Syndrome 20
Acute Flaccid Myelitis 11 Synthetic Cannabinoids 30
Anaplasmosis 4 Thrombocytosis and Essential
Anaplastic Large Cell Lymphoma, Thrombocythemia 7
ALK-Negative, Breast 6 Thrombotic Microangiopathy 19
Anemia due to Pyruvate Kinase Traumatic Brain Compression
Deficiency Anemia due to Other and Herniation 29
Disorders of Glycolytic Enzymes 6 Vertebrogenic Pain 22
Cervicogenic Headache 11
Complications of Immune Z Code Update
Effector Cellular Therapy 31 Allergy to Mammalian Meats 33
Cough 24 Encounter for Immunization
Depression Not Otherwise Specified 9 Safety Counseling 34
Esophageal and Esophagogastric Personal History of Suicidal
Junction Polyps 15 Behavior and Non-Suicidal
External Cause of Injury Code for Self-Harm 33
Legal Intervention Involving Social Determinants of Health 34
Other Specified Means,
Unspecified Person Injured 32 New/Revised ICD-10-PCS Codes
Gastric Intestinal Metaplasia 15 Coronary Intravascular Lithotripsy 41
Hereditary Alpha Tryptasemia 8 Coronary Orbital Atherectomy 41
Coding advice and new code assignments contained in this issue

effective with discharges October 1, 2021.
Division of Liver for Staged New Technology Section X
Hepatectomy 48 Group 1 Update 57
Endoscopic Banding of Percutaneous Creation of
Hemorrhoidal Plexus 47 Arteriovenous Fistula Using
Endoscopic Division of Tongue, Thermal Resistance Energy 60
Palate and Pharynx Muscle 50 Pharyngeal Electrical Stimulation 76
Extraction of Bone Marrow from Posterior Dynamic Distraction 67
Other Sites 47 Regional Anticoagulation for
Fragmentation of Intracranial Artery 46 Renal Replacement Therapy 80
Insertion of Infusion Device in Skull 51 Replacement Combined with
Percutaneous Bypass of Brachial Restriction of Descending
Artery for Arteriovenous Fistula Thoracic Aorta 61
Creation 45 Restriction of Coronary Sinus 63
Restriction of Left Ventricle 44 Single-Use Duodenoscope during
Sesamoidectomy of Great Toe 52 Endoscopic Retrograde
Shoulder Hemiarthroplasty 53 Cholangiopancreatography 65
Total Artificial Heart Systems 42 Transfusion of Hyperimmune
Transcatheter Replacement of Globulin and High-Dose
Pulmonary Valve 43 Immune Globulin 76
Ultrasonic Surgical Aspiration Transthoracic Echocardiography
of Brain 38 with Computer-Aided Image
Vertebral Body Tethering 51 Acquisition 59
Section B – Imaging Section 3 – Administration

Fluoroscopic Guidance of Introduction of Antineoplastic
Hepatobiliary Sites 57 Monoclonal Antibody 54
Laparoscopic Irrigation of
Section X - New Technology Peritoneal Cavity 55
Antibiotic-Eluting Bone Void Filler 74 Transfusion of Nonautologous
Application of Bioengineered Pathogen Reduced
Allogenic Construct 66 Cryoprecipitated Fibrinogen
Chimeric Antigen Receptor Complex 54
T-Cell Immunotherapy 71
Colonic Irrigation for Colonoscopy 64 Section 4 – Measurement and
Computer-Aided Assessment of Monitoring
Intracranial Vascular Activity 77 Measurement of Flow in Cerebral
Computer-Aided Mechanical Shunt 55
Aspiration Thrombectomy 58
Computer-Aided Triage and Section 5- Extracorporeal or
Notification of Pulmonary Systemic Assistance and
Artery Flow 77 Performance
Concurrent Measurement of mRNA, Automated Chest Compression 56
PCR Test and Detection of
Antibodies 79 Announcement
Customizable Interbody Fusion 68 Addition of April 1st
Introduction of New Therapeutic Maintenance of ICD-10-CM and
Substances 69 ICD-10-PCS Coding Systems 100
Mechanical Initial Specimen
Diversion of Whole Blood Ask the Editor
Using Active Negative Pressure 78 Medically Induced Coma 113
Monitoring of Tissue Oxygen Unspecified Coma 112
Saturation in Gastrointestinal Tract 63
2 Fourth Quarter 2021 Coding Clinic
Coding Clinic for Medical Advisors, Centers for Edward A. Liechty, M.D.
Medicare & Medicaid Services Representative, American
ICD•10•CM/PCS Academy of Pediatrics,
Published quarterly by the Perry Alexion, M.D.
Edith Hambrick, M.D. Indianapolis, IN
American Hospital Association
Central Office on Karen Nakano, M.D.
Jeffrey F. Linzer, M.D., FAAP
ICD-10-CM/PCS Editorial Advisory Board Representative, American
155 N. Wacker Drive Donna Ganzer, Chairman Academy of Pediatrics,
Chicago, IL 60606. President, Ganzer Network Atlanta, GA
Corporation, Great Neck, NY
ISSN 0742-9800
Elena Miller, MPH, RHIA, CCS
Chrystel Barron, MHI, RHIA,
Coding Clinic for Director, Coding Audit and
CPHIMS, CCS, CCS-P, CDIP,
Education, Atrium Health
ICD-10-CM/PCS CHTS-TR, CICA, CHRI
Charlotte, NC
Online subscription information Coding Education Instructor
can be found at www. Cleveland Clinic
Lee R. Morisy, M.D., FACS
codingclinicadvisor.com Representative, Amer. College
Sue Bowman, MJ, RHIA,
Click Help Center then of Surgeons, Memphis, TN
CCS, FAHIMA
subscriptions for more
Senior Director, Coding Policy and
information. Bernard Pfeifer, M.D.
Compliance, American Health
Executive Editor Information Management Representative for American
Nelly Leon-Chisen, RHIA Association, Chicago Medical Assn., Harwich, MA
Director, Central Office on
Mady Hue, RHIA Donna Pickett, RHIA, MPH
ICD-10-CM/PCS
Technical Advisor, Technology, Chief, Classifications and
Coding and Pricing Group Public Health Data Standards,
Editorial Staff, AHA Central
Centers for Medicare & Centers for Disease Control &
Office on ICD-10-CM/PCS
Medicaid Services, Baltimore Prevention, Hyattsville, MD
Karen Ayala, RHIT
Donna Jones, RHIA, CCS
Coding Specialist Evan Pollack, M.D., FACP
Regulatory Compliance
Representative for American
Senior Coding Consultant
Kristina Cool, RHIA, CCS College of Physicians, Bryn
HCA Healthcare
Coding Consultant Mawr, PA
Nashville, TN 37203
Denene Harper, RHIA
Senior Coding Consultant Subscriptions? Questions? Problems?
Call 312-422-3366
Diane Komar, RHIT
Coding Consultant Individual answers within AHA Coding Clinic® are available for repro-
duction by hospitals and health systems for the purpose of responding to
Susan Latham, RHIT, CCS payor audit requests. The answer needs to be reproduced in its entirety,
Coding Consultant and not edited or altered in any way. Payors, consultants, and other
for-profit, commercial entities may only use AHA Coding Clinic® content
as an internal reference and for audit purposes. AHA Coding Clinic®
Anita Rapier, RHIT, CCS content may not be utilized for commercial, for-profit purposes and may
Managing Editor not be re-sold, repackaged or distributed without the consent of the
Senior Coding Consultant American Hospital Association Central Office. The Content may not be
compiled, shared, or distributed in a way that circumvents the need for
Cherrsse Ruffin, RHIT an individual or entity to access, purchase, or obtain a license to utilize
Coding Consultant Coding Clinic content. The use of usernames and passwords should be
limited to the purchaser and/or user and not shared with other individuals
or entities to circumvent the purchase of an individual license. For more
Kathy White, RHIA
information on obtaining a license to utilize Coding Clinic beyond what is
Coding Consultant listed above, please contact Tim Carlson tcarlson@aha.org.
Gretchen Young-Charles, RHIA
Senior Coding Consultant Coding Clinic is the official publication for ICD-10-CM/PCS coding
guidelines and advice as designated by the four cooperating parties. The
Halima Zayyad-Matarieh, RHIA cooperating parties listed below have final approval of the coding advice
Coding Consultant provided in this publication: American Hospital Association, American
Health Information Management Association, Centers for Medicare &
Medicaid Services (formerly HCFA), National Center for Health Statistics
CDC Medical Officer
David Berglund, M.D. © 2021 by the American Hospital Association. All rights reserved.
Medical Officer, Centers for Reproduction or use of this publication in any form or in any information
Disease Control & Prevention storage or retrieval system is forbidden without express permission of
the publisher. For permission to reprint material from this publication,
please write to the Central Office on ICD-10-CM/PCS, American Hospital
Association, 155 N. Wacker Drive, Suite 400, Chicago, IL 60606.
Coding Clinic Fourth Quarter 2021 3
ICD-10-CM New/Revised Codes
Summary explanations of the Fiscal Year 2022 (FY 2022) ICD-10-
CM changes effective October 1, 2021 are provided below. Addenda
changes demonstrating the specific revisions to the code titles or
instructional notes are not included in the explanations below. The
official ICD-10-CM addenda have been posted on the Centers for
Disease Control and Prevention’s (CDC) National Center for Health
Statistics (NCHS) website at: https://www.cdc.gov/nchs/icd/icd10cm.
htm.
In response to the national emergency that was declared concerning

the COVID-19 outbreak, the NCHS implemented five new ICD-10-CM
diagnosis codes, effective January 1, 2021. The link to the new ICD-
10-CM codes for the 2019 Novel Coronavirus (COVID-19) effective
January 1, 2021 follows:
https://www.cdc.gov/nchs/data/icd/Announcement-New-ICD-code-for-
coronavirus-19-508.pdf
The information below regarding new or revised ICD-10-CM codes

relates only to codes effective October 1, 2021.
There are 159 new ICD-10-CM codes effective October 1, 2021. In

addition, there are 20 revised codes and 32 codes have been deleted.
Anaplasmosis
Subcategory A79.8 Other specified rickettsioses, was expanded

and code A79.82, Anaplasmosis [A. phagocytophilum], has been
created to specifically identify this disease.
Anaplasmosis is a tick-borne disease caused by the bite of an infected

tick, mostly the blacklegged tick or deer tick (lxodes scapularis) and

the western blacklegged tick (lxodes pacificus). It is important to note
Ixodes ticks are commonly coinfected with other organisms and can
transmit Lyme disease, Babesia, Ehrlichia, Rickettsia, and Powassan
virus. In rare cases, anaplasmosis can spread by blood transfusions.
Early signs and symptoms usually occur one to five days after an
infected tick bite. Symptoms are often mild or moderate in nature and
may include fever, chills, malaise, muscle aches and headaches.
Unlike Lyme disease, anaplasmosis does not commonly cause a
rash. Signs and symptoms of severe or late stage illness can include
respiratory failure, bleeding problems, organ failure, and death. Risk
factor of severe illness can be due to delayed treatment, age (older
patients), and a weakened immune system. Prompt treatment can
reduce the risk of developing severe anaplasmosis illness.
The creation of this code will improve coding accuracy, as well as

increase provider and, consequently, population, awareness of this
disease. In addition, the new code will allow the ability to monitor
the spread of the disease nationally, and therefore assist in the
development of appropriate prevention strategies to reduce the
spread of the disease to ensure public safety.
Question:
A 63-year-old patient presented to the hospital
with abrupt onset of fevers, chills, and muscle
weakness. Diagnostic blood work came back
positive for Lyme disease co-infected with
Ehrlichia, and Anaplasmosis. The patient
reported a tick bite while hiking through the
woods about one week ago. The provider
diagnosed Ehrlichia, Lyme disease and
Anaplasmosis; treated the patient with an
antibiotic; and discharged the patient home.
What are the appropriate ICD-10-CM code
assignments for this admission?
Answer:
Assign code A69.20, Lyme disease,
unspecified, and code A79.82, Anaplasmosis
[A. phagocytophilum]. The Excludes1 note
at subcategory A77.4, Ehrlichiosis, prohibits
assigning code A79.82 and code A77.40,
Ehrlichiosis, unspecified, together.

Malignant Neoplasm of Bilateral Ovaries
Code C56.3, Malignant neoplasm of bilateral ovaries, was created

to identify a malignancy in both ovaries. This concept was repeated
for a secondary malignant neoplasm of both ovaries, with the creation
of code C79.63, Secondary malignant neoplasm of bilateral
ovaries.
Anaplastic Large Cell Lymphoma,

ALK-Negative, Breast
A new code has been created for anaplastic large cell lymphoma,
ALK-negative, of the breast (C84.7A), and there is an inclusion term
for breast implant associated anaplastic large cell lymphoma (BIA-
ALCL).
BIA-ALCL is a rare type of non-Hodgkin’s lymphoma that can develop

around breast implants. It is not a disease of the lymph nodes or the
breast tissue. This is a cancer of the immune system, rather than a
type of breast cancer. BIA-ALCL occurs most frequently in patients
who have breast implants with a textured surface. It has been found
with both silicone and saline implants in patients with both breast
cancer reconstruction and cosmetic surgery.
The most common symptoms are swelling of the lymph nodes,

unexplained breast enlargement, asymmetry, fluid buildup or a lump
or pain in the breast or armpit. These symptoms may occur after the
surgical incision has healed, often years after implant placement. A
complication code from chapter 19 is not assigned for ALK-negative
breast implant associated anaplastic large cell lymphoma.
Anemia Due to Pyruvate Kinase Deficiency

Anemia Due to Other Disorders
of Glycolytic Enzymes
New codes have been created to describe anemia due to pyruvate

kinase deficiency and anemia due to other disorders of glycolytic
enzymes as follows:
• D55.21 Anemia due to pyruvate kinase deficiency

• D55.29 Anemia due to other disorders of glycolytic
enzymes

Red blood cell (RBC) pyruvate kinase (PK) deficiency is a rare
congenital hemolytic anemia caused by mutations in the pyruvate
kinase liver and red blood cells (PKLR) gene that encodes PK. The
PKLR gene provides instructions for making an enzyme called PK.
The PK enzyme is involved in a critical energy-producing process
known as glycolysis. PK deficiency is inherited via an autosomal
recessive pattern and has a wide geographic distribution. People with
this disorder have chronic hemolytic anemia, a condition in which
RBCs break down faster than normal, resulting in a shortage of RBCs
(anemia).
The degree of hemolysis in PK deficiency is variable, ranging from

mild or fully compensated forms of anemia to life-threatening anemia
requiring regular transfusions. This condition may occur at any point
from infancy through young adulthood. The manifestations of PK
deficiency can be unpredictable throughout life and the potential for
serious complications require frequent monitoring, regardless of the
degree of anemia. Iron overload is one of the serious complications
commonly seen. Patients with this condition have a significant burden
of disease and there is a negative impact on quality of life. There is
no cure for PK deficiency and treatment measures are supportive in
nature.
Other disorders of glycolytic enzymes include deficiencies of the

glycolytic enzymes: hexokinase (HK), phosphoglucose isomerase
(PGI), phosphofructokinase (PFK), aldolase (ALD), triose phosphate
isomerase, phosphoglycerate kinase (PGK), and enolase. All of these
deficiencies have also been reported in association with chronic
hemolytic anemia.
The creation of these new codes was supported by the American

Society of Hematology (ASH) and will help to determine the incidence
and prevalence of this disease, which could lead to improved
treatment for this patient population.
Thrombocytosis and Essential Thrombocythemia
New subcategory D75.83, Thrombocytosis, has been created

to separately identify other thrombocytosis, including secondary
thrombocytosis and reactive thrombocytosis (D75.838) and
unspecified thrombocytosis (D75.839). The change will allow
for differentiation in coding neoplastic cases of essential

thrombocythemia and cases of secondary or reactive thrombocytosis,
which are not neoplastic in nature.
Thrombocythemia and thrombocytosis are characterized by an

abnormally high platelet count in the blood. Thrombocytosis (or
thrombocythemia) is often described as secondary or reactive, in
which another disease, condition, or outside factor causes the high
platelet count. Treatment and outlook for secondary thrombocytosis
depend on the underlying cause. When the cause of the high platelet
count is not known, the preferred term is thrombocythemia.
Hereditary Alpha Tryptasemia
Subcategory D89.4, Mast cell activation syndrome and related

disorders, has been expanded with the creation of code D89.44,
Hereditary alpha tryptasemia.
Hereditary alpha tryptasemia (HαT) is a genetic trait that is

characterized by an elevated basal serum tryptase, a mast cell
mediator, and increased copies of the gene TPSAB1. The increase
of tryptase and copies of TPSAB1 are associated with multiple
complaints, such as skin flushing, pruritus, dysautonomia (dysfunction
of the autonomic nervous system), chronic pain, and connective
tissue abnormalities. Those with hereditary alpha tryptasemia have an
increased risk of severe allergic reactions to stinging insects, including
anaphylaxis. This new code will enable tracking of disease prevalence
and patient outcomes for this condition.
Niemann-Pick disease Type A/B
Subcategory E75.24 Niemann-Pick disease has been further

expanded, and a unique code E75.244 Niemann-Pick disease type
A/B, has been created.
Niemann-Pick disease (NPD) types A and B (and A/B) are also

known as acid sphingomyelinase deficiency (ASMD), and these
are rare progressive genetic disorders that are potentially life
threatening. ASMD results from a deficiency of an enzyme called acid
sphingomyelinase, also known as ASM enzyme, which is required to
metabolize a fatty substance called sphingomyelin. When the body
is unable to make enough ASM enzymes, sphingomyelin cannot be
broken down efficiently, which leads to a buildup of fatty substances in

major organs such as the liver, lungs, and spleen. Over time, this can
lead to complications, as these organs may not be able to function
properly. This disease has a wide variety of symptoms that can affect
the liver, lung, spleen, blood, as well as the digestive system.
There are three types of ASMD: type A, type A/B, and type B. Codes
already exist for type A and type B at subcategory E75.24, Niemann-
Pick disease. Therefore, a unique code has been created for type
A/B. ASMD type A/B includes patients with disease manifestations
in-between type A and type B; the diagnosis is sometimes called
intermediate NPD or type A/B ASMD. There can be considerable
overlap along the entire ASMD disease spectrum with symptoms
ranging in onset, complexity and severity. The creation of code
E75.244 will allow accurate reporting of ASMD type A/B and allow
further specification of the clinical manifestations and the risks
associated with this specific type of ASMD.
NPD types C and D have a different pathophysiology and are not

caused by ASMD.
Depression Not Otherwise Specified
A code has been created to identify depression (unspecified) and the

narrative at category F32 was revised from Major depressive disorder,
single episode to “Depressive episode.” This retitling brings back
the WHO ICD-10 category title, and also brings the title into better
alignment with all of what has been included in the category. The new
code follows:
• F32.A Depression, unspecified
Depression is a common mental health disorder. Approximately

30% of patients report symptoms of depression to their primary care
providers; however, fewer than 10% of these patients have major
depression. Although depression can begin at almost any age, it
typically develops during a person’s mid-teens, 20s, or 30s. When
untreated, an episode of depression may last from 6 months to two
years or more, and episodes tend to recur several times over a
lifetime.
The exact etiology of depression is unclear; however, risk factors may

include heredity, certain physical disorders, emotionally distressing
events, changes in hormone levels, and side effects of certain drugs.

Symptoms of depression vary, and typically develop gradually over
days or weeks. Symptoms may include anxiety, feelings of loneliness,
irritability, sadness, poor concentration, poor hygiene, and loss of
interest in activities that were once enjoyed. Some people have
poor appetite while others overeat. Some become withdrawn, have
difficulty sleeping or sleep more than usual, and some have thoughts
of death and suicide.
Previously in ICD-10-CM, the default for Depression not otherwise

specified (NOS) was code F32.9, Major depressive disorder, single
episode, unspecified. However, this code did not separately capture
the actual occurrence of depression not further specified, and
statistically inflated the incidence of major depressive disorder.
Question:
A 25-year-old male patient was seen in his
physician’s office for a follow up visit. He
continues to express feelings of loneliness,
sadness, and loss of interest in hobbies that
he once enjoyed. The provider diagnosed
depression. What is the correct code
assignment for depression?
Answer:
Assign code F32.A, Depression, unspecified,
for depression not further specified.
Other Intellectual Disabilities
Code F78, Other intellectual disabilities, has been expanded with

the creation of subcategory F78.A, Other genetic related intellectual
disabilities. As a result, there are now new codes to capture genetic
causes of intellectual disabilities.
Code F78.A1, SYNGAP1-related intellectual disability, was

created to capture intellectual disability due to insufficiency of the
gene SYNGAP1. SYNGAP1 is one of the more common genes
related to intellectual disability, and its presence is an essential part
of neurodevelopment and neuron function. SYNGAP1 insufficiency
is a rare, genetic autosomal dominant disorder, which decreases
the expression of SYNGAP1 resulting in disability. The impairments

may be characterized by intellectual disability, developmental delays
along with varying degrees of autism, epilepsy, hypotonia and sleep
disturbances.
Code F78.A9, Other genetic related intellectual disability, was

created to capture other specified genetic forms of intellectual
disability. Codes titled “other” or “other specified” are for use when the
information in the medical record provides detail for which a specific
code does not exist.
The creation of these two new codes will aid in disease prevalence
monitoring, comparison of best practices and treatment costs, as well
as recruitment of subjects for clinical trials and patient registries.
Acute Flaccid Myelitis
A new code (G04.82) was created to identify acute flaccid myelitis

(AFM). Although rare, AFM is a serious neurologic condition that
affects the gray matter of the spinal cord and causes the muscles
and reflexes of the body to weaken. Neurologic symptoms may be
preceded by a febrile respiratory illness and sometimes pain in the
extremities. The most common signs and symptoms may include
facial drooping/weakness, trouble moving the eyes, drooping eyelids,
trouble swallowing or slurred speech. More severe symptoms involve
complete paralysis, the inability to breathe, and respiratory failure,
which can result in the need for long-term mechanical ventilation. AFM
is also known as a “polio-like” illness. The most recent cases in the
United States have been seen in children.
Cervicogenic Headache
A new code (G44.86) was created to specifically capture cervicogenic

headache (CGH).
A CGH is a type of secondary headache that results from referred

pain from the neck that can be due to a variety of conditions. When
the associated cervical condition is known and documented, the
condition should also be reported as instructed by the “code also”
note found at this new code.
Pain caused by a CGH typically begins in the neck and the back of
the head and radiates towards the front of the head. People with

these types of headaches usually also have neck pain and stiffness.
Certain neck movements can provoke these headaches. CGH can be
difficult to diagnose because the pain is not always felt in the neck and
CGH symptoms can mimic migraines or tension-type headaches.
There are many conditions that can cause CGH. They may occur due
to degenerative conditions, like osteoarthritis, or traumatic conditions,
such as fracture, dislocation or whiplash injury. Underlying medical
conditions such as rheumatoid arthritis, cancer, or infection may also
cause these headaches. Sequencing of CGH and the associated
conditions depends on the circumstances of the encounter.
Question:
A patient with cervical disc displacement of C2-
C3 presented to their provider’s office due to
frequent headaches and neck pain. The patient
was diagnosed with cervicogenic headaches
(CGH) associated with disc displacement
and was prescribed medication for pain
management. What is the appropriate code
assignment for CGH associated with C2-C3
disc displacement?
Answer:
Assign code G44.86, Cervicogenic headache,
for CGH. Code M50.21, Other cervical disc
displacement, high cervical region, should
also be assigned to capture the associated
condition.
Immune Effector Cell-Associated

Neurotoxicity Syndrome
Code G92, Toxic encephalopathy, has been expanded based on the

American Society for Transplantation and Cellular Therapy (ASTCT)
scale. This expansion also includes codes that describe other and
unspecified toxic encephalopathy. The new codes are as follows:
• G92.00, Immune effector cell-associated neurotoxicity

syndrome, grade unspecified
syndrome, grade 1

syndrome, grade 2
syndrome, grade 3
syndrome, grade 4
syndrome, grade 5
• G92.8, Other toxic encephalopathy
• G92.9, Unspecified toxic encephalopathy.
Immune effector cell-associated neurotoxicity syndrome (ICANS) is a

disorder involving the central nervous system that is associated with
immune therapies such as chimeric antigen receptor (CAR) T-cell
therapy, that activate a patient’s immune response to attack cancer
cells in hematologic and solid tumor malignancies.
ICANS can occur with or independently of cytokine release syndrome

(CRS), another condition that is associated with CAR T-cell therapy.
Symptoms usually occur within 1-3 weeks after CAR T-cell infusion.
They include expressive aphasia, impairments of attention, changes in
handwriting, tremor, motor weakness, and lethargy that can progress
to global aphasia, seizures, a depressed level of consciousness, and
in rare cases, cerebral edema.
In 2018, the ASTCT developed a consensus grading for ICANS.

Factors such as an immune effector cell encephalopathy (ICE) score,
along with an evaluation for level of consciousness, seizure activity,
motor findings, and elevated intracranial pressure/cerebral edema
determine the ASTCT ICANS grade according to the most severe
event (not attributable to any other cause). For example, a patient
with grade 4 ICANS indicates at least one of the following as the most
severe event: being unarousable or requiring vigorous or repetitive
tactile stimuli; prolonged, repetitive seizures or electrical seizures
without return to baseline in between; deep focal motor weakness
such as hemiparesis or paraparesis; or diffuse cerebral edema on
neuroimaging. A patient with grade 2 ICANS awakens to voice, and
is without seizure activity, motor findings or intracranial pressure/
cerebral edema.

These new codes should only be assigned based on explicit
documentation by the provider of the ICANS grade; otherwise, assign
the code for unspecified grade. The underlying cause of ICANS is
coded first. Code also any associated signs and symptoms, such as
seizures and cerebral edema.
Non-Ischemic Myocardial Injury
Code I5A, Non-ischemic myocardial injury (non-traumatic), has

been created to identify a non-traumatic, non-ischemic myocardial
injury. The definition of a non-ischemic myocardial infarction (MI) was
most recently updated in 2018.
According to the Fourth Universal Definition of Myocardial Infarction,

an acute myocardial injury is characterized by the rise and/or fall
of cardiac troponin levels with at least one value above the 99th
percentile upper reference limit. A diagnosis of MI is reserved for
patients with myocardial ischemia as the cause of myocardial injury,
whether attributable to acute atherothrombosis (type 1 MI) or supply/
demand mismatch without acute atherothrombosis (type 2 MI).
Myocardial injury in the absence of ischemia is categorized as acute
or chronic nonischemic myocardial injury. Based on high sensitivity
troponin tests, clinicians can now distinguish whether patients have
suffered a non-ischemic myocardial injury versus one of the other MI
subtypes. This new code will allow for the appropriate classification of
these patients.
When assigning code I5A, sequence the underlying cause first,

such as acute kidney failure, acute myocarditis, etc., if known and/or
applicable.
Question:
A patient presents to the Emergency
Department after becoming progressively
somnolent. Diagnostic workup revealed
elevated troponin level and intermittent atrial
fibrillation and the patient was admitted
for further cardiology management. The
patient never reported any chest pain; did
not demonstrate electrocardiogram (ECG)
changes; troponin levels stabilized; and
at discharge, the provider diagnosed non-

ischemic myocardial injury. How would non-
ischemic myocardial injury be coded?
Answer:
Assign code I5A, Non-ischemic myocardial
injury (non-ischemic), for non-ischemic
myocardial injury.
Esophageal and Esophagogastric Junction Polyps
Code K22.8, Other specified diseases of esophagus, has been

expanded and three new codes have been created to describe
hyperplastic (non-adenomatous) esophageal and esophagogastric
junction polyps, as well as other specified diseases of the esophagus
as follows:
• K22.81, Esophageal polyp

• K22.82, Esophagogastric junction polyp
• K22.89, Other specified diseases of esophagus
Hyperplastic (non-adenomatous) polyps are commonly found at

the esophagogastric junction and the distal esophagus. Typically,
these polyps are asymptomatic and are categorized by hyperplastic
epithelium (foveolar-type, squamous, or both) with variable amounts
of inflamed stroma. Esophageal polyps may be associated with
erosive esophagitis. Other causes include but are not limited to
infection, drug-induced pill esophagitis and prior surgery involving an
anastomosis or a polypectomy.
Previously, ICD-10-CM did not provide specific codes to classify

non-adenomatous or hyperplastic polyps of the esophagus or the
esophagogastric junction.
Gastric Intestinal Metaplasia
Subcategory K31.A, Gastric intestinal metaplasia, has been created

for gastric intestinal metaplasia of the stomach with and without
dysplasia and unspecified gastric intestinal metaplasia.
• K31.A0, Gastric intestinal metaplasia, unspecified

• K31.A11, Gastric intestinal metaplasia without dysplasia,
involving the antrum

involving the body (corpus)
involving the fundus
involving the cardia
involving multiple sites
unspecified site
• K31.A21, Gastric intestinal metaplasia with low grade
dysplasia
• K31.A22, Gastric intestinal metaplasia with high grade
dysplasia
• K31.A29, Gastric intestinal metaplasia with dysplasia,
unspecified
Gastric intestinal metaplasia (GIM) occurs when the normal gastric

epithelium that lines the stomach is replaced with goblet cells from
the intestines. Risk factors associated with GIM are H. pylori infection,
chronic bile reflux, cigarette smoking, family history of gastric cancer,
and high salt intake. GIM is a precancerous lesion. Typically, there
are no noticeable symptoms and GIM may be demonstrated on
diagnostic endoscopy. The pathway to gastric adenocarcinoma is
believed to be a progression from chronic gastritis, atrophic gastritis,
GIM, dysplasia, and finally, abnormal cancerous cells. Metaplastic
changes in the antrum and body of the stomach, indicating diffuse
GIM, are associated with a higher risk for cancer versus involvement
of the antrum alone. The presence of dysplasia, a benign unequivocal
neoplastic epithelial lesion, adds an even greater risk for malignant
transformation, with the location of the lesion being less important.
Irritant Contact Dermatitis
Codes have been created for irritant contact dermatitis that is

associated with prolonged exposure to moisture as follows:
• 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 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
One of the many functions of skin is to protect the body against

substances that penetrate its outer layer and cause damage before
the skin is able to recover and repair itself. Plants, chemicals,
detergents, oils, solvents, acids, and infectious microorganisms are
among the list of irritants that cause irritant contact dermatitis. Irritant
contact dermatitis is damage to the outer layer of skin in reaction
to contact with a substance. A red, itchy, rash or dry, cracked, scaly
skin may develop within minutes to hours of exposure. The area
may become swollen and burn as the irritant penetrates and causes
inflammation. Moisture-associated skin damage causes inflammation
and erosion of the epidermis due to prolonged exposure to secretions
of the body and peristomal moisture. When there is overexposure
to excess amounts of water, the skin softens, swells and becomes
wrinkled, as the body is unable to regulate the absorption of water.
The erosion of the epidermis may produce an exudate that macerates
and breaks down the skin. The warm, humid and soiled conditions
may allow microorganisms to colonize with and without skin infection.
Question:
A patient, who is status post colectomy
secondary to ulcerative colitis, presents
with complaints of skin irritation around his
ileostomy. The provider diagnosed irritant
contact dermatitis caused by leakage of stool
related to the retraction of the ileostomy.
What are the appropriate diagnosis code
assignments for the encounter?
Answer:
Assign code L24.B3, Irritant contact dermatitis
related to fecal or urinary stoma or fistula, for

the irritant contact dermatitis involving the skin
around the ileostomy. Assign code K94.13,
Enterostomy malfunction, for retraction of the
ileostomy.
Question:
An adult patient with stress urinary incontinence
is diagnosed with urine-induced vulvar contact
dermatitis. What are the diagnosis code
assignments for the encounter?
Answer:
Assign code L24.A2, Irritant contact dermatitis
due to fecal, urinary or dual incontinence.
Contact dermatitis that is associated with
prolonged exposure to urine is a form of irritant
contact dermatitis. Assign code N39.3, Stress
incontinence (female) (male), for the stress
urinary incontinence.
Question:
An 80-year-old patient, who wears adult diapers
because of urinary and fecal incontinence,
presents to the Emergency Department due
to painful, irritated and excoriated skin of the
vulva and buttocks. The provider’s diagnostic
statement lists, “Contact dermatitis due to fecal
and urinary incontinence.” What is the ICD-10-
CM code assignment for contact dermatitis in
an incontinent patient who wears adult diapers?
Answer:
Assign code L22, Diaper dermatitis, for contact
dermatitis due to irritation from urine and feces
and diaper wear. Also, assign codes R15.9, Full
incontinence of feces, and R32, Unspecified
urinary incontinence, as secondary diagnoses.
Question:
What codes are assigned for leakage of a
cystostomy catheter causing irritant contact
dermatitis due to urine?

Answer:
Assign codes T83.030A, Leakage of cystosto-
my catheter, initial encounter, and L24.B3,
Irritant contact dermatitis related to fecal or uri-
nary stoma or fistula.
Thrombotic Microangiopathy
Code M31.1, Thrombotic microangiopathy, was expanded to identify
hematopoietic stem cell transplantation associated microangiopathy
(HSCT-TMA), along with unspecified and other specified types of
thrombotic microangiopathies as follows:
• M31.10, Thrombotic microangiopathy, unspecified

• M31.11, Hematopoietic stem cell transplantation-
associated thrombotic microangiopathy [HSCT-TMA]
• M31.19, Other thrombotic microangiopathy
HSCT-TMA is a serious, life-threatening complication of hematopoietic

stem cell transplantation that is caused by endothelial damage. The
condition occurs in both autologous and allogeneic transplants but is
more common in allogeneic transplants.
HSCT-TMA typically presents within the first 100 days post-

transplantation. Patients generally present with signs of
microangiopathic hemolytic anemia, consumptive thrombocytopenia in
the absence of coagulopathy, and microvascular thrombosis with end-
organ damage.
HSCT-TMA often occurs simultaneously with other conditions such

as graft vs. host disease, hepatic veno-occlusive disease, sinusoidal
obstruction syndrome and/or atypical hemolytic uremic syndrome.
When assigning code M31.11, code first, if applicable, a code from
subcategory T86.0-, Complications of bone marrow transplant, or
code T86.5, Complications of stem cell transplant, to capture any
complications of bone marrow or stem cell transplant. As instructed
by the “use additional code” note found at code M31.11, any specific
organ dysfunction should also be coded. In addition, Excludes1
notes were added at subcategory D68.5, Primary thrombophilia, and
category D69, Purpura and other hemorrhagic conditions, to exclude
thrombotic thrombocytopenic purpura (M31.19).

Sjögren Syndrome
Subcategory M35.0- has been expanded and the code narrative

retitled from “Sicca syndrome” to “Sjögren syndrome.” The following
new codes were created to describe Sjögren syndrome and the
associated manifestations:
• M35.05, Sjögren syndrome with inflammatory arthritis

• M35.06, Sjögren syndrome with peripheral nervous
system involvement
• M35.07, Sjögren syndrome with central nervous system
involvement
• M35.08, Sjögren syndrome with gastrointestinal
involvement
• M35.0A, Sjögren syndrome with glomerular disease
• M35.0B, Sjögren syndrome with vasculitis
• M35.0C, Sjögren syndrome with dental involvement
In addition, the narrative at codes M35.00 through M35.04 and

M35.09 have also been retitled from Sicca syndrome to Sjögren
syndrome. Sicca syndrome is now an inclusion term at subcategory
M35.0-.
Sjögren syndrome is an autoimmune disease that is commonly

associated with “Sicca syndrome” or dryness of the mouth and
eyes. Immune cells attack and destroy the healthy cells of moisture
producing glands such as the salivary and lacrimal glands that
produce saliva and tears. The dryness may have many consequences
on the body. A dry mouth may cause dental decay, gingivitis, yeast
infection and difficulty chewing and swallowing food. Dry eyes may
feel irritated or burn with an increased risk for light sensitivity, infection
and corneal damage. While the eyes and mouth are most commonly
involved, Sjögren syndrome is a systemic condition. It affects the
entire body. There may be stiffness, swelling, and pain of the joints,
inflammation of the small vessels of the kidneys, lungs and liver
causing interstitial cystitis, interstitial pneumonia and primary biliary
cholangitis. Numbness and tingling of the extremities may indicate
peripheral nerve involvement. Central nerve involvement may cause
transverse myelitis, muscle weakness, cognitive impairment and
psychiatric conditions.

Non-Radiographic Axial Spondyloarthritis
New codes were created in category M45, Ankylosing spondylitis, to

identify non-radiographic axial spondyloarthritis as follows:
• M45.A0, Non-radiographic axial spondyloarthritis of

unspecified sites in spine
occipito-atlanto-axial region
cervical region
cervicothoracic region
thoracic region
thoracolumbar region
lumbar region
lumbosacral region
• M45.A8, Non-radiographic axial spondyloarthritis of sacral
and sacrococcygeal region
• M45.AB, Non-radiographic axial spondyloarthritis of
multiple sites in spine
Non-radiographic axial spondyloarthritis (nr-AxSpA) is a form of

spondyloarthritis, which is a group of inflammatory diseases that
cause arthritis. “Non-radiographic” means there is no visible damage
seen on X-rays. However, patients are symptomatic, typically with
back pain. “Axial” refers to the joints that the disease affects, such as
the spine, ribs and pelvis. The telltale sign of nr-AxSpA is the type of
back pain that occurs with this form of arthritis. Back pain associated
with nr-AxSpA progressively gets worse at night, while at rest, and
will often subside with movement. By contrast, back pain caused by
mechanical issues, such as strains, sprains, or slipped discs, tends to
improve at rest and increases with movement. Other symptoms of nr-
AxSpA can include weakness, fatigue, stiff and swollen joints, swollen
fingers and heel pain.
Common conditions associated with patients who have this condition

are uveitis, inflammatory bowel disease (IBD), and psoriatic arthritis.
In addition, nr-AxSpA may be described as an early stage of

ankylosing spondylitis (AS), another type of spondyloarthritis. The
main difference between nr-AxSpA and AS is that AS involves visible
damage, which can be demonstrated on imaging reports. While nr-
AxSpA can transition into AS, not all patients who develop nr-AxSpA
will progress to AS.
These new codes will allow for better identification and tracking of this
distinct set of patients.
Vertebrogenic Pain
Code M54.5, Low back pain, was expanded to allow the specific
classification of vertebrogenic low back pain. The new codes identify
low back pain, unspecified (M54.50), vertebrogenic low back pain
(M54.51), and other low back pain (M54.59).
The cause of chronic low back pain is difficult to diagnose. Although

the intervertebral discs are typically the cause, the vertebral endplates
are often overlooked as a potential source of chronic low back pain.
Research involving Modic/endplate changes, which may be seen on

magnetic resonance imaging (MRI), show a relationship between
Modic type endplate changes (lumbar vertebral body marrow and
endplate lesions), and vertebrogenic low back pain.
Low back pain is a broad non-specific diagnosis, which was previously

identified by a single code. The new code will specifically describe
vertebrogenic low back pain and differentiate vertebrogenic pain from
non-specific causes of back pain.
Question:
A patient previously underwent a magnetic
resonance imaging (MRI) of the spine for low
back pain, and the provider’s final interpretation
was Modic type endplate changes. He now
presents for a follow-up visit for the low back
pain, and the provider diagnosed vertebrogenic
low back pain. What is the correct code
assignment for vertebrogenic low back pain?
Answer:
Assign code M54.51, Vertebrogenic low back
pain.

Newborn Affected by Maternal Group B
Streptococcus Colonization
A new code P00.82, Newborn affected by (positive) maternal

group B streptococcus (GBS) colonization, has been created.
Group B streptococcus (GBS), also known as Group B Strep, is a type

of bacterial infection that can be found in a pregnant patient’s genital
area. Typically, GBS infection does not cause problems in healthy
patients before pregnancy. However, GBS can cause serious illness
in the newborn, such as sepsis, pneumonia, meningitis, or seizures.
Approximately one in four pregnant patients (25%) have GBS in their
rectum or vagina. During pregnancy, the mother can pass GBS to
the baby or the infant may be infected from the mother’s genital tract
during birth.
Providers routinely test the newborn for GBS as part of the infant’s
prenatal care. However, not every infant who is born to a mother who
tests positive for GBS will become ill. Newborns are at increased
risk for GBS infection if their mother tests positive for the bacteria
during pregnancy. GBS infection is a leading cause of meningitis
and bloodstream infections in a newborn’s first three months of life.
Because of the high risk of morbidity and mortality for infants who are
born to GBS positive mothers, the American Academy of Pediatrics
(AAP) requested the creation of this code to capture important clinical
information and to allow for adequate tracking and monitoring.
Question:
A newborn, who had a normal vaginal delivery,
is diagnosed with group B streptococcus
colonization and is administered antibiotics
prophylactically. What code should be assigned
for this condition?
Answer:
Assign code Z38.00, Single liveborn infant,
delivered vaginally, as the principal diagnosis.
Assign code P00.82 Newborn affected by
(positive) maternal group B streptococcus
(GBS) colonization, for GBS colonization.

Abnormal Findings on Neonatal Screening
Code P09, Abnormal findings on neonatal screening, has been

expanded with unique codes to describe failed or abnormal results
on screening tests in newborns, as well as abnormal findings on
mandated newborn screens. Four main condition categories are
currently screened: metabolic disorders, endocrine conditions,
hematologic conditions, and neonatal hearing loss. In addition,
newborns are screened for critical congenital heart disease (CCHD).
Abnormal findings on neonatal screening are classified in category

P09 as follows:
• P09.1, Abnormal findings on neonatal screening for

inborn errors of metabolism
congenital endocrine disease
congenital hematologic disorders
• P09.4, Abnormal findings on neonatal screening for cystic
fibrosis
critical congenital heart disease
neonatal hearing loss
• P09.8, Other abnormal findings on neonatal screening
• P09.9, Abnormal findings on neonatal screening,
unspecified
Cough
Code R05, Cough, has been expanded and new codes created to
identify specific types of cough as noted below:
• R05.1, Acute cough

• R05.2, Subacute cough
• R05.3, Chronic cough
• R05.4, Cough syncope
• R05.8, Other specified cough
• R05.9, Cough, unspecified

Coughing is a part of the body’s natural defense mechanism against
inhaled irritants and respiratory infections. The cough clears the
airways of foreign materials and excess secretions. Coughing usually
resolves after the inciting factor is eliminated; however, for some
people, the cough becomes persistent, impacting quality of life and
prompting the patient to seek medical attention.
An acute cough is defined as a cough of less than three weeks

duration in an adult. An acute cough may be a sign of a life-
threatening condition or an exacerbation of a pre-existing respiratory
condition, but most acute coughs are associated with respiratory tract
infections (RTIs) and acute bronchitis is the most common cause
of cough. A cough associated with a RTI usually resolves after the
infection clears.
A subacute cough is very similar to an acute cough in that both may

be related to RTIs and typically resolves after the infection clears.
However, a subacute cough may be caused by conditions such as
pertussis, infection with Mycoplasma or Chlamydia, exacerbations
of other disease (asthma or COPD), or post-infectious cough. The
difference between acute and subacute cough is the duration of the
cough, with subacute lasting longer—from three to eight weeks.
A cough that persists despite treatment of underlying etiologies is

a chronic cough. This type of cough occurs in a small number of
patients and is defined as one that persists after extensive medical
investigation. It is considered a diagnosis of exclusion. The American
Thoracic Society (ATS) and the American College of Chest Physicians
(CHEST) guidelines define an unexplained chronic cough (UCC) as
a cough that occurs as follows: (1) one with no diagnosable cause,
(2) explained but refractory chronic cough, and (3) unexplained and
refractory chronic cough. Some of the more severe symptoms of
chronic cough include incontinence, vomiting and sleep deprivation.
Cough syncope, also called “laryngeal ictus” results in loss of

consciousness after prolonged bouts of cough. This rare phenomenon
can result from transient increases in intracranial pressure and
consequent reduction in cerebral blood flow due to abnormally high
internal jugular vein pressures. Management of cough syncope
focuses on treatment of the underlying condition. There is a “Code
first syncope and collapse (R55)” note at code R05.4, Cough syncope.

Nocturnal Polyuria
Code R35.8, Other polyuria, was expanded to allow the addition

of new code R35.81, Nocturnal polyuria. Code R35.89, Other
polyuria, was also added under this new subcategory to allow the
continued reporting of other and unspecified polyuria.
Nocturnal polyuria is a condition in which polyuria occurs only at

night and in the absence of conditions such as neurogenic bladder,
small bladder, overactive bladder or benign prostatic hyperplasia.
Nocturnal polyuria is typically caused by the production of too much
urine at night. With this condition, the usual day to night ratio of urine
production is altered with more than one third of the patient’s total
daily urine output occurring at night, although the total daily urine
output remains normal. Nocturnal polyuria is more specific than
nocturia or polyuria. It usually does not overlap with these conditions.
This condition may occur in patients with edema forming conditions,

such as congestive heart failure; in patients with neurodegenerative
conditions, such as Parkinson’s disease or Alzheimer’s disease;
and in patients with diabetes mellitus and/or chronic kidney disease.
However, the cause of the majority of cases of nocturnal polyuria is
unknown.
Non-Suicidal Self-Harm
A new code has been created to describe non-suicidal self-harm

(R45.88). The new code provides a way to differentiate between
suicidal and non-suicidal self-harm, and allows non-suicidal self-harm
to be treated and tracked in clinical databases.
Non-suicidal self-harm is directly and intentionally inflicting damage

to one’s own body without intention of suicide. Self-harm may include
cutting, biting, burning, severe abrading or scratching, pinching,
banging or punching objects and oneself, and breaking bones.
Self-harm is not a mental illness, but a behavior that indicates a need

for better coping skills. It is a harmful way to cope with emotional
pain, anger and frustration. Individuals engaging in self-harm
report that they do it, because it feels good or it provides a rush.
Several illnesses are associated with self-harm, including borderline
personality disorder, depression, eating disorders, anxiety or
posttraumatic stress disorder.

Self-harm has less to do with the method used to hurt one’s body than
the intention to hurt oneself.
Question:
A 13-year-old presented to the pediatrician’s
office after his mother witnessed, on several
occasions the patient intentionally biting
himself. He denied wanting to end his life and
stated that he often feels anxious because
of stressful situations at school. The provider
diagnosed non-suicidal self-harm. What is the
correct code assignment for non-suicidal self-
harm?
Answer:
Assign code R45.88, Nonsuicidal self-harm, for
this condition. Assign additional codes for any
bite injury.
Pediatric Feeding Disorder
Code R63.3, Feeding difficulties, has been expanded and several

codes were created to separately classify feeding difficulties,
unspecified (R63.30), pediatric feeding disorder, acute (R63.31),
pediatric feeding disorder, chronic (R63.32) and other feeding
difficulties (R63.39). Codes R63.31 and R63.32 are used for infants
and children older than 28 days. However, if the feeding problem
starts at birth and persists beyond the perinatal period, codes from
category P92, Feeding problems of newborn, may be assigned
with codes from subcategory R63. Any associated conditions (e.g.,
dysphagia, malnutrition) should also be coded, if applicable.
Pediatric feeding disorder (PFD) is defined as impaired oral intake

that is not age-appropriate, and is associated with medical, nutritional,
feeding skill, and/or psychosocial dysfunction. Patients with PFD can
experience limitations, including not being able to feed effectively
which leads to participation restrictions or modifications in childcare,
school, and other environments involving mealtime interactions. PFDs
can profoundly affect a child’s physical, social, emotional, and/or
cognitive function, and increase caregiver stress.

Consistent with accepted norms, PFD can be classified into acute (< 3
months’ duration) and chronic (> 3 months’ duration). Acute PFD may
be caused by medical conditions, such as esophagitis or a choking
episode. Chronic PFD has myriad causes (e.g., gastroesophageal
reflux, dysphagia, malnutrition, and psychosocial issues). As with
other clinical conditions, it is the provider’s responsibility to document
whether the PFD is acute or chronic. If the PFD is not specified as
acute or chronic, code R63.30, Feeding difficulties, unspecified,
should be assigned.
These new diagnosis codes will enable providers and researchers to

better characterize pediatric feeding disorders, facilitate inclusion of all
relevant disciplines in treatment planning, and allow the advancement
of clinical research.
Abnormal Findings of Blood Amino-Acid Level
A new code was created to describe abnormal findings of blood

amino-acid level (R79.83), which includes homocysteinemia.
Previously, ICD-10-CM classified homocysteinemia and

homocystinuria to code E72.11, Homocystinuria, within subcategory
E72.1, Disorders of sulfur-bearing amino-acid metabolism. However,
clinically, homocysteinemia is distinct from homocystinuria, as
homocystinuria generally refers to an inborn error of metabolism,
and typically manifests with certain phenotypes representing disease
states. Homocysteinemia is defined as elevation of homocysteine
levels in blood. Therefore, using the term homocysteinemia
in the clinical setting does not express the same meaning as
homocystinuria.
Question:
What is the correct code assignment for
homocysteinemia?
Answer:
Assign code R79.83, Abnormal findings of
blood amino-acid level, for homocysteinemia.

Traumatic Brain Compression and Herniation
A new subcategory S06.A, Traumatic brain compression and

herniation, has been created with new codes to identify traumatic
brain compression with and without herniation. The new codes with
the corresponding seventh characters for initial encounter, subsequent
encounter and sequela are as follows:
• S06.A0, Traumatic brain compression without herniation

• S06.A1, Traumatic brain compression with herniation
Brain compression and herniation may occur when brain tissue,

cerebrospinal fluid, and blood vessels are moved or pushed away
from their usual position inside the skull. Pressure resulting in such
movement can be caused by brain swelling from a head injury, stroke,
brain tumor, abscess, hydrocephaly, or other underlying cause.
Brain herniation can occur between areas inside the skull, such as
those separated by a rigid membrane like the tentorium or falx, or to
the outside of the skull, through the foramen magnum, or through a
craniotomy opening, or other defect, whether traumatic or congenital.
Traumatic brain injury (TBI) is one of the most common causes of

brain compression and brain herniation. Different parts of the brain
may herniate, each causing a different clinical syndrome. Brain
compression may also be significant, whether or not herniation is
present. Brain compression and herniation may be fatal if not treated.
The presence or absence of brain compression or herniation is an

important clinical distinction. TBI is an important area of research, and
having codes to differentiate whether or not brain herniation is present
will allow for enhanced research and possibly advance the care of
these patients.
When assigning codes for traumatic brain herniation, sequence first a

code for the underlying TBI, such as diffuse TBI, focal TBI, traumatic
subdural hemorrhage, traumatic subarachnoid hemorrhage, etc. An
Excludes1 note was added at code G93.5, Compression of brain,
to exclude subcategory S06.A, Traumatic brain compression and
herniation.

Synthetic Cannabinoids
Subcategory T40.7, Poisoning by, adverse effect of and underdosing

of cannabis (derivatives), has been expanded to differentiate
poisoning, adverse effect of and underdosing of cannabis from
synthetic cannabinoids.
The two new sub-subcategories are:

• T40.71, Poisoning by, adverse effect of and underdosing
of cannabis (derivatives)
• T40.72, Poisoning by, adverse effect of and underdosing
of synthetic cannabinoids
Corresponding codes have been created at each subcategory for
poisoning accidental (unintentional), poisoning intentional self-
harm, poisoning assault, and poisoning undetermined, as well as for
adverse effect and underdosing. Appropriate seventh characters are
required for initial encounter, subsequent encounter and sequela.
Synthetic cannabinoids are man-made psychoactive substances

made up of hundreds of chemical compounds that some people
use as an alternative to marijuana. These chemicals are called
cannabinoids because they act on the same brain cell receptors as
tetrahydrocannabinol (THC), which is the main active ingredient in
marijuana. However, the hundreds of known synthetic cannabinoid
chemicals are different from THC and may affect the brain in distinct
and unpredictable ways. The majority of synthetic cannabinoids are
made illicitly and are illegal in the United States (US). The federal
government has banned many specific synthetic cannabinoids and
many states and local governments have passed their own laws
targeting these substances.
Synthetic cannabinoids have contributed to illness, injury and even

death in the US. They are harmful and can affect your brain health
causing issues with mood, concentration problems, seizures,
hallucinations, delusions, psychosis, suicidal thoughts and/or violent
behavior.
These substances can also cause other health problems such as

breathing issues, gastrointestinal symptoms, elevated heart rate
and/or blood pressure. Synthetic cannabinoids are addictive and
can cause withdrawal symptoms in those who have used these
substances heavily over a long period.

Complications of Immune Effector Cellular Therapy
A new code has been created to capture complications of immune

effector cellular (IEC) therapy with the corresponding seventh
characters for initial encounter, subsequent encounter and sequela as
follows:
• T80.82, Complication of immune effector cellular therapy
Immune effector cells have the ability to modulate or effect an

immune response. B cells, dendritic cells, natural killer cells, and T
cells are collected from the patient, transformed into a therapeutic
product, and then administered back into the patient. These cellular
therapy products are part of an innovative cancer treatment called
immunotherapy, in which the patient’s immune system attacks the
malignancy. Although immunotherapy has improved outcomes for
pediatric and adult patients, this treatment may be toxic for some
patients, causing cytokine release syndrome (CRS) and immune
effector cell-associated neurotoxicity syndrome (ICANS). As IEC
therapies, especially chimeric antigen receptor (CAR) T-cell therapy,
become more widely used, there is a need for standardized toxicity
management.
When reporting codes for complications of IEC therapy, assign an

additional code to describe the specific complication, such as CRS or
ICANS. The creation of this code will help to facilitate improved data
collection and track outcomes.
Post COVID-19 Condition
Code U09.9, Post COVID-19 condition, unspecified, was created

to identify health problems that can last for an extended time (often
weeks or months) after the initial COVID-19 infection has resolved,
even if the initial infection was mild or asymptomatic. As experts
from the Centers for Disease Control and Prevention (CDC) and
the World Health Organization (WHO) continue to learn about the
short-term and long-term health effects associated with COVID-19,
scientific knowledge is evolving. Post COVID conditions (also referred
to as “long COVID” or “long-haul COVID”) can refer to post COVID
conditions ranging from symptoms such as fatigue or loss of smell or
taste, to more serious conditions such as chronic respiratory failure.

Code U09.9 should not be assigned for manifestations of an active
(current) COVID-19 infection. Refer to the new guidelines (included
in this issue of Coding Clinic) for additional information on the usage
of code U09.9. Please be aware that code Z86.16, Personal history
of COVID-19, should not be assigned if the patient still has any
COVID-19 related manifestation or residual symptoms as the Official
Guidelines for Coding and Reporting state, “personal history codes
explain a patient’s past medical condition that no longer exists and is
not receiving any treatment, but that has the potential for recurrence,
and therefore may require continued monitoring.”
Please refer to the Frequently Asked Questions Regarding ICD-10-

CM/PCS Coding for COVID-19 on page 101 of this issue of Coding
Clinic that has been updated to reflect the usage of code U09.9.
External Cause of Injury Code for Legal

Intervention Involving Other Specified Means,
Unspecified Person Injured
A new code has been created at subcategory Y35.89, Legal

intervention involving other specified means, to separately classify
legal intervention involving other specified means, unspecified person
injured (Y35.899).
This new code will identify “unspecified person injured” to be

consistent with the ICD-10-CM coding convention.

Z Codes Update
There are eight new Z codes created as noted below.
Status
Code Z91.014, Allergy to mammalian meats, was created to track

food allergy to meats such as beef, lamb, pork and other red meats.
Tracking food allergy to red meat and other products derived from
mammals is important in alpha-gal syndrome, a recently identified
type of food allergy. In the United States, the condition most often
begins when a Lone Star tick bites a person and transmits the alpha-
gal sugar molecule into the person’s body. In some individuals, the
tick bite triggers an immune system reaction that later produces mild
to severe allergic reactions to mammalian meats.

History (of)
Code Z91.5, Personal history of self-harm, was expanded with new

codes created as noted below:
• Z91.51 Personal history of suicidal behavior

• Z91.52 Personal history of nonsuicidal self-harm
Code Z91.51 will allow the reporting of personal history of suicidal

behavior, including personal history of parasuicide, personal history of
self-poisoning, and personal history of suicide attempt. Code Z91.52
will allow the unique identification of personal history of nonsuicidal
self-harm (self-injury), including personal history of self-inflicted injury
without suicidal intent, and personal history of self-mutilation. The new
codes will provide the ability to differentiate between history of suicidal
behavior from history of non-suicidal self-harm. Please note that, new
code R45.88, Nonsuicidal self-harm, was created and described
earlier on page 26 of this issue of Coding Clinic.
Subcategory Z92.8, Personal history of other medical treatment, was

expanded with the creation of sub-subcategory Z92.85, Personal
history of cellular therapy. Four new codes were created. Code
Z92.850, Personal history of Chimeric Antigen Receptor T-cell
therapy, was created to track patients who have received Chimeric
Antigen Receptor T-Cell Therapy (CAR-T). Tracking encounters for

these patients is important for the long-term impact and benefits of
CAR-T therapy, assessment of costs and other issues presented by
this evolving therapy. Three other codes created under subcategory
Z92.8 are for personal history of other cellular therapy (Z92.858),
personal history of unspecified cellular therapy (Z92.859), and
personal history of gene therapy (Z92.86)
Counseling
Code Z71.85, Encounter for immunization safety counseling,

was created to identify encounters where the caregiver or patient
presents specifically for counseling regarding the safety of a vaccine.
This code should not be used for the provision of general information
regarding risks and potential side effects during routine encounters
for the administration of vaccines. These encounters may involve the
patient or parent seeking an alternative vaccine, alternative vaccine
schedule or a discussion with the provider regarding vaccine product
safety. The immunization may or may not be provided during the
same encounter. Also, assign code Z23, Encounter for immunization,
if the immunization is provided during the same encounter. If the
immunization is not carried out during the same encounter, if
appropriate, also assign a code from category Z28, Immunization not
carried out and underimmunization status.
Social Determinants of Health
Eleven new codes have been created to provide additional information

regarding social determinants of health (SDOH) in the following
categories/subcategories:
• Z55, Problems related to education and literacy – Code

Z55.5 was added for less than a high school diploma, to
distinctly represent the known risk imparted by inability to
attain a high school diploma or equivalent, independent of
literacy.
• Z58, Problems related to physical environment – is a new

category with code Z58.6 created to identify inadequate
drinking-water supply, including lack of safe drinking water.
• Z59.0, Homelessness, has been expanded with new codes

to distinguish sheltered homelessness (Z59.01), unsheltered

homelessness (Z59.02) and unspecified homelessness
(Z59.00). A critical use case for this distinction is discharge
planning from both a treatment plan and risk perspective.
• Code Z59.4, Lack of adequate food and safe drinking water,

has been revised and is now a subcategory for lack of
adequate food; safe drinking water has been moved to new
category Z58. New codes have been created as follows:
Z59.41, Food insecurity, and Z59.48, Other specified
lack of adequate food. The health risks and health costs
associated with food insecurity are well documented.
Research by the United States Department of Agriculture
indicates health risk increases as severity of food insecurity
increases. Inadequate food or lack of food not specified as
“food insecurity” is classified to code Z59.48.
• Subcategory Z59.8, Other problems related to housing

and economic circumstances, has been expanded and a new
subcategory (Z59.81) created with specific codes to classify
housing instability, housed. Subcategory Z59.81 includes
foreclosure on home loan, past due on rent or mortgage, and
unwanted multiple moves in the last 12 months. The new
codes distinguish housing instability, housed, with risk of
homelessness (Z59.811), homelessness in past 12 months
(Z59.812), and unspecified (Z59.819).
• New code Z59.89, Other problems related to housing and

economic circumstances, includes foreclosure on loan,
isolated dwelling and problems with creditors.
The new codes are aligned with standardized screening questions

and answers such as the Protocol for Responding to and Assessing
Patients’ Assets, Risks, and Experiences (PRAPARE), the
Accountable Health Screening Tool, or the Health Leads Screening
Tools.
The following commonly accepted definitions for homelessness

and housing instability have been provided by the Gravity Project, a
multi-stakeholder public collaborative with the goal to develop, test,
and validate standardized SDOH data for use in patient care, care
coordination between health and human services sectors, population
health management, public health, value-based payment and clinical
research.

Homelessness
Defined as because of economic difficulties, currently living in a
shelter, motel, temporary or transitional living situation, scattered site
housing, not having a consistent place to sleep at night, or sleeping in
a place not meant for human habitation.
Source Homelessness During Infancy: Associations With Infant and Maternal Health
and Hardship Outcomes
Source Unstable Housing and Caregiver and Child Health in Renter Families
Homelessness, sheltered
Defined as because of economic difficulties, currently living in a
shelter, motel, temporary or transitional living situation, scattered site
housing, or not having a consistent place to sleep at night.
Homelessness, unsheltered
Defined as residing in a place not meant for human habitation, such
as cars, parks, sidewalks, abandoned buildings (on the street).
Source HUD
Housing instability, housed

Defined as currently consistently housed, but experiencing any of the
following circumstances in the past 12 months: being behind on rent
or mortgage, multiple moves.
Source Promoting Caregiver and Child Health Through Housing and Stability
Screening in Clinical Settings
Housing instability, housed with risk of homelessness

Defined as currently consistently housed, but with the imminent threat
of being forced to live in a shelter, motel, temporary or transitional
living situation, scattered site housing, not having a consistent place
to sleep at night, or in a place not meant for human habitation.
Housing instability, housed, homelessness in the past 12 months

Defined as currently consistently housed, but with a history of
homelessness, for any period of time during the past 12 months.

In addition, the ICD-10-CM Official Guidelines for Coding and
Reporting have been revised and a new section created for Social
Determinants of Health under Chapter 21, Factors influencing health
status and contact with health services. Information previously found
in Section I of the guidelines related to documentation that may be
used for code assignment for social determinants of health has been
moved to this newly created section. For the specific changes, please
refer to the summary of the modifications to the ICD-10-CM Official
Guidelines for Coding and Reporting, starting on page 95 of this
issue.

ICD-10-PCS New/Revised Codes
A summary of the Fiscal Year 2022 (FY 2022) ICD-10-PCS changes
effective October 1, 2021 is provided below. The addenda changes
demonstrating the specific revisions to the code titles are not included
in the explanations below. The FY 2022 ICD-10-PCS updates,
including the complete list of ICD-10-PCS code titles, addenda, and
a conversion Table showing changes from the previous year are
available on the Centers for Medicare & Medicaid Services (CMS)
website at https://www.cms.gov/medicare/icd-10/2022-icd-10-pcs.
There are 191 new ICD-10-PCS codes effective October 1, 2021.

There were 62 revised code titles and 107 codes deleted.
The majority of new codes are in Section 0-Medical and Surgical

and Section X-New Technology. There are also a small number of
changes in Sections B-Imaging, 3-Administration, 4-Measurement
and Monitoring, and 5-Extracorporeal or Systemic Assistance and
Performance.
The specific changes are described below by section. Additions are

shown as underlined, and deletions are shown as strikeouts in the
excerpts from the ICD-10-PCS Tables below. The changes originate
from public comments, CMS internal review, as well as questions
submitted to Coding Clinic discussed by the Editorial Advisory Board
for Coding Clinic with recommendations for more specific values.
Section 0-Medical and Surgical
Ultrasonic Surgical Aspiration of Brain
In code Table 00D, Extraction of Central Nervous System and Cranial

Nerves, the body part values 0 Brain and 7 Cerebral Hemisphere,
have been added to identify procedures such as microsurgical
hemispherotomy performed using cavitron ultrasonic surgical
aspiration as shown below.

Body Part Approach Device Qualifier
0 Brain 0 Open Z No Device Z No Qualifier
7 Cerebral 3 Percutaneous
Hemisphere 4 Percutaneous
Endoscopic
The Cavitron Ultrasonic Surgical Aspirator (CUSA) uses ultrasonic

frequencies/vibrations to destroy and emulsify target tissues. The
ultrasound waves cause the cells to separate from one another
while the device irrigates the area with sterile saline. The CUSA
then aspirates the fluid back out of the surgical site through a built-in
suction tube.
Question:
A patient presented for microsurgical
hemispherotomy for intractable seizures.
During surgery, the incision along the previous
suture line was opened. Subcutaneous
dissection was carried out down to the bone
flap, which was then elevated and retracted.
The dura was opened along the previous suture
line. At this point, entry into the temporal horn
was made. Using a cavitron ultrasonic surgical
aspirator (CUSA), the temporal horn was
gradually removed until the atrium was reached
and from the atrium, any tissue between the
ventricle and the thalamus was removed. The
choroid plexus was identified and medial to
the choroid plexus, an additional part of the
fornix was removed and sectioned. At this point
under visual inspection, it was confirmed that
the corpus callosum was completely resected
as also the frontal basal dissection. What is
the appropriate root operation for the use of a
cavitron ultrasonic surgical aspirator (CUSA) to
remove brain tissue?

Answer:
Assign the following procedure code:
00D00ZZ Extraction of brain, open

approach, for the cavitron
ultrasonic surgical aspiration of
the corpus callosum, a structure
that connects the cerebral
hemispheres.
The ICD-10-PCS Body Part Key instructs

coding professionals to use the body part value
0 Brain for procedures performed on the corpus
callosum.
Question:
A patient presented for left frontal lobe
resection of residual central nervous system
(CNS) neuroblastoma to reduce tumor burden.
At surgery, after incision and previous stitch
removal the scalp flap was reflected anteriorly,
the bony edge was delineated circumferentially,
the dura was tacked back and the brain
was inspected. There was an opening in the
frontal region anteriorly that was consistent
with residual tumor. Using the CUSA, pieces
of tumor were resected. Frozen specimen
came back positive for CNS neuroblastoma,
therefore, gross total resection identifying white
matter around the hemosiderin stained tissue in
this area was performed. Further resection was
completed in gross total fashion with the CUSA.
What is the appropriate root operation for the
use of a cavitron ultrasonic surgical aspirator
(CUSA) to resect the CNS neuroblastoma?
Answer:
00D70ZZ Extraction of cerebral

hemisphere, open approach,
for the CUSA resection of
neuroblastoma.

Coronary Orbital Atherectomy
In code Table 02C, Extirpation of Heart and Great Vessels, new codes
have been created by adding Qualifier Value 7 Orbital Atherectomy
Technique, for the coronary artery body parts as shown below. The
change creates replacement codes in the Med/Surg Section for codes
deleted as a result of updating Section X Group 1 codes. For more
information on the updating of Section X, refer to page 57 of this
issue.
Section: 0 Medical and Surgical

Body System 2 Heart and Great Vessels
Operation: C Extirpation
0 Coronary Artery, 3 Percutaneous Z No Device 7 Orbital
One Artery Atherectomy
1 Coronary Artery, Technique
Two Arteries
2 Coronary Artery,
Three Arteries
3 Coronary Artery,
Four or More
Arteries
Coronary Intravascular Lithotripsy
In code Table 02F, Fragmentation of Heart and Great Vessels, body

part values for coronary artery(ies) as noted below were added to
identify coronary intravascular lithotripsy.

0 Coronary Artery, 3 Percutaneous Z No Device Z No Qualifier
One Artery
1 Coronary Artery,
Two Arteries
2 Coronary Artery,
Three Arteries
3 Coronary Artery,
Four or More
Arteries

Coronary intravascular lithotripsy (IVL) is a new treatment that utilizes
controlled sound waves in short pulses to selectively crack intimal
and medial calcium within coronary artery(ies) without affecting soft
tissue. Once fractured, the calcium’s resistance to balloon dilatation
is reduced, thereby allowing the blood vessel to be dilated using a
low-pressure angioplasty balloon prior to coronary stenting. Separate
ICD-10-PCS code(s) are assigned for angioplasty or stent insertion if
performed.
The procedure is performed using multiple lithotripsy emitters that

are integrated into a semi-compliant balloon-catheter platform.
The coronary IVL catheter is advanced to the target lesion and the
integrated balloon is inflated with fluid at a low pressure to contact
the arterial wall. Coronary IVL is activated, creating a small bubble
within the catheter balloon that rapidly expands and collapses. Sonic
pressure waves are created that travel through the innermost layer of
the vessel wall to crack the calcified lesions within the vessel wall.
Total Artificial Heart Systems
In table 02R, Replacement of Heart and Great Vessels, new

device value L Biologic with Synthetic Substitute, Autoregulated
Electrohydraulic, was created as shown below to identify implantation
of an autoregulated electrohydraulic total artificial heart system.

A Heart 0 Open L Biologic Z No Qualifier
with Synthetic
Substitute,
Autoregulated
Electrohydraulic
In addition, a new device value M Synthetic Substitute, Pneumatic,

was created to identify implantation of a total artificial heart that uses
external pneumatic drivers.

A Heart 0 Open M Synthetic Substitute, Z No Qualifier
Pneumatic

The new codes will distinguish between two totally artificial heart
systems: SynCardia and Carmat. The SynCardia device is a
pneumatically driven pulsatile system and is indicated for use as a
bridge to transplantation in cardiac transplant-eligible candidates
at risk of imminent death from biventricular failure. The Carmat
device is an integrated autoregulated and electrohydraulically driven
biocompatible, pulsatile, system intended for full cardiac support. Both
systems are inserted using an open approach.
Transcatheter Replacement of Pulmonary Valve

In code Table 02R, Replacement of Heart and Great Vessels, new
seventh character qualifier values L, “In Existing Conduit and M
Native Site,” have been added as noted below. The change will allow
distinguishing transcatheter replacement of the pulmonary valve at a
native site versus at an existing conduit site.

H Pulmonary 3 Percutaneous 8 Zooplastic H Transapical
Valve Tissue L In Existing
Conduit
M Native Site
Z No Qualifier
Transcatheter replacement of the pulmonary valve at the valve’s
native site is typically performed for Tetralogy of Fallot with either
pulmonary valve stenosis or pulmonary atresia. Less commonly, it
may be performed for truncus arteriosus, double-outlet right ventricle,
and other congenital conditions, which affect blood flow to the lungs.
The procedure typically uses zooplastic valve tissue mounted onto
an hourglass-shaped nitinol frame for delivery, seating, and when
replacing the pulmonary artery at its native site between the right
ventricle and the main pulmonary artery.
Another type of transcatheter pulmonary valve replacement is
performed within a previously placed right ventricular-pulmonary
artery (RV-PA) valved conduit. This procedure has been performed for
approximately 10 years, but it does not take place at the native site.
The RV-PA conduit is designed with a bioprosthetic valve inside the
conduit, which takes over the function of the pulmonary valve, albeit
at a different location. As the patient grows, if the valve within the
conduit develops dysfunction, the valve can be replaced by implanting
another valve within the conduit via a transcatheter “valve-in-valve”
technique.

Restriction of Left Ventricle
In code Table 02V, Restriction of Heart and Great Vessels, the body
part value L, Ventricle, Left, has been added to the device values
listed below for all available approaches. This change will allow
the identification of procedures such as placement of the Ancora
AccuCinch® device. The procedure is used to treat heart failure
and functional mitral regurgitation by targeting left ventricular (LV)
dysfunction and abnormal dilation of the heart.

L Ventricle, Left 0 Open C Extraluminal Z No Qualifier
3 Percutaneous Device
4 Percutaneous D Intraluminal
Endoscopic Device
Z No Device
Question:
A patient, who had been diagnosed with heart
failure, dyspnea and severe mitral regurgitation
with moderate to severe left ventricular
dysfunction and left ventricular ejection fraction,
underwent mitral valve annuloplasty using the
Ancora AccuCinch® percutaneous device.
During surgery, a wire was placed across
the aortic valve to gain access into the left
ventricular cavity. A flexible wire delivery sheath
was placed beneath the mitral annulus at the
superior aspect of the ventricle and the base
of the heart. The Trac™ catheter was placed
around the mitral annulus. The AccuCinch®
device was ultimately deployed. The device
seated well and there was a reduction of mitral
regurgitation. What is the appropriate ICD-10-
PCS code for mitral valve annuloplasty using
the Ancora AccuCinch® device?

Answer:
02VL3DZ Restriction of left ventricle with

intraluminal device, percuta-
neous approach, for the mitral
valve annuloplasty using Ancora
AccuCinch® device.
The AccuCinch® device (percutaneous

ventricular repair system) was developed to
treat both heart failure and functional mitral
regurgitation. It is implanted into the subvalvular
space of the left ventricle, and the objective
of the procedure is to improve the abnormal
dilation of the heart. Once cinched properly
into place, the device is intended to reduce the
size of the left ventricle by making the mitral
valve opening smaller while providing strength
and support to the heart wall so that the valve
functions better and is less likely to leak.
Percutaneous Bypass of Brachial Artery for Arteriovenous

Fistula Creation
In the Medical and Surgical Section Table 031, Bypass of Upper

Arteries, the approach value 3 Percutaneous, has been added for
the brachial artery body part values and applied to the qualifier
value F Lower Arm Vein, as shown below. The change will allow the
identification of procedures such as the creation of an arteriovenous
(AV) fistula by connecting the brachial artery to a lower arm vein using
the Ellipsys® Vascular Access System.

7 Brachial 0 Open 9 Autologous 0 Upper Arm
Artery, Right Venous Tissue Artery, Right
A Autologous 3 Lower Arm
Arterial Tissue Artery, Right
J Synthetic D Upper Arm
Substitute Vein
K Nonautologous F Lower Arm
Tissue Substitute Vein
Z No Device V Superior
Vena Cava
W Lower
Extremity Vein
7 Brachial 3 Z No Device F Lower Arm

Artery, Right Percutaneous Vein
8 Brachial 0 Open 9 Autologous 1 Upper Arm
Artery, Left Venous Tissue Artery, Left
A Autologous 4 Lower Arm
Arterial Tissue Artery, Left
J Synthetic D Upper Arm
Substitute Vein
K Nonautologous F Lower Arm
Tissue Substitute Vein
Z No Device V Superior
Vena Cava
W Lower
Extremity Vein
8 Brachial 3 Z No Device F Lower Arm
Artery, Left Percutaneous Vein
Fragmentation of Intracranial Artery

In the Medical and Surgical Section table 03F, Fragmentation of
Upper Arteries, a new body part value G Intracranial Artery, was
added as shown below. This change allows the identification of
procedures such as clot maceration performed in a cerebral artery
using a microcatheter.

G Intracranial 3 Percutaneous Z No Device 0 Ultrasonic
Artery Z No Qualifier

Endoscopic Banding of Hemorrhoidal Plexus
In Table, 06L Occlusion of Lower Veins, approach values 7 Via Natural

or Artificial Opening and 8 Via Natural or Artificial Opening Endoscopic
have been added to the body part value Y Lower Vein, as shown
below. The change will allow the identification of procedures such as
endoscopic banding of the hemorrhoidal plexus.

Y Lower Vein 0 Open C Extraluminal C Hemorrhoidal
3 Percutaneous Device Plexus
4 Percutaneous D Intraluminal Z No Qualifier
Endoscopic Device
7 Via Natural or Z No Device
Artificial Opening
8 Via Natural or
Artificial Opening
Endoscopic
Extraction of Bone Marrow from Other Sites
In Table 07D, Extraction of Lymphatic and Hemic Systems, the body

part value T Bone Marrow, has been added as shown below to identify
when bone marrow is extracted from other sites, such as the femur.

Q Bone 0 Open Z No Device T Bone Marrow
Marrow, 3 Percutaneous
Sternum
R Bone
Marrow, Iliac
S Bone
Marrow,
Vertebral
T Bone Marrow
Question:
A patient with pancytopenia underwent
percutaneous bone marrow biopsy. A
dermatotomy was created on the right thigh. A
bone marrow biopsy needle was advanced into
the femoral diaphysis just below the surgical

neck, for bone marrow aspiration. Next, a bone
marrow core biopsy sample was obtained from
a second puncture site. What are the correct
code assignments for the biopsies?
Answer:
Assign the following ICD-10-PCS codes:
079T3ZX Drainage of bone marrow,

percutaneous approach,
diagnostic, for the fine needle
aspiration biopsy, and
07DT3ZX Extraction of bone marrow,

percutaneous approach,
diagnostic, for the needle core
biopsy performed at a separate
site on the femur.
Drainage is the correct root operation when

bone marrow is aspirated to obtain bone
marrow cells suspended in fluid. Extraction is
the root operation for removal of a sample of
solid bone marrow.
Division of Liver for Staged Hepatectomy
In Table 0F8, Division of Hepatobiliary System and Pancreas, all liver

body part values have been added as shown below. The change will
allow the reporting of associating liver partition and portal vein ligation
for staged hepatectomy (ALPPS).

0 Liver 0 Open Z No Device Z No Qualifier
1 Liver, Right 3 Percutaneous
Lobe 4 Percutaneous
2 Liver, Left Lobe Endoscopic
G Pancreas

Question:
A patient presents for associating liver partition
and portal vein ligation for staged hepatectomy
(ALPPS) due to intrahepatic cholangiocellular
carcinoma of the right liver lobe. The procedure
is carried out in order to create hypertrophy in
the small left lateral liver lobe. After achieving
pneumoperitoneum robotic ports were placed.
The robot was brought in and ports were
docked for robotic assisted laparoscopic
surgery. A cholecystectomy was performed.
Then, the right portal vein was isolated and
a Hem-o-lock clip was placed, completely
occluding portal flow. Next, the hepatic
parenchyma between segments 4 and 3 was
divided using a scalpel. Segment 4 pedicle
was identified, clipped and divided followed
by stage 1 ALPPS procedures. Approximately
50% parenchyma dissection was performed.
The liver splitting sites were then sprayed with
FloSeal® for homeostasis. How should this
procedure coded in ICD-10-PCS? Are the portal
vein occlusion and cholecystectomy procedures
coded separately?
Answer:
Assign the following ICD-10-PCS codes:
0F824ZZ Division of left lobe liver,

percutaneous endoscopic
approach, for the ALPPS of the
liver to create hypertrophy in the
left lobe of the liver;
0FT44ZZ Resection of gallbladder,

approach, for the
cholecystectomy;

06L84CZ Occlusion of portal vein with
extraluminal device,
approach, for the portal vein
occlusion using a clip; and
8E0W3CZ Robotic assisted procedure of

trunk region, percutaneous
approach, for the robotic
assisted laparoscopy.
ALPPS is most accurately classified as a

Division procedure. If the gallbladder had been
removed as part of an excision or resection
of the right lobe of the liver, the gallbladder
resection would not be coded separately.
However, in this case the right lobe of the liver
was not excised or resected, so it is appropriate
to code the gallbladder removal.
Endoscopic Division of Tongue, Palate and Pharynx Muscle
In Table 0K8, Division of Muscles, the approach values 7 Via

Natural or Artificial Opening and 8 Via Natural or Artificial Opening
Endoscopic, have been added to the body part value 4 Tongue,
Palate, Pharynx Muscle. The change will allow the identification
of procedures such as the stapling of Zenker’s diverticulum via a
transorifice or transorifice endoscopic approach as shown below.

4 Tongue, Palate, 0 Open Z No Device Z No Qualifier
Pharynx Muscle 3 Percutaneous
4 Percutaneous
Endoscopic
7 Via Natural or
Artificial Opening
8 Via Natural or
Artificial Opening
Endoscopic

Insertion of Infusion Device in Skull
In Table 0NH, Insertion of Head and Facial Bones, the device

value 3 Infusion Device, has been added to the body part value 0
Skull. The change will allow the identification of procedures such
as the implantation of an Ommaya reservoir for the intracranial
administration of chemotherapy as shown below.

0 Skull 0 Open 3 Infusion Device Z No Qualifier
4 Internal Fixation
Device
5 External
Fixation Device
M Bone Growth
Stimulator
N Neurostimulator
Generator
0 Skull 3 Percutaneous 3 Infusion Device Z No Qualifier
4 Percutaneous 4 Internal Fixation
Endoscopic Device
5 External
Fixation Device
M Bone Growth
Stimulator
Vertebral Body Tethering
In Table 0PS, Reposition of Upper Bones, the device value 3 Spinal

Stabilization Device, Vertebral Body Tether, has been added to the
body part Thoracic Vertebra as shown below.

4 Thoracic 0 Open 3 Spinal Z No Qualifier
Vertebra 4 Percutaneous Stabilization
Endoscopic Device,
Vertebral Body
Tether

A similar change was made in Table 0QS, Reposition of Lower Bones,
to add the same device value to the body part Lumbar Vertebra as
shown below. The change to both Tables will allow the reporting
of vertebral body tethering (VBT) in the treatment of progressive
idiopathic scoliosis.

0 Lumbar 0 Open 3 Spinal Z No Qualifier
Vertebra 4 Percutaneous Stabilization
Endoscopic Device,
Vertebral Body
Tether
VBT is an alternative surgical treatment to traditional techniques for

the treatment of progressive idiopathic scoliosis in young patients
whose bones have not fully matured. Traditional treatments include
conservative management and spinal fusion. VBT’s objective is to
obtain and maintain correction of spinal curvature deformities while
allowing continued growth to occur. The surgery differs from spinal
fusion, because the spine is still able to bend and flex.
The Tether™ - Vertebral Body Tethering System is a non-fusion

spinal device that uses a strong, flexible cord to pull on the outside
of a scoliosis curve to straighten out the spine. The procedure is
performed using anchors and vertebral body screws placed laterally
using a thoracoscopic or thoracotomy approach. A tensioning cord is
secured to the vertebral body screws with set screws. During surgery,
tension is applied to the cord to exert pressure on the vertebrae
to partially straighten the patient’s spine slowing the growth on the
tall side of the vertebra, so that the short side of the vertebra can
grow and catch up. After surgery, as the child grows taller, the cord
continues to straighten the spine gradually correcting the deformity.
Sesamoidectomy of Great Toe
In Table 0QB, Excision of Lower Bones, the qualifier value 2

Sesamoid Bone(s) 1st Toe, has been added to the body part values N
Metatarsal, Right and P Metatarsal, Left, to identify procedures such
as excision of the fibular or tibial sesamoid bone as shown below.
Refer to Coding Clinic Second Quarter 2021, pages 18 and 19, for a
case study and more information on tibial sesamoidectomy.

N Metatarsal, 0 Open Z No Device 2 Sesamoid
Right 3 Percutaneous Bone(s) 1st Toe
P Metatarsal, 4 Percutaneous X Diagnostic
Left Endoscopic Z No Qualifier
Shoulder Hemiarthroplasty
In Tables 0RP, Removal of Upper Joints, and 0RW, Revision of Upper

Joints, new qualifier values have been added to 6 Humeral Surface
and 7 Glenoid Surface for the device value Synthetic Substitute to
identify the revision and removal of components of partial shoulder
arthroplasties. The change results in 28 new procedure codes.
For Table 0RP, Removal of Upper Joints, the changes are shown
below:

J Shoulder 0 Open J Synthetic 6 Humeral Surface
Joint, Right 3 Percutaneous Substitute 7 Glenoid Surface
K Shoulder 4 Percutaneous
Joint, Left Endoscopic
Similar changes were made for Table 0RW, Revision of Upper Joints,
as shown below:

J Shoulder 0 Open J Synthetic 6 Humeral
Joint, Right 3 Percutaneous Substitute Surface
K Shoulder 4 Percutaneous 7 Glenoid
Joint, Left Endoscopic Surface
X External

Section 3 – Administration
Transfusion
In the Administration Section, Table 302, Circulatory Body System,

Transfusion, the approach value 0 Open, has been deleted for body
systems 3 Peripheral Vein, 4 Central Vein and 8 Vein. The open
approach is considered clinically invalid because a cutdown for
venous access is classified as a percutaneous approach. This change
results in the deletion of 87 codes.
Nonautologous Pathogen Reduced Cryoprecipitated

Fibrinogen Complex
In Table 302, Circulatory Body System, Transfusion, new substance

value D Pathogen Reduced Cryoprecipitated Fibrinogen Complex,
was created to identify this service as shown below.
Body Approach Substance Qualifier

System/
Region
3 Peripheral 3 Percutaneous D Pathogen 1
Vein Reduced Nonautologous
4 Central Vein Cryoprecipitated
Fibrinogen
Complex
Pathogen reduced cryoprecipitated fibrinogen complex (PRCFC) is a

highly processed, pathogen reduced product used to treat fibrinogen
deficiency-related bleeding, including massive hemorrhage. PRCFC
contains a concentrated source of fibrinogen and other clotting factors
including factor XIII and von Willebrand factor (vWF) which are
necessary to achieve stable clot formation and restore hemostasis.
PRCFC is produced from plasma treated by the INTERCEPT® Blood
System to inactivate pathogens allowing for a longer shelf life than
traditional cryoprecipitate.
Antineoplastic Monoclonal Antibody
In code Table 3E0, Physiological Systems and Anatomical Regions,

Introduction, the code titles for codes that include the qualifier value M
Monoclonal Antibody, were revised so that the code titles also include

the sixth character substance value 0 Antineoplastic. This change
resulted in the revision of the code title for 62 codes without an actual
change in the ICD-10-PCS code itself. The change was requested
for clarification purposes only, to assist coders with appropriate code
assignment. For example, the code narrative was revised as follows:
From: 3E0400M Introduction of monoclonal antibody into

central vein, open approach
To: 3E0400M Introduction of antineoplastic,

monoclonal antibody, into central vein,
open approach
Laparoscopic Irrigation of Peritoneal Cavity
In code Table 3E1, Physiological Systems and Anatomical Regions,

Irrigation, approach value 4 Percutaneous Endoscopic, was added
to body part value M Peritoneal Cavity. This change allows the
identification of procedures such as laparoscopic irrigation of the
peritoneal cavity, for therapeutic or diagnostic purposes.
Body System/ Approach Substance Qualifier

Region
M Peritoneal 4 Percutaneous 8 Irrigating X Diagnostic
Cavity Endoscopic Substance Z No Qualifier
Section 4- Measurement and Monitoring
Measurement of Flow in a Cerebral Fluid Shunt
In code Table 4B0, Measurement of Physiological Devices, a new

code was created by adding a new Function/Device Value W
Cerebrospinal Fluid Shunt and Qualifier Value 0 Wireless Sensor as
shown below. The new code identifies non-invasive assessment of the
flow of cerebrospinal fluid (CSF) through an existing implanted CSF
shunt.
Body System/ Approach Function / Device Qualifier

Region
0 Central X External W Cerebrospinal 0 Wireless
Nervous Fluid Shunt Sensor

The new code may be used to report the use of FlowSense, a
wireless, noninvasive thermal flow sensor. The sensor can be applied
to the skin of a patient’s neck overlying the shunt to detect the
presence and magnitude of cerebrospinal fluid in patients suffering
from hydrocephalus. FlowSense enables monitoring of CSF flow by
using measurements of temperature and heat transfer to potentially
eliminate delays with diagnostic testing and expedite appropriate
triage and treatment. FlowSense is composed of soft silicone and is
similar in size to a bandage. Data is wirelessly transmitted to a custom
designed mobile app.
Section 5-Extracorporeal or Systemic Assistance

and Performance
Automated Chest Compression
In the Extracorporeal or Systemic Assistance and Performance Table

5A1, a new qualifier value J Automated, has been added to the body
system value 2 Cardiac, as shown below. The change will allow
reporting mechanical chest compressions performed using devices
such as the LUCAS® device and Defibtech.
Mechanical chest compression devices apply external automated

cardiopulmonary resuscitation (CPR) to a patient’s chest in place
of a human rescuer. The devices are broadly categorized as load
distributing band or piston devices, based on the mechanism that is
used to deliver compressions. Automated chest compression may
be used as an adjunct to manual CPR to provide extended CPR with
minimal interruptions when fatigue, insufficient personnel, or patient
transport (e.g., ambulance, intra-hospital) prevent the delivery of
effective or consistent manual CPR.
Body System Duration Function Qualifier

2 Cardiac 2 Continuous 1 Output J Automated
Z No Qualifier

Section B – Imaging
Fluoroscopic Guidance of Hepatobiliary Sites
In the Imaging Section, Table BF1, Fluoroscopy of Hepatobiliary

System and Pancreas, a new body part value 5 Liver, and the qualifier
value A Guidance, have been added. The change will allow the
reporting of fluoroscopic guidance used with procedures such as the
drainage of liver abscesses.
Body Part Contrast Qualifier Qualifier

5 Liver 0 High Osmolar Z None Z None
1 Low Osmolar
Y Other
Contrast
5 Liver Z None Z None A Guidance
Section X-New Technology
New Technology Group 1 Update

At the September 11-12, 2018 ICD-10 Coordination and Maintenance
(C&M) Committee Meeting CMS announced plans to begin analyzing
the frequency of the New Technology Group 1 codes within Section
X as it has been 3 years since the implementation of these codes.
At the March 9-10, 2021 C&M Committee Meeting, CMS announced
that based on review of the data and the clinical aspects of each
procedure code, CMS proposed one of the options below:
1. Leave the code in Section X (e.g., procedure codes related to
the administration of a specific medication)
2. Reassign the code to the Med/Surg or other section of
ICD-10-PCS and delete from Section X (e.g., NTAP has
expired, data analysis and clinical review justifies incorporating
this technology/procedure into the main Med/Surg Section)
3. Delete the Section X code (e.g., the procedure is not reported
as anticipated in the data, therefore the absence of a unique
code for this technology/procedure in the classification has
minimal impact)
4. Create a new code in Med/Surg or other section of
ICD-10-PCS and delete the code from Section X (e.g., NTAP
has expired, data analysis and clinical review justify uniquely
identifying the technology in the Med/Surg Section)

As a result, for FY 2022, 14 codes were deleted from Section X, New
Technology Group 1. Four new codes have been created in the Med/
Surg Section to identify the extirpation of matter from coronary artery
using orbital atherectomy technique, which was previously classified
to Section X (and described on page 41 of this issue of Coding Clinic).
Computer-Aided Mechanical Aspiration Thrombectomy
In code Table X2C, New Technology, Cardiovascular System,

Extirpation, new codes were created to identify the extirpation of
matter from the arterial and venous systems using a computer-aided
mechanical thrombectomy aspiration device as shown below.
Body Part Approach Device/ Qualifier

Substance/
Technology
P Abdominal Aorta 3 Percutaneous T Computer- 7 New
Q Upper Extremity aided Technology
Vein, Right Mechanical Group 7
R Upper Extremity Aspiration
Vein, Left
S Lower Extremity
Artery, Right
T Lower Extremity
Artery, Left
U Lower Extremity
Vein, Right
V Lower Extremity
Vein, Left
Y Great Vessel
The procedure uses mechanical aspiration thrombectomy via

the Indigo® System to treat occlusions in a non-coronary or non-
intracranial artery or vein, or in an arterial bypass graft. Via vascular
access (typically the femoral vein), the catheter is manipulated to
the clot under imaging guidance, including through the heart to
the pulmonary arteries. Once the clot is reached, the Lightning™
component of the Indigo® System is turned on and the thrombus
is removed using aspiration rather than mechanical force as in
conventional thrombectomies.

The Lightning™ component also has sensors that detect whether
the device is in thrombus or blood and only turns on suction when in
thrombus. Since aspiration rather than mechanical force is used to
remove the thrombus, it does not rely on a large intravascular device
to capture the clot and does not need to be repeatedly placed into and
removed from the body for adequate thrombus removal.
Transthoracic Echocardiography with Computer-Aided

Image Acquisition
The root operation “Inspection” has been added to Section X, New

Technology, Cardiovascular System, resulting in a new Table X2J.
In addition, the body part value A Heart and the Device/Substance/
Technology value 4 Transthoracic Echocardiography Computer-aided
Guidance was created as shown below. The change will identify the
utilization of software to guide transthoracic echocardiography (TTE)
image acquisition.
Section: X New Technology

Body System: 2 Cardiovascular System
Operation: J Inspection
Body Part Approach Device/ Substance/ Qualifier
Technology
A Heart X External 4 Transthoracic 7 New Technology
Echocardiography, Group 7
Computer-aided
Guidance
An example of this new technology is Caption GuidanceTM, an

artificial intelligence guided medical imaging acquisition software
system. It is used for the acquisition of cardiac ultrasound images.
The system provides real-time guidance during 2D TTE to assist in
obtaining anatomically correct and optimized images that represent
standard 2D echocardiographic diagnostic views and orientations.
Facilities can report separately the transthoracic echocardiography

using the appropriate code(s) in Section B, Imaging.

Percutaneous Creation of Arteriovenous Fistula
Using Thermal Resistance Energy
The root operation “Bypass” has been added to Section X, New

Technology, Cardiovascular System, resulting in a new Table X2K.
In addition, the body part value B Radial Artery, Right, and C Radial
Artery, Left, as well as the Device/Substance/Technology value 1
Thermal Resistance Energy, were created as shown below. The
new codes allow the identification of the percutaneous creation of an
arteriovenous fistula (AVF) using thermal resistance energy.

Operation: K Bypass
Substance/
Technology
B Radial Artery, Right 3 Percutaneous 1 Thermal 7 New
C Radial Artery, Left Resistance Technology
Energy Group 7
The Ellipsys® Vascular Access System is a device that enables

percutaneous creation of an AVF using thermal resistance energy
to access the bloodstream for hemodialysis to treat end-stage renal
disease (ESRD). The Ellipsys® Vascular Access System creates a
side-by-side percutaneous AVF (pAVF) and is an alternative to the
surgical “end-to-side” approach used for most surgical AVFs, where
one vessel is truncated and the end is attached to the side of another
vessel.
The pAVF is created by cannulating the cubital vein under ultrasound

guidance. A needle is inserted through the vein puncturing the lumen
of the adjacent radial artery and a guidewire is inserted into the
artery. A specialized catheter is then used to bring the artery and
vein together. The adventitia of the two vessels are fused together
with thermal resistance energy (i.e., direct heat), creating an elliptical
anastomosis. Using Doppler ultrasound, the flow through the fistula
is assessed and the flow is immediately increased by balloon
angioplasty of the anastomosis. The balloon angioplasty is coded
separately since it has a different objective.

Replacement Combined with Restriction
of Descending Thoracic Aorta
Two new codes were created to identify replacement combined with

restriction of the descending thoracic aorta. Both codes would be
reported for this procedure, as there are two separate root operations
with different objectives involved.
X2RX0N7 Replacement of thoracic aorta, arch using branched

synthetic substitute with intraluminal device, open
approach, new technology group 7
X2VW0N7 Restriction of thoracic aorta, descending using

branched synthetic substitute with intraluminal device,
open approach, new technology group 7
Changes were made at code Table X2R, Cardiovascular System,

Replacement, with the creation of a new body part value X, Thoracic
Aorta, Arch, and a new device/substance/technology value N,
Branched Synthetic Substitute with Intraluminal Device, as shown
below.

Operation: R Replacement

Substance/
Technology
X Thoracic 0 Open N Branched 7 New
Aorta, Arch Synthetic Technology
Substitute Group 7
with Intraluminal
Device
In addition, a new code Table X2V, Cardiovascular System,

Restriction, was created with a body part value W Thoracic Aorta,
Descending, and a device/substance/technology value N Branched
Synthetic Substitute with Intraluminal Device as shown below.

Operation: V Restriction
Substance/
Technology
W Thoracic 0 Open N Branched 7 New
Aorta, Synthetic Technology
Descending Substitute with Group 7
Intraluminal
Device
In cases of aneurysm and/or dissection, when disease involving

the aortic arch extends into the descending thoracic aorta, a two-
stage repair has been traditionally necessary. The first stage entails
replacement of the ascending aorta and transverse arch with an
elephant trunk (ET) graft, while the second stage requires treatment
of the descending thoracic or thoracoabdominal aorta with a separate
endograft after an interval for patient recovery.
The Thoraflex™ Hybrid Device is a dual-purpose device that replaces

the ascending aorta and aortic arch while also stabilizing and repairing
the descending thoracic aorta in a single procedure. The device is a
sterile single-use, gelatin sealed frozen elephant trunk (FET) surgical
device that is comprised of a woven polyester proximal branched
arch graft pre-sewn to an anastomotic sewing collar and distal stent.
It is deployed through an open aortic arch and is positioned into the
descending thoracic aorta. Once completely deployed, the collar is
sutured to the aorta, and graft anastomoses are then performed in a
manner depending upon the chosen product design.
The device is available currently in two design configurations:

Thoraflex™ Hybrid Plexus Graft, a multi- branch design that enables
individual aortic arch branch reconstruction, and the Thoraflex™
Hybrid Ante-Flo™ design that allows the island technique where the
aortic arch branches and associated aortic tissue are reattached as a
patch to an opening cut in the graft.

Restriction of Coronary Sinus
Table X2V, Cardiovascular System, Restriction, also describes the

insertion of a reduction device in the coronary sinus for refractory
angina as noted below.

Operation: V Restriction
Substance/
Technology
7 Coronary 3 Percutaneous Q Reduction 7 New
Sinus Device Technology
Group 7
The Neovasc Reducer™ System is an implant inserted percutane-

ously into the coronary sinus vein via a right jugular venous access.
The device creates a permanent and controlled narrowing to modulate
blood flow and pressure in the coronary sinus and increase the perfu-
sion of oxygenated blood to certain areas of the heart muscle. There
are two implantation options, one uses a SupraCore wire, and the oth-
er uses a regular long J-wire.
Monitoring of Tissue Oxygen Saturation

in Gastrointestinal Tract
A new code Table XD2, Gastrointestinal System, Monitoring, was

created with device/substance/technology value V Oxygen Saturation,
for the body part value G Upper GI, and H Lower GI as shown below.
The new codes will identify the monitoring of tissue oxygen saturation
levels of the gastrointestinal (GI) tract during endoscopic imaging
used for endoscopic observation, diagnosis, treatment, and image
recording in minimally invasive surgeries of abdominal gynecologic
and thoracic areas. Separate ICD-10-PCS codes should be assigned
for any concomitant surgical procedures.

Body System: D Gastrointestinal System
Operation: 2 Monitoring

Substance/
Technology
G Upper GI 4 Percutaneous V Oxygen 7 New
H Lower GI Endoscopic Saturation Technology
8 Via Natural Group 7
or Artificial
Opening
Endoscopic
Facilities may use the new code, if desired, to report the utilization of
an endoscopic video imaging system that allows for the visualization
of hemoglobin oxygen saturation (StO2) levels of blood in superficial
tissue using a 2D endoscopic image during GI procedures. The
technology assists physicians in identifying potentially ischemic tissue
that is not appropriately oxygenated.
Colonic Irrigation for Colonoscopy
At new code Table XDP, Gastrointestinal System, Irrigation, value

K Intraoperative Single-use Oversleeve, was created as shown
below. The new code describes the colonic irrigation performed
intraoperatively with a disposable oversleeve for colonoscopy
procedures.

Body System: D Gastrointestinal System
Operation: P Irrigation

Substance/
Technology
H Lower GI 8 Via Natural K Intraoperative 7 New
or Artificial Single-use Technology
Opening Oversleeve Group 7
Endoscopic

The Pure-Vu® System is an oversleeve based, high intensity, intra-
procedural cleansing device connected to a standard colonoscope. It
is designed to provide pulsed vortex irrigation consisting of a mixture
of air and water to break-up fecal matter, blood clots and other debris
and scrub the walls of the colon while simultaneously removing the
debris through two suction channels. It is used to avoid aborted and
delayed procedures due to poor visualization of the colon mucosa
where the bowel has not been adequately prepared. Indications
include lower gastrointestinal bleed that does not allow for adequate
bowel preparation.
Single-Use Duodenoscope during Endoscopic Retrograde

Cholangiopancreatography
Two codes were created in Section X, New Technology, to identify

use of a single-use duodenoscope for endoscopic pancreaticobiliary
system procedures. New codes in Table XFJ, Hepatobiliary System
and Pancreas, Inspection, were created with the body part values
B Hepatobiliary Duct, and D Pancreatic Duct, as well as device/
substance/technology value A Single-use Duodenoscope, as shown
below.
The applicable ICD-10-PCS pancreaticobiliary system code(s)

using the approach value 8 Via Natural or Artificial Opening
Endoscopic, is (are) separately assigned. Facilities may choose
to report the radiologic portion of the endoscopic retrograde
cholangiopancreatography (ERCP) procedure with a code from
Imaging Section table BF1, Fluoroscopy of Hepatobiliary System and
Pancreas.

Body System: F Hepatobiliary System and Pancreas
Operation: J Inspection

Substance/
Technology
B Hepatobiliary 8 Via Natural A Single-use 7 New
Duct or Artificial Duodenoscope Technology
D Pancreatic Opening Group 7
Duct Endoscopic

The EXALT™ Model D and aScope™ Duodeno are examples of
single-use, flexible duodenoscopes indicated for diagnostic and
therapeutic treatment of the pancreaticobiliary system during ERCP
procedures. They are intended to eliminate the risk of patient-to-
patient transmission of infection related to reprocessing of reusable
duodenoscopes.
Application of Bioengineered Allogeneic Construct
At code Table XHR, Skin, Subcutaneous Tissue, Fascia and

Breast, Replacement, a new device/substance/technology value F
Bioengineered Allogeneic Construct was added as shown below. The
new code was created for replacement of skin using bioengineered
allogeneic construct for the treatment of adults with severe thermal
burns.

Body System: H Skin, Subcutaneous Tissue, Fascia and Breast
Operation: R Replacement

Substance/
Technology
P Skin X External F Bioengineered 7 New Technology
Allogeneic Group 7
Construct
StrataGraftTM skin tissue is a viable, bioengineered, allogeneic

construct made up of an epidermal layer of viable, fully stratified,
allogeneic human Near-diploid Immortalized Keratinocytes (NIKS®)
cells growing on a dermal layer composed of viable normal human
dermal fibroblasts embedded in a collagen-rich matrix. The tissue
provides immediate wound coverage, functions as an epidermal
barrier, and promotes durable wound closure and regenerative
healing eventually by replacing the patient’s own cells.

Posterior Dynamic Distraction
At code Table XNS, Bones, Reposition, new codes were created with
a new device/substance/technology value C Posterior (Dynamic)
Distraction Device, applied to the body part values for the lumbar
and thoracic vertebrae as shown below. The change identifies the
utilization of a posterior dynamic distraction device in procedures to
treat patients with adolescent idiopathic scoliosis. In addition, the
applicable ICD-10-PCS code(s) from table 0RG, Fusion Upper Joints,
or 0SG, Fusion Lower Joints, should be assigned for any spinal fusion
performed at the non-instrumented segment of the vertebrae.

Body System: N Bones
Operation: S Reposition

Substance/
Technology
0 Lumbar 0 Open C Posterior 7 New
Vertebra 3 Percutaneous (Dynamic) Technology
4 Thoracic Distraction Device Group 7
Vertebra
The ApiFix Minimally Invasive Deformity Correction (MID-C) System

is a posterior dynamic deformity correction system that provides
permanent curve correction while retaining spine flexibility. The
system consists of a ratchet-based expandable rod, which is anchored
to pedicle screws located on the concave side of a scoliotic deformity.
It acts as an “internal brace” with motion-preserving polyaxial joints.
Deformity correction is achieved intraoperatively by distraction
leading to rod elongation. After the surgical procedure, further curve
correction is achieved with scoliosis specific exercises or with normal
daily activities. These exercises activate the ratchet with further rod
expansion and curve reduction without the need for additional surgery.

Customizable Interbody Fusion
Twelve new codes were created to describe the use of a patient

specific (customizable) intervertebral body fusion device for the
correction of adult spinal deformity. At code Table XRG, Fusion of
Joints, a new device/substance/technology value R Interbody Fusion
Device, Customizable, was added as shown below.

Body System: R Joints
Operation: G Fusion

Substance/
Technology
A Thoracolumbar 0 Open R Interbody 7 New
Vertebral Joint 3 Percutaneous Fusion Device, Technology
B Lumbar Vertebral 4 Percutaneous Customizable Group 7
Joint Endoscopic
C Lumbar Vertebral
Joints, 2 or more
D Lumbosacral
Joint
The aprevo™ Intervertebral Body Fusion Devices are personalized,

patient-specific interbody fusion devices created using the patient’s
own computed tomography scan to create a 3D model of the
deformity. The model is used to manufacture personalized implants
from 3D printed titanium to provide a more precise fit against the
patient’s anatomy.
Surgical implantation of the customized device is similar to that of
pre-fabricated interbody fusion devices, except for the trial-and-error
fit process to select the closest possible size and fit for the patient’s
anatomical needs. The procedure may be performed using the
anterior, lateral or transforaminal/posterior approach. A discectomy
is performed and endplate cartilage is removed. Distractors may be
used to distract the vertebral segments, restore disc height, open the
neural foramen, and for implant delivery. After placement, anterior/
posterior and lateral fluoroscopy is used to confirm appropriate final
position of the implant. Supplemental fixation is also used, such as
pedicle screws with rods, which is not coded separately when used in
spinal fusion.

Introduction of New Therapeutic Substances
Effective October 1, 2021, eight new substance values were added

to code Table XW0, Anatomical Regions, Introduction, for the eight
substances listed below. Please note that all of the substances below
have a qualifier of 7, New Technology Group 7.
Device/Substance/Technology
2 Bromelain-enriched Proteolytic Enzyme

5 Narsoplimab Monoclonal Antibody
6 Terlipressin
7 Trilaciclib
8 Lurbinectedin
9 Satralizumab-mwge
B Amivantamab Monoclonal Antibody
L Lifileucel Immunotherapy
Bromelain-enriched Proteolytic Enzyme
NexoBrid™ is a mixture of proteolytic enzymes (enriched in

bromelain) used for eschar removal in adults with deep partial
thickness and/or full thickness thermal burns. The proteolytic enzymes
can be applied at bedside to selectively remove eschar and denatured
collagen while sparing healthy tissue. New ICD-10-PCS codes have
been created for the external application to skin or subcutaneous
tissue.
Narsoplimab
Narsoplimab is a fully human monoclonal antibody for the treatment

of hematopoietic stem cell transplantation-associated thrombotic
microangiopathy (HSCT-TMA), also known as transplant-associated
thrombotic microangiopathy (TA-TMA). New ICD-10-PCS codes have
been created for the intravenous (IV) administration of Narsoplimab
into the central or peripheral veins. In addition, a unique ICD-10-CM
code has been created for HSCT-TMA. This condition is described in
more detail on page 19 of this issue of Coding Clinic.

Terlipressin
TERLIVAZ® (terlipressin) is for intravenous (IV) use in the treatment

of adults with hepatorenal syndrome type 1 (HRS-1), a serious, life-
threatening condition characterized by development of acute or sub-
acute renal failure in patients with advanced chronic liver disease.
TERLIVAZ® (Nα-tryglycl-8-lysine-vasopressin) is a pro-drug for the
endogenous/natural porcine hormone [Lys8]-vasopressin and a
synthetic vasopressin analog derived from the natural/endogenous
human hormone [Arg8]-vasopressin. The medication inhibits portal
hypertension with simultaneous reduction of blood circulation in
portal vessels. New ICD-10-PCS codes have been created for the IV
administration of terlipressin into the central or peripheral veins.
Trilaciclib
Trilaciclib is myelopreservation therapy indicated for the mitigation of

clinically significant chemotherapy-induced myelosuppression in adult
patients with small cell lung cancer. Myelosuppression is one of the
most common treatment-related adverse events in patients receiving
systemic chemotherapy. Trilaciclib is administered intravenously
30 minutes before chemotherapy to reduce the side effects of the
treatment, which include neutropenia, anemia, thrombocytopenia, and
the need for supportive care interventions and hospitalizations.
Lurbinectedin
ZEPZELCA™ (lurbinectedin) is a transcription inhibitor and a synthetic

marine-derived agent. It is indicated for the treatment of adult patients
with metastatic small cell lung cancer with disease progression on or
after platinum-based chemotherapy. ZEPZELCA™ is administered
intravenously over the course of one hour and repeated every 21
days.
Satralizumab-mwge
ENSPRYNG™ (satralizumab-mwge) is an interleukin-6 (IL-6) receptor

antagonist for the treatment of adult patients with neuromyelitis optica
spectrum disorder, a rare, inflammatory, potentially life-threatening
autoimmune central nervous system disorder. The disorder is
characterized primarily by severe, unpredictable relapses of optic
neuritis and/or acute longitudinally extensive transverse myelitis.
ENSPRYNG™ is administered via subcutaneous injection.

Amivantamab
Amivantamab is a monoclonal antibody for the treatment of patients

with metastatic non-small cell lung cancer with epidermal growth
factor receptor (EGFR) exon 20 insertion mutations whose disease
has progressed on or after platinum-based chemotherapy. It is
administered intravenously on a 28-day cycle, weekly for the first
cycle and every 2 weeks thereafter.
Lifileucel Immunotherapy
Lifileucel is a one-time, autologous tumor infiltrating lymphocyte (TIL)

cell-based therapy for the treatment of solid tumors. TIL cell therapy
with lifileucel involves the adoptive cell transfer of autologous T-cells
directly isolated from the tumor tissue and expanded ex-vivo without
any prior selection or genetic modification. The lifileucel manufacturing
process isolates autologous TIL from tumor tissue and expands them
to produce large numbers of reinvigorated T-cells. After the infusion
of lifileucel, the TIL migrate back into the tumor, including metastases,
where they trigger specific tumor cell killing upon recognition of tumor
antigens. One of the indications is for the treatment of patients with
unresectable or metastatic melanoma who were previously treated
with at least one systemic therapy.
Chimeric Antigen Receptor T-Cell Immunotherapy
Chimeric Antigen Receptor (CAR) T-cell immunotherapy is a cell-

based gene therapy in which immune cells are removed from a
patient, armed with new proteins that allow them to recognize cancer,
and then reinfused into the patient in large numbers. These cells
persist in the body, becoming “living drugs.”
Changes have been made to resolve the conflict for the intravenous
administration of CAR T-cell therapies, which had been classified
to two different tables. The two codes in Table XW0, Anatomical
Regions, Introduction, were not product-specific, with Substance
value C, Engineered Autologous Chimeric Antigen Receptor T-cell
Immunotherapy. Yescarta® (axicabtagene ciloleucel) and KYMRIAH®
(tisagenlecleucel) were previously reported with the non-product-
specific codes. On the other hand, the two codes in Table XW2,
Anatomical Regions, Transfusion, were product specific with
Substance value 4 Brexucabtagene Autoleucel Immunotherapy, and

7, Lisocabtagene Maraleucel Immunotherapy. For more information
on Brexucabtagene Autoleucel Immunotherapy, and Lisocabtagene
Maraleucel Immunotherapy, please refer to Coding Clinic, Fourth
Quarter 2020, pages 77-78.
As noted in Coding Clinic, Fourth Quarter 2020, page 77, the root
operation Transfusion was originally utilized based on the root
operation definitions and receipt of public comments. CAR T-cell
therapy is comprised of blood/blood product, and therefore, the root
operation Transfusion was originally determined to be more clinically
accurate. The full definition for the root operation Introduction is
“Putting in or on a therapeutic, diagnostic, nutritional, physiological, or
prophylactic substance except blood or blood products.”
Based on a proposal discussed at the September 2020 ICD-10

Coordination and Maintenance (C&M) Committee meeting and
additional public comments, changes have been made so that all
CAR T-cell immunotherapies are classified to a single root operation
in code Table XW0, Anatomical Regions, Introduction, for consistency
in the classification of CAR T-cell immunotherapy. During the
comment period, many felt that CAR T-cell and other cell-derived
immunotherapies were not a blood or blood product as traditionally
understood; and, therefore the root operation Transfusion was not
ideal. As a result, the codes for CAR T-cell products in Table XW2,
Anatomical Regions, Transfusion, were deleted and replaced with
new codes in Table XW0, Anatomical Regions, Introduction. Please
note that all of the new CAR T-cell immunotherapy codes below have
a qualifier of 7, New Technology Group 7.
New non-product-specific codes have been created to distinguish

autologous from allogeneic engineered CAR T-cell immunotherapy.
The non-product-specific codes for Engineered Autologous
Chimeric Antigen Receptor T-cell Immunotherapy with a qualifier
of 3, New Technology Group 3 have been deleted. Substance
Value C, Engineered Autologous Chimeric Antigen Receptor T-cell
Immunotherapy, was revised and a new Substance Value G was
created as shown below. The new codes may be used to identify
the infusion of new engineered autologous or allogeneic CAR-T cell
immunotherapy products that do not have unique codes. Please note
the new non-product-specific CAR T-cell immunotherapy codes have
a qualifier of 7, New Technology Group 7.

C Engineered Chimeric Antigen Receptor T-cell Immunotherapy,

Autologous
G Engineered Chimeric Antigen Receptor T-cell Immunotherapy,
Allogeneic
Engineered autologous CAR T-cell immunotherapy involves use of

the patient’s own blood, separating out the T-cells and genetically
engineering them to produce receptors on their surface called
chimeric antigen receptors, or CARs. These special receptors allow
the T-cells to recognize and attach to a specific protein, or antigen,
on tumor cells. The engineered CAR T-cells reinfused into the patient
further multiply in the patient’s body and kill cancer cells that harbor
the antigen on their surfaces.
Engineered allogeneic CAR T-cell immunotherapy is derived from

healthy donors; is engineered in advance; and stored in large
numbers. Once infused into the patient, similar to autologous CAR
T-cell immunotherapies, the allogeneic CAR T-cells will target and kill
the diseased cells. They are also referred to as “off the shelf” since
they are more rapidly available when compared to autologous CAR
T-cell immunotherapies that have to be generated individually from a
patient’s own cells. Complications such as graft-versus-host disease
and rejection of the allogeneic cells are more likely to occur with
allogeneic CAR T-cells. However, gene editing and other strategies
are being developed to reduce or eliminate these limitations.
New product-specific Substance values have been created for

existing products as noted below:
H Axicabtagene Ciloleucel Immunotherapy

J Tisagenlecleucel Immunotherapy
M Brexucabtagene Autoleucel Immunotherapy
N Lisocabtagene Maraleucel Immunotherapy

In addition, new product-specific Substance values were created for
new CAR T-cell immunotherapy products as noted below.
A Ciltacabtagene Autoleucel
K Idecabtagene Vicleucel Immunotherapy
Ciltacabtagene Autoleucel
Ciltacabtagene autoleucel (cilta-cel) is an autologous CAR T-cell

therapy directed against B-cell maturation antigen (BCMA) for the
treatment of patients with relapsed or refractory multiple myeloma.
Cilta-cel is designed to recognize myeloma cells and destroy them.
Its CAR T-cell technology consists of harvesting the patient’s own
T-cells, programming them to express a chimeric antigen receptor
that identifies BCMA, and reinfusing these modified cells back into the
patient. The modified T-cells bind to the myeloma cells displaying the
BCMA antigen. The T-cells become activated and proliferate resulting
in the release of pro-inflammatory cells to kill malignant myeloma
cells.
Idecabtagene Vicleucel
Idecabtagene vicleucel (ide-cel), is a B-cell maturation antigen-

directed genetically modified autologous CAR T-cell therapy for
the treatment of adult patients with relapsed or refractory multiple
myeloma. Ide-cel is administered as a single IV infusion through the
central or peripheral vein, primarily in the hospital inpatient setting as
a standalone procedure.
Antibiotic-Eluting Bone Void Filler
A new code has been created at Table XW0, Anatomical Regions,

Introduction, with the addition of a new body part value V Bones and
a new Device/Substance/ Technology value P Antibiotic-eluting Bone
Void Filler, as noted below.

Technology
V Bones 0 Open P Antibiotic-eluting 7 New Technology
Bone Void Filler Group 7
CERAMENT® G is a dual-action implantable antibiotic-eluting bone

void filler intended to fill a space remaining after bone excision/de-
bridement, as well as to administer antibiotic therapy. It consists of hy-
droxyapatite, calcium sulfate, and gentamicin sulfate. CERAMENT®
G remodels into bone and elutes gentamicin, which prevents coloniza-
tion of gentamicin-sensitive microorganisms to protect bone healing.
CERAMENT® G is used for dead-space management (bone voids)

as part of the treatment of osteomyelitis associated with bone trauma,
joint replacement, hardware revisions, and diabetes-related bone in-
fections, as well as the treatment of osteomyelitis as a single-stage
procedure instead of a two-stage procedure. CERAMENT® G is pre-
pared by mixing the pre-packaged components into a paste, which
may then be injected using a tip extender with a needle attached to
the delivery syringe, or molded into beads and placed into the bone voids.
While Coding Clinic for ICD-10-CM and ICD-10-PCS advice published

in Second Quarter 2013, pages 35-36, advised to use the root opera-
tion Supplement for “bone void fillers,” CERAMENT® G is a different
type of material than the bone void filler addressed by Coding Clinic.
The primary objective of the procedure addressed by Coding Clinic
appears to meet the definition of the root operation Supplement, to
physically reinforce and/or augment the function of the bone; however,
CERAMENT® G does not meet the definition of a device.
The definition of a device initially published in the ICD-10-PCS Refer-
ence Manual, Appendix B, page 120, and reprinted in Coding Clinic,
Second Quarter, 2014, page 13 states: “Material that is classified as
a PCS device is also distinguishable by the fact that it is removable.
Although it may not be practical to remove some types of devices
once they become established at the site, it is physically possible to
remove a device for some time after the procedure.” CERAMENT® G
remodels to host bone, is completely resorbed over 6 to 12 months,
and therefore, does not meet this definition of a device, as it is not
physically possible to remove it. Instead, the substance is considered
similar to bone morphogenetic protein (BMP) which is classified to the
root operation Introduction.

Transfusion of Hyperimmune Globulin
and High-Dose Immune Globulin
In code Table XW1, Anatomical Regions, Transfusion, new

Substance values D High-Dose Intravenous Immune Globulin and
E Hyperimmune Globulin, were created. The change allows the
identification of the intravenous administration of these substances to
enable efficient tracking when used for the treatment of COVID-19.

Substance/
Technology
3 Peripheral 3 Percutaneous D High-Dose 7 New
Vein Intravenous Technology
Immune Globulin Group 7
4 Central Vein
E Hyperimmune
Globulin
Pharyngeal Electrical Stimulation
In new code Table XWH, Anatomical Regions, Insertion, Device/

Substance/ Technology value Q Neurostimulator Lead was added as
shown below. The new code identifies the use of electrical pulses to
stimulate sensory nerves in the oropharynx. The procedure is used
to treat neurogenic dysphagia in adult patients with a tracheostomy
when weaned from mechanical ventilation or from non-progressive
neurogenic dysphagia (e.g. from stroke, traumatic brain injury, critical
illness polyneuropathy, Guillain-Barre syndrome).

Substance/
Technology
D Mouth and 7 Via Natural or Q Neurostimulator 7 New
Pharynx Artificial Opening Lead Technology
Group 7
Phagenyx® uses electrical pulses to stimulate sensory nerves in the

oropharynx. The stimulated nerves send signals to the motor cortex in
the brain, increasing cortical activity and promoting neuroplasticity to
restore swallowing control through functional cortical reorganization.

The Phagenyx® System is comprised of a sterile single patient use
catheter with an optional feeding lumen and a Base Station. The
feeding tube can be used to administer nutrition and fluids if required-
-only one tube is required for both treatment and feeding. Facilities
may report the insertion of a feeding tube using the appropriate code
in table 0DH, Insertion of Gastrointestinal System, if desired.
Computer-Aided Assessment of Intracranial Vascular Activity
A new code has been created at Section X code Table XXE Measure-
ment of Physiological Systems, to identify the use of software that
characterizes Alberta Stroke Program Early CT Score (ASPECTS)
Regions of Interest (ROIs) using computed tomography (CT) image
data as shown below. The new ICD-10-PCS code would be reported
in addition to the CT and CT angiogram using the appropriate codes
in Section B, Imaging.
Rapid ASPECTS is a computer-aided diagnosis software device used

to assist the clinician in the assessment and characterization of brain
tissue abnormalities and provide triage and appropriate care of stroke
patients. The software automatically registers images and segments
and analyzes ASPECTS ROIs. The imaging features are then synthe-
sized by an artificial intelligence algorithm into a single ASPECT Score
used to evaluate the extent of disease for patients presenting for di-
agnostic imaging workup with known middle cerebral artery or internal
carotid artery occlusion. The extent of disease refers to the number of
ASPECTS regions affected, which is reflected in the total score.

Technology
0 Central X External 0 Intracranial Vascular 7 New
Nervous Activity, Computer-aided Technology
Assessment Group 7
Computer-Aided Triage and Notification of Pulmonary

Artery Flow
A new code has been created at Section X code Table XXE
Measurement of Physiological Systems as shown below. The code
will identify software analysis of computed tomography pulmonary
angiography (CTPA) with computer-aided triage and notification
software to detect pulmonary embolism (PE). Facilities can report the
CTPA using the appropriate code(s) in Section B, Imaging.

Body Part Approach Device/Substance / Qualifier
Technology
3 Arterial X External 2 Pulmonary Artery New Technology
Flow, Computer- Group 7
aided Triage and
Notification
Aidoc Briefcase for PE is an artificial intelligence-based solution for

triage and notification of suspected PE cases used to shorten the
period of time between when the patient receives CTPA imaging and
when the radiologist informs the referring physician of positive PE.
The device flags and communicates suspected positive findings of
PE prompting the radiologist to assess relevant original imaging files,
expediting the attention given to the suspect case.
Mechanical Initial Specimen Diversion of Whole Blood

Using Active Negative Pressure
A new code has been created in Section X table XXE, Measurement

of Physiological Systems, to describe the mechanical initial specimen
diversion of whole blood using active negative pressure as shown
below.
Body Part Approach Device / Substance / Qualifier

Technology
5 Circulatory X External R Infection, Mechanical 7 New

Initial Technology
Specimen Diversion Group 7
Technique Using Active
Negative Pressure
The Steripath® MicroTM Blood Collection System, also referred to as

Steripath® MicroTM Initial Specimen Diversion Device (ISDD®), is a
single-use, disposable device, used in the collection of blood cultures.
The device is intended to reduce blood culture contamination and
false positive diagnostic test results for sepsis.
The Steripath® MicroTM ISDD® uses a syringe-driven (or blood

culture bottle-driven) architecture that uses negative pressure to

divert and sequester the initial portion of blood known to most likely
contain contaminants. The diverted blood is isolated and a second
independent blood flow pathway is opened to collect the specimen for
blood culture testing.
Concurrent Measurement of mRNA, PCR test

and Detection of Antibodies
Three new codes have been created in Section X Table XXE,

Measurement of Physiological Systems, to identify each component
of the concurrent measurement of mRNA, PCR test and detection of
antibodies from blood and nasal specimens to detect the cause of
ischemic stroke and COVID-19 infection status as shown below.

Technology
5 Circulatory X External T Intracranial Arterial 7 New

Flow, Whole Blood Technology
mRNA Group 7
V Infection, Serum/
Plasma Nanoparticle
Fluorescence SARS-
CoV-2 Antibody
Detection
9 Nose 7 Via Natural U Infection, 7 New
or Artificial Nasopharyngeal Technology
Opening Fluid SARS-CoV-2 Group 7
Polymerase Chain
Reaction
The Ischemia Care Respiratory and Stroke Test (ISC-REST) is a

blood and swab collection kit using blood and nasopharyngeal fluid
specimens to assist with determining the cause of ischemic strokes.
The test kit is composed of three tests: the ISCDx test is used to
stratify the cause of ischemic strokes by differentiating cardioembolic
stroke from large artery atherosclerotic stroke; the QIAGEN Access
Anti-SARS-CoV-2 Total Test, a serological test that uses nanoparticle
fluorescence to detect antibodies to SARS-CoV-2 present in serum or
plasma; and the QIAstat-Dx Respiratory SARS-CoV-2 Panel, a real-

time PCR test that uses a nasopharyngeal swab sample to test for
current COVID-19 infection
All three ICD-10-PCS codes are needed to report the ISC-REST test
kit:
XXE5XT7 Measurement of intracranial arterial flow, whole blood

mRNA, New Technology Group 7
XXE5XV7 Measurement of infection, serum/plasma nanoparticle

fluorescence SARS-CoV-2 antibody detection, New
Technology Group 7
XXE97U7 Measurement of infection, nasopharyngeal fluid

sars-cov-2 polymerase chain reaction, New Technology
Group 7
Regional Anticoagulation for Renal Replacement Therapy
A code has been created in Section X, Table XY0, Extracorporeal

Introduction with a new substance value 3 Nafamostat Anticoagulant,
to identify regional anticoagulation in an extracorporeal dialysis circuit
with nafamostat as shown below. Facilities can continue to report the
renal replacement therapy (RRT) using the appropriate code from the
Table 5A1, Extracorporeal or Systemic Assistance and Performance,
Physiological Systems, Performance.

Technology
Y Extracorporeal X Externa 3 Nafamostat 7 New
Anticoagulant Technology
Group 7
Nafamostat is the active ingredient of Niyad™, an anticoagulant

for the dialysis filter. Nafamostat is a broad spectrum, protease
inhibitor that inhibits thrombin at the platelet thrombin receptor. When
nafamostat is administered into the afferent limb of the RRT circuit,
the blood becomes anticoagulated because of nafamostat’s rapid
action on thrombin. The anticoagulation effect is primarily limited to
the RRT circuit as the amount of nafamostat that is returned to the
patient via the efferent limb is limited and is rapidly metabolized.

Changes to the ICD-10-CM Official Guidelines
for Coding and Reporting
A summary of the modifications to the ICD-10-CM Official Guidelines
for Coding and Reporting are included below. The complete guidelines
may be downloaded by visiting
http://www.cdc.gov/nchs/icd/icd10cm.htm
The modifications are published below using the following format:
Narrative changes appear in bold text (e.g., severe sepsis)

Items underlined were moved within the guidelines since January
1, 2021 (e.g., severe sepsis)
Deletions are shown as strikeouts (e.g., severe sepsis)
Italics are used to indicate revisions to heading changes
Section I. Conventions, general coding guidelines and chapter

specific guidelines
B. General Coding Guidelines . . .
2. Level of Detail in Coding

Diagnosis codes are to be used and reported at their
highest number of characters available and to the highest
level of specificity documented in the medical record. .
..
3. Code or codes from A00.0 through T88.9, Z00-Z99.8,

U00-U85
The appropriate code or codes from A00.0 through
T88.9, Z00-Z99.8, and U00-U85 must be used to identify
diagnoses, symptoms, conditions, problems, complaints or
other reason(s) for the encounter/visit. . . .
13. Laterality . . .
When laterality is not documented by the patient’s
provider, code assignment for the affected side
may be based on medical record documentation
from other clinicians. If there is conflicting medical
record documentation regarding the affected side,
the patient’s attending provider should be queried
for clarification. Codes for “unspecified” side should

rarely be used, such as when the documentation in
the record is insufficient to determine the affected side
and it is not possible to obtain clarification.
14. Documentation by Clinicians Other than the Patient’s

Provider . . .
Code assignment is based on the documentation by
the patient’s provider (i.e., physician or other qualified
healthcare practitioner legally accountable for establishing
the patient’s diagnosis). There are a few exceptions
when, such as codes for the Body Mass Index (BMI),
depth of non-pressure chronic ulcers, pressure ulcer
stage, coma scale, and NIH stroke scale (NIHSS)
codes, code assignment may be based on medical
record documentation from clinicians who are not the
patient’s provider (i.e., physician or other qualified
healthcare practitioner legally accountable for establishing
the patient’s diagnosis). since this In this context,
“clinicians” other than the patient’s provider refer
to healthcare professionals permitted, based on
regulatory or accreditation requirements or internal
hospital policies, to document in a patient’s official
medical record.
These exceptions include codes for:

• Body Mass Index (BMI)
• Depth of non-pressure chronic ulcers
• Pressure ulcer stage
• Coma scale
• NIH stroke scale (NIHSS)
• Social determinants of health (SDOH)
• Laterality
• Blood alcohol level
This information is typically, or may be, documented

by other clinicians involved in the care of the patient
(e.g., a dietitian often documents the BMI, a nurse often
documents the pressure ulcer stages, and an emergency
medical technician often documents the coma scale).
However, the associated diagnosis (such as overweight,
obesity, acute stroke, or pressure ulcer, or a condition
classifiable to category F10, Alcohol related disorders)
must be documented by the patient’s provider. If there is

conflicting medical record documentation, either from the
same clinician or different clinicians, the patient’s attending
provider should be queried for clarification.
For social determinants of health, such as information

found in categories Z55-Z65, Persons with potential health
hazards related to socioeconomic and psychosocial
circumstances, code assignment may be based on medical
record documentation from clinicians involved in the care
of the patient who are not the patient’s provider since
this information represents social information, rather than
medical diagnoses.
The BMI, coma scale, NIHSS codes, blood alcohol level

and codes for social determinants of health categories
Z55-Z65 should only be reported as secondary diagnoses.
See Section I.C.21.c.17 for additional information

regarding coding social determinants of health. . . .
For social determinants of health, such as information

found in categories Z55-Z65, Persons with potential health
hazards related to socioeconomic and psychosocial
circumstances, code assignment may be based on medical
record documentation from clinicians involved in the care
of the patient who are not the patient’s provider since
this information represents social information, rather than
medical diagnoses. Patient self-reported documentation
may also be used to assign codes for social determinants
of health, as long as the patient self-reported information
is signed-off by and incorporated into the health record by
either a clinician or provider.
18. Use of Sign/Symptom/Unspecified Codes

Sign/symptom and “unspecified” codes have acceptable,
even necessary, uses. While specific diagnosis codes
should be reported when they are supported by the
available medical record documentation and clinical
knowledge of the patient’s health condition, there are
instances when signs/symptoms or unspecified codes are
the best choices for accurately reflecting the healthcare
encounter. Each healthcare encounter should be coded to
the level of certainty known for that encounter.

As stated in the introductory section of these
official coding guidelines, a joint effort between
the healthcare provider and the coder is essential
to achieve complete and accurate documentation,
code assignment, and reporting of diagnoses and
procedures. The importance of consistent, complete
documentation in the medical record cannot be
overemphasized. Without such documentation
accurate coding cannot be achieved. The entire record
should be reviewed to determine the specific reason
for the encounter and the conditions treated. . . .
19. Coding for Healthcare Encounters in Hurricane

Aftermath . . .
c. Other External Causes of Morbidity Code Issues . . .
W54.0-, Bitten by dog . . .
d. Use of Z codes
Z codes (other reasons for healthcare encounters)
may be assigned as appropriate to further explain
the reasons for presenting for healthcare services,
including transfers between healthcare facilities, or
provide additional information relevant to a patient
encounter. The ICD-10-CM Official Guidelines for
Coding and Reporting identify which codes maybe
assigned as principal or first-listed diagnosis only,
secondary diagnosis only, or principal/first-listed or
secondary (depending on the circumstances). Possible
applicable Z codes include:
Z59.0-, Homelessness . . .
C. Chapter Specific Coding Guidelines . . .
Chapter 1: Certain Infectious and Parasitic Diseases

(A00-B99), U07.1, U09.9 . . .
a. Human Immunodeficiency Virus (HIV) Infections . . .
2) Selection and sequencing of HIV codes . . .

(d) Asymptomatic human immunodeficiency virus
...
Z21, Asymptomatic human immunodeficiency virus
[HIV] infection status, is to be applied when the
patient without any documentation of symptoms is
listed as being “HIV positive,” “known HIV,” “HIV
test positive,” or similar terminology. Do not use this
code if the term “AIDS” or “HIV disease” is used
or if the patient is treated for any HIV-related illness
or is described as having any condition(s) resulting
from his/her HIV positive status; use B20 in these
cases. . . .
(h) Encounters for testing for HIV . . .

Use additional codes for any associated high-risk
behavior, if applicable.
(i) History of HIV managed by medication

If a patient with documented history of HIV
disease is currently managed on antiretroviral
medications, assign code B20, Human
immunodeficiency virus [HIV] disease. Code
Z79.899, Other long term (current) drug
therapy, may be assigned as an additional
code to identify the long-term (current) use of
antiretroviral medications. . .
g. Coronavirus infections
1) COVID-19 infection (infection due to SARS-CoV-2)

...
.
(g) Signs and symptoms without definitive
diagnosis of COVID-19 . . .
• R05.1 Acute cough, or R05.9, Cough,

unspecified . . .

(j) Follow-up visits after COVID-19 infection has
resolved
For individuals who previously had COVID-19

without residual symptom(s) or condition(s),
and are being seen for follow-up evaluation, and
COVID-19 test results are negative, assign codes
Z09, Encounter for follow-up examination after
completed treatment for conditions other than
malignant neoplasm, and Z86.16, Personal history
of COVID-19.
For follow-up visits for individuals with

symptom(s) or condition(s) related to a previous
COVID-19 infection, see guideline I.C.1.g.1.m.
See Section I.C.21.c.8, Factors influencing health

states and contact with health services, Follow-
up
(l) Multisystem Inflammatory Syndrome . . .
If MIS develops as a result of a previous COVID-19

infection, assign codes M35.81, Multisystem
inflammatory syndrome, and B94.8, Sequelae of
other specified infectious and parasitic diseases.
If an individual with a history of COVID-19 develops

MIS and the provider does not indicate the MIS
is due to the previous COVID-19 infection, assign
codes M35.81, Multisystem inflammatory syndrome,
and Z86.16, Personal history of COVID-19 U09.9,
Post COVID-19 condition, unspecified.
(m) Post COVID-19 Condition
For sequela of COVID-19, or associated

symptoms or conditions that develop following
a previous COVID-19 infection, assign a code(s)
for the specific symptom(s) or condition(s)
related to the previous COVID-19 infection,
if known, and code U09.9, Post COVID-19
condition, unspecified.

Code U09.9 should not be assigned for
manifestations of an active (current) COVID-19
infection.
If a patient has a condition(s) associated with

a previous COVID-19 infection and develops
a new active (current) COVID-19 infection,
code U09.9 may be assigned in conjunction
with code U07.1, COVID-19, to identify that
the patient also has a condition(s) associated
with a previous COVID-19 infection. Code(s)
for the specific condition(s) associated with
the previous COVID-19 infection and code(s)
for manifestation(s) of the new active (current)
COVID-19 infection should also be assigned.
2. Chapter 2: Neoplasms (C00-D49)
General guidelines . . .
l. Sequencing of neoplasm codes . . .
3) Malignant neoplasm in a pregnant patient

When a pregnant woman patient has a malignant
neoplasm, a code from subcategory O9A.1-, Malig-
nant neoplasm complicating pregnancy, childbirth, and
the puerperium, should be sequenced first, followed
by the appropriate code from Chapter 2 to indicate the
type of neoplasm. . . .
s. Breast Implant Associated Anaplastic Large Cell

Lymphoma
Breast implant associated anaplastic large cell
lymphoma (BIA-ALCL) is a type of lymphoma that
can develop around breast implants. Assign code
C84.7A, Anaplastic large cell lymphoma, ALK-
negative, breast, for BIA-ALCL. Do not assign a
complication code from chapter 19. . . .

4. Chapter 4: Endocrine, Nutritional, and Metabolic
Diseases (E00-E89)
a. Diabetes mellitus . . .
3) Diabetes mellitus and the use of insulinand, oral

hypoglycemics, and injectable non-insulin drugs . . .
If the documentation in a medical record does not
indicate the type of diabetes but does indicate that
the patient uses insulin, code E11-, Type 2 diabetes
mellitus, should be assigned. An a Additional code(s)
should be assigned from category Z79 to identify the
long-term (current) use of insulin, or oral hypoglycemic
drugs, or injectable non-insulin antidiabetic, as
follows:
If the patient is treated with both oral medications and

insulin, only the code for long-term (current) use of
insulin both code Z79.4, Long term (current) use of
insulin, and code Z79.84, Long term (current) use
of oral hypoglycemic drugs, should be assigned. . . .
6) Secondary diabetes mellitus . . .

Secondary diabetes mellitus and the use of insulin,
or oral hypoglycemic drugs, or injectable non-
insulin antidiabetic drugs
For patients with secondary diabetes mellitus who

routinely use insulin, oral hypoglycemic drugs, or
injectable non-insulin drugs, additional code(s) from
category Z79 should be assigned to identify the long-
term (current) use of insulin, oral hypoglycemic drugs,
or non-injectable non-insulin drugs as follows:
If the patient is treated with both oral medications and

insulin, only the code for long-term (current) use of
insulin both code Z79.4, Long term (current) use of
insulin, and code Z79.84, Long term (current) use
of oral hypoglycemic drugs, should be assigned.

5. Chapter 5: Mental, Behavioral and Neurodevelopmental
disorders (F01 – F99) . . .
b. Mental and behavioral disorders due to psychoactive

substance use . . .
3) Psychoactive Substance Use, Unspecified . . .

As with all other unspecified diagnoses, the codes
for unspecified psychoactive substance use (F10.9-
, F11.9-, F12.9-, F13.9-, F14.9-, F15.9-, F16.9-,
F18.9-, F19.9-) should only be assigned based on
provider documentation and when they meet the
definition of a reportable diagnosis (see Section III,
Reporting Additional Diagnoses). These codes are
to be used only when the psychoactive substance
use is associated with a substance related physical
disorder included in (chapter 5 disorders (such as
sexual dysfunction, and sleep disorder), or a mental
or behavioral disorder) or medical condition, and
such a relationship is documented by the provider.
4) Medical Conditions Due to Psychoactive

Substance Use, Abuse and Dependence
Medical conditions due to substance use,
abuse, and dependence are not classified
as substance-induced disorders. Assign the
diagnosis code for the medical condition as
directed by the Alphabetical Index along with
the appropriate psychoactive substance use,
abuse or dependence code. For example, for
alcoholic pancreatitis due to alcohol dependence,
assign the appropriate code from subcategory
K85.2, Alcohol induced acute pancreatitis, and
the appropriate code from subcategory F10.2,
such as code F10.20, Alcohol dependence,
uncomplicated. It would not be appropriate to
assign code F10.288, Alcohol dependence with
other alcohol-induced disorder.

5) Blood Alcohol Level
A code from category Y90, Evidence of alcohol
involvement determined by blood alcohol
level, may be assigned when this information
is documented and the patient’s provider has
documented a condition classifiable to category
F10, Alcohol related disorders. The blood alcohol
level does not need to be documented by the
patient’s provider in order for it to be coded.
9. Chapter 9: Diseases of the Circulatory System (I00-I99)
a. Hypertension . . .
5) Hypertensive Retinopathy
Subcategory H35.0, Background retinopathy and
retinal vascular changes, should be used along with a
code from categoryies I10 – I15, in the Hypertensive
diseases section, to include the systemic
hypertension. The sequencing is based on the reason
for the encounter
12. Chapter 12: Diseases of the Skin and Subcutaneous

Tissue (L00-L99)
a. Pressure ulcer stage codes . . .
2) Unstageable pressure ulcers . . .

If during an encounter, the stage of an
unstageable pressure ulcer is revealed after
debridement, assign only the code for the stage
revealed following debridement.
13. Chapter 13: Diseases of the Musculoskeletal System

and Connective Tissue (M00-M99) . . .
e. Multisystem Inflammatory Syndrome
See Section I.C.1.g.1.l for Multisystem Inflammatory

Syndrome

15. Chapter 15: Pregnancy, Childbirth, and the Puerperium
(O00-O9A)
a. General Rules for Obstetric Cases . . .
3) Final character for trimester . . .

When the classification does not provide an
obstetric code with an “in childbirth” option, it
is appropriate to assign a code describing the
current trimester. . . .
g. Diabetes mellitus in pregnancy
Pregnant women patients who are diabetic should be

assigned a code from category O24, Diabetes mellitus
in pregnancy, childbirth, and the puerperium, first,
followed by the appropriate diabetes code(s) (E08-
E13) from Chapter 4. . . .
i. Gestational (pregnancy induced) diabetes
Gestational (pregnancy induced) diabetes can occur

during the second and third trimester of pregnancy
in women patients who were not diabetic prior
to pregnancy. Gestational diabetes can cause
complications in the pregnancy similar to those of
pre-existing diabetes mellitus. It also puts the woman
patient at greater risk of developing diabetes after the
pregnancy. . . .
l. Alcohol, tobacco and drug use during pregnancy,

childbirth and the puerperium
1) Alcohol use during pregnancy, childbirth and the

puerperium
Codes under subcategory O99.31, Alcohol use
complicating pregnancy, childbirth, and the
puerperium, should be assigned for any pregnancy
case when a mother patient uses alcohol during the
pregnancy or postpartum. A secondary code from
category F10, Alcohol related disorders, should also
be assigned to identify manifestations of the alcohol
use. . . .

3) Drug use during pregnancy, childbirth and the
puerperium
Codes under subcategory O99.32, Drug use
complicating pregnancy, childbirth, and the
puerperium, should be assigned for any pregnancy
case when a mother patient uses drugs during the
pregnancy or postpartum.
n. Normal Delivery, Code O80
1) Encounter for full term uncomplicated delivery

Code O80 should be assigned when a woman
patient is admitted for a full-term normal delivery
and delivers a single, healthy infant without any
complications antepartum, during the delivery, or
postpartum during the delivery episode. Code O80 is
always a principal diagnosis. . . .
o. The Peripartum and Postpartum Periods . . .
5) Pregnancy associated cardiomyopathy . . .

Code O90.3 is only for use when the cardiomyopathy
develops as a result of pregnancy in a woman
patient who did not have pre-existing heart disease.
p. Code O94, Sequelae of complication of pregnancy,

childbirth, and the puerperium
1) Code O94
Code O94, Sequelae of complication of pregnancy,
childbirth, and the puerperium, is for use in those
cases when an initial complication of a pregnancy
develops a sequela or sequelae requiring care or
treatment at a future date. . . .
18. Chapter 18: Symptoms, signs, and abnormal clinical

and laboratory findings, not elsewhere classified
(R00-R99) . . .
e. Coma scale
Code R40.20, Unspecified coma, may be assigned in
conjunction with codes for any medical condition.
Do not report codes for unspecified coma, individual

or total Glasgow coma scale scores for a patient with a
medically induced coma or a sedated patient.
1) Coma Scale
The coma scale codes (R40.21- to R40.24-) can
be used in conjunction with traumatic brain injury
codes. These codes are primarily for use by trauma
registries, but they may be used in any setting where
this information is collected. The coma scale codes
should be sequenced after the diagnosis code(s). . . .
If multiple coma scores are captured within

the first 24 hours after hospital admission,
assign only the code for the score at the time of
admission. ICD-10-CM does not classify coma
scores that are reported after admission but less
than 24 hours later. . . .
19. Chapter 19: Injury, poisoning, and certain other

consequences of external causes (S00-T88) . . .
d. Coding of Burns and Corrosions
6) Burns and corrosions classified according to

extent of body surface involved
Assign codes from category T31, Burns classified
according to extent of body surface involved, or T32,
Corrosions classified according to extent of body
surface involved, for acute burns or corrosions
when the site of the burn or corrosion is not
specified or when there is a need for additional data.
. . Codes from categories T31 and T32 should not
be used for sequelae of burns or corrosions. . . .
21. Chapter 21: Factors influencing health status and

contact with health services (Z00-Z99) . . .
b. Z Codes Indicate a Reason for an Encounter

or Provide Additional Information about a Patient
Encounter
Z codes are not procedure codes. A corresponding
procedure code must accompany a Z code to describe
any procedure performed.

c. Categories of Z Codes . . .
4) History (of) . . .
A history of an illness, even if no longer present,
is important information that may alter the type of
treatment ordered.
The reason for the encounter (for example,

screening or counseling) should be sequenced
first and the appropriate personal and/or family
history code(s) should be assigned as additional
diagnos(es). . . .
The history Z codes/categories are . . .
Z91.5- Personal history of self-harm . . .
9) Donor . . .
These codes are only for individuals donating for
others, as well as not for self-donations. . . .
10) Counseling . . .
The counseling Z codes/categories are . . .
Z71 Persons encountering health services for

other counseling and medical advice, not
elsewhere classified . . .
Code Z71.85, Encounter for immunization
safety counseling, is to be used for coun-
seling of the patient or caregiver regarding
the safety of a vaccine. This code should
not be used for the provision of general in-
formation regarding risks and potential side
effects during routine encounters for the ad-
ministration of vaccines.
14) Miscellaneous Z Codes

The miscellaneous Z codes capture a number of
other health care encounters that do not fall into
one of the other categories. Certain Some of these
codes identify the reason for the encounter; others
are for use as additional codes that provide useful
information on circumstances that may affect a
patient’s care and treatment. . .

17) Social Determinants of Health
Codes describing social determinants of
health (SDOH) should be assigned when this
information is documented.
For social determinants of health, such as
information found in categories Z55- Z65,
Persons with potential health hazards related to
socioeconomic and psychosocial circumstances,
code assignment may be based on medical record
documentation from clinicians involved in the care
of the patient who are not the patient’s provider
since this information represents social information,
rather than medical diagnoses. For example,
coding professionals may utilize documentation
of social information from social workers,
community health workers, case managers, or
nurses, if their documentation is included in the
official medical record.
Patient self-reported documentation may be used
to assign codes for social determinants of health,
as long as the patient self-reported information is
signed-off by and incorporated into the medical
record by either a clinician or provider.
Social determinants of health codes are located
primarily in these Z code categories:
Z55 Problems related to education and literacy
Z56 Problems related to employment and
unemployment
Z57 Occupational exposure to risk factors
Z58 Problems related to physical environment
Z59 Problems related to housing and economic
circumstances
Z60 Problems related to social environment
Z62 Problems related to upbringing
Z63 Other problems related to primary support
group, including family circumstances
Z64 Problems related to certain psychosocial
circumstances
Z65 Problems related to other psychosocial
circumstances
See Section I.B.14. Documentation by Clinicians
Other than the Patient’s Provider.

22. Chapter 22: Codes for Special Purposes (U00-U85)
U07.0 Vaping-related disorder (see Section I.C.10.e.,

Vaping-related disorders)
U07.1 COVID-19 (see Section I.C.1.g.1., COVID-19
infection)
U09.9 Post COVID-19 condition, unspecified (see
Section I.C.1.g.1.m)
Section IV. Diagnostic Coding and Reporting Guidelines for

Outpatient Services . . .
B. Codes from A00.0 through T88.9, Z00-Z99, U00-U85

The appropriate code(s) from A00.0 through T88.9, Z00-Z99 and
U00-U85 must be used to identify diagnoses, symptoms, conditions,
problems, complaints, or other reason(s) for the encounter/visit. . . .
F. Level of Detail in Coding . . .
3. Highest level of specificity

Code to the highest level of specificity when supported
by the medical record documentation.

Changes to the ICD-10-PCS Official Guidelines
for Coding and Reporting
A summary of the modifications to the ICD-10-PCS Official Guidelines
for Coding and Reporting is included below. The complete guidelines
may be downloaded by visiting https://www.cms.gov/medicare/icd-
10/2022-icd-10-pcs.
The modifications are published below using the following format:
Narrative changes appear in bold text (e.g., more definitive root

operation).
Items underlined were moved within the guidelines since October 1,
2021
(e.g., control of acute bleeding). Deletions are shown as strikeouts
(e.g., any of the definitive root operations).
Medical and Surgical Section Guidelines (section 0)
B3. Root Operation . . .

Control vs. more definitive specific root operations
B3.7
The root operation Control is defined as, “Stopping, or attempting to
stop, postprocedural or other acute bleeding.” If an attempt to stop
postprocedural or other acute bleeding is unsuccessful, and to stop
the bleeding requires performing a more definitive root operation,
such as Bypass, Detachment, Excision, Extraction, Reposition,
Replacement, or Resection, then the more definitive root operation
is coded instead of Control. Control is the root operation coded
when the procedure performed to achieve hemostasis, beyond
what would be considered integral to a procedure, utilizes
techniques (e.g., cautery, application of substances or pressure,
suturing or ligation or clipping of bleeding points at the site) that
are not described by a more specific root operation definition,
such as Bypass, Detachment, Excision, Extraction, Reposition,
Replacement, or Resection. If a more specific root operation
definition applies to the procedure performed, then the more
specific root operation is coded instead of Control.
Example: Resection of spleen to stop bleeding is coded to Resection
instead of Control Silver nitrate cautery to treat acute nasal
bleeding is coded to the root operation Control.

Example: Liquid embolization of the right internal iliac artery to
treat acute hematoma by stopping blood flow is coded to the
root operation Occlusion.
Example: Suctioning of residual blood to achieve hemostasis
during a transbronchial cryobiopsy is considered integral to the
cryobiopsy procedure and is not coded separately.
B4. Body Part . . .
B4.1c
If a procedure is performed on a continuous section of a tubular
body part, code the body part value corresponding to the furthest
anatomical site from the point of entry anatomically most proximal
(closest to the heart) portion of the tubular body part.
Example: A procedure performed on a continuous section of artery
from the femoral artery to the external iliac artery with the point of
entry at the femoral artery is coded to the external iliac body part. A
procedure performed on a continuous section of artery from the
femoral artery to the external iliac artery with the point of entry at
the external iliac artery is also coded to the external iliac artery
body part.
Upper and lower intestinal tract

B4.8
In the Gastrointestinal body system, the general body part values
Upper Intestinal Tract and Lower Intestinal Tract are provided as an
option for the root operations such as Change, Insertion, Inspection,
Removal and Revision.
New Technology Section Guidelines (section X)

E. New Technology Section
General guidelines
E1.a
Example: XW04321 Introduction of Ceftazidime-Avibactam Anti-
infective into Central Vein, Percutaneous Approach, New Technology
Group 1, can be coded to indicate that Ceftazidime-Avibactam Anti-
infective was administered via a central vein. XW043A6 Introduction
of Cefiderocol Anti-infective into Central Vein, Percutaneous
Approach, New Technology Group 6, can be coded to indicate
that Cefiderocol Anti-infective was administered via a central
vein.

Explanation of the Revised Guideline for Control
The revised guideline for Control is intended to clarify the appropriate
use of this root operation. All three general types of scenarios
involving procedures to control bleeding are provided in the revised
guideline:
1. Those that should assign the root operation Control.

2. Those that should assign a more specific root operation.
3. Those that do not assign a separate code.
Scenario 1:
Procedures that meet the definition of the root operation Control
use the same techniques—suturing or other ligation or clipping or
cautery of bleeding points, application of substances or pressure to
the site—as are typically meant by the term “achieving hemostasis”
during surgery. When any or all of these techniques are used during
a separate procedure performed to control acute bleeding, the root
operation Control is assigned. In such cases, the diagnosis on the
procedure report may include current or recent acute bleeding. Silver
nitrate cautery to treat acute nasal bleeding is used in the revised
guideline as an example of this type of scenario.
The root operation Control can also be assigned as an additional

code in those rare surgical cases where the documentation in the
procedure report indicates that something unexpected occurred,
requiring additional measures beyond routine hemostasis. An example
is a surgical procedure where the procedure site had to be reopened
before leaving the surgical suite, due to continued bleeding at the site.
Scenario 2:
Because the root operation Control is only assigned when the
techniques used are the same as those typically used to “achieve
hemostasis,” any procedure performed to control bleeding that
uses a technique consistent with the definition of one of the other,
more specific root operations, then the procedure code is assigned
accordingly. A fundamental principle of ICD-10-PCS coding is that
the root operation definitions determine the most accurate code that
specifies physically what was done to the anatomic site. Assigning
root operation Occlusion for liquid embolization of the right internal
iliac artery to treat acute hematoma is used in the revised guideline as
an example of this type of scenario.

Scenario 3:
Types of scenarios in which a separate code is not assigned are also
covered in the revised guideline, to emphasize the fact that Control
is not intended to be assigned for routine, expected techniques used
during a procedure to achieve hemostasis. The revised guideline uses
transbronchial cryobiopsy with suctioning of residual blood to achieve
hemostasis as an example, to remind coders that typical measures
taken to achieve hemostasis are still considered integral to the
procedure and are not coded separately.

Announcement
Addition of April 1st Maintenance of the ICD-10-CM
and ICD-10-PCS Coding Systems
In the fiscal year 2022 Hospital Inpatient Prospective Payment System

final rule published on August 2, 2021, the Centers for Medicare
& Medicaid Services (CMS) announced it is adopting an April 1
implementation date for ICD-10-CM and ICD-10-PCS code updates,
in addition to the annual October 1 update, beginning with April 1,
2022. This April 1 code update would be in addition to the existing
April 1 update under section 1886(d)(5)(k)(vii) of the Act for diagnosis
or procedure code revisions needed to describe new technologies and
medical services for purposes of the new technology add-on payment
process. The April 1 implementation will use a phased-in approach,
such that initially, the number and nature of the code updates would
be fewer and less comprehensive as compared to the existing
October 1 update.
Earlier recognition of diagnoses, conditions, and illnesses as well as

procedures, services, and treatments in the claims data would be
beneficial for purposes of reporting, data collection, tracking clinical
outcomes, claims processing, surveillance, research, policy decisions
and data interoperability.
The existing established process for code maintenance will be used,

meaning that the codes will be presented at the ICD-10 Coordination
and Maintenance Committee meeting with opportunity for public
comment. Coding guidelines and coding advice will be updated as
needed. Any new ICD-10 code updates finalized for implementation
on the following April 1 would be announced in November of the prior
year.

New/Revised Frequently Asked Questions
Regarding ICD-10-CM/PCS Coding for COVID-19
Revised August 27, 2021
Question:
When a patient is diagnosed with COVID-19,
we understand that signs and symptoms are
not manifestations and would not be separately
coded. We also understand that Guideline
I.C.18.b. states that “signs or symptoms
that are routinely associated with a disease
process should not be assigned as additional
codes, unless otherwise instructed by the
classification.” When a patient diagnosed
with COVID-19 presents with both respiratory
signs/symptoms (e.g., shortness of breath,
cough) and non-respiratory signs/symptoms
(e.g. gastrointestinal problems, dermatologic
or venous sufficiency issues), may the non-
respiratory signs/symptoms/conditions be
coded separately since they are not routinely
associated with COVID-19? (4/28/2020; revised
8/25/21)
Answer:
People infected with COVID-19 may vary
from being asymptomatic to having a range of
symptoms and severity. Therefore, for coding
purposes, signs and symptoms associated with
COVID-19 may be coded separately, unless
the signs or symptoms are routinely associated
with a manifestation. For example, cough
would not be coded separately if the patient
has pneumonia due to COVID-19, as cough
is a symptom of pneumonia. The additional
coding of signs or symptoms not explained by
the manifestations would provide additional
information on the severity of the disease.

Question:
A child diagnosed with COVID-19 several
weeks ago is now admitted with multisystem
inflammatory syndrome in children (MIS-C)
due to COVID-19. The patient no longer
has COVID-19. How should this be coded?
(7/23/2020; revised 12/11/2020, 8/25/21)
Answer:
Assign code M35.8, Other specified systemic
involvement of connective tissue, for discharg-
es prior to January 1, 2021, or code M35.81,
Multisystem inflammatory syndrome, for dis-
charges after January 1, 2021, as the principal
diagnosis, for the MIS-C, and code B94.8,
Sequelae of other specified infectious and
parasitic diseases, for discharges/encounters
prior to October 1, 2021, or code U09.9, Post
COVID-19 condition, unspecified, for discharg-
es/encounters on or after October 1, 2021, as
a secondary diagnosis for the sequelae of a
COVID-19 infection.
If the documentation is not clear regarding

whether the physician considers a condition
to be an acute manifestation of a current
COVID-19 infection vs. a residual effect from
a previous COVID-19 infection, query the
provider. As stated in the ICD-10-CM Official
Guidelines for Coding and Reporting, the
provider’s documentation that the individual has
COVID-19 is sufficient for coding purposes.
Question:
The patient presents to the facility with
symptoms such as generalized weakness and
lack of appetite, and the provider documents a
diagnosis of “post COVID-19 syndrome.” How
should this be coded? (12/11/2020; revised
8/25/21)

Answer:
[Effective 10/1/21:]
For discharges/encounters on or after October
1, 2021, assign codes R53.1, Weakness,
R63.0, Anorexia, and U09.9, Post COVID-19
condition, unspecified, for a diagnosis of
post COVID-19 syndrome with generalized
weakness and lack of appetite This is
supported by the instructional note at code
U09.9 to “code first the specific condition
related to COVID-19 if known.”
[Prior to 10/1/21:]
For discharges/encounters prior to October
1, 2021, unless the provider specifically
documents that the symptoms are the result
of COVID-19, assign code(s) for the specific
symptom(s) and a code for personal history
of COVID-19. “Post COVID-19 syndrome”
indicates temporality, but not that the current
symptom(s) or clinical condition(s) are a
residual effect (sequelae) of COVID-19. As
stated in the ICD-10-CM Official Guidelines
for Coding and Reporting, in the absence
of Alphabetic Index guidance for coding
syndromes, assign codes for the documented
manifestations of the syndrome.
The appropriate personal history code is
Z86.19, Personal history of other infectious and
prior to January 1, 2021 or code Z86.16,
Personal history of COVID-19, for discharges/
encounters after January 1, 2021.
If the provider documents that the symptoms
are the result (residual effect) of COVID-19,
assign code(s) for the specific symptom(s)
and code B94.8, Sequelae of other specified
infectious and parasitic diseases. According to
the ICD-10-CM Official Guidelines for Coding
and Reporting, a sequela is the residual effect
(condition produced) after the acute phase of
an illness or injury has terminated.

Question:
A patient was COVID-19 positive at a short
term acute care hospital where he was being
cared for COVID-19 related respiratory
problems and completed treatment with
Remdesivir and Dexamethasone. After more
than a two-month stay, the patient is now
transferred to a long-term care hospital (LTCH)
with acute respiratory failure for tracheostomy
weaning. At the time of transfer, the patient had
been weaned from ventilator to tracheostomy
collar at 28%. Diagnosis on admission was
history of COVID-19, acute respiratory failure,
and tracheostomy dependence. When queried
regarding the patient’s COVID-19 status on
admission to the LTCH, the provider indicated
that the patient was no longer infectious and
is being admitted only to treat the residual
respiratory failure requiring oxygenation via
tracheostomy. May we assign code J96.90 as
a principal diagnosis, followed by code Z86.16,
Personal history of COVID-19, since the patient
no longer has a COVID-19 infection? (3/1/21;
revised 8/25/21)
Answer:
Query the provider whether “residual
respiratory failure” refers to acute on chronic,
or chronic respiratory failure. Assign the
appropriate respiratory failure code based
on the response, followed by code B94.8,
prior to October 1, 2021, or code U09.9,
Post COVID-19 condition, unspecified, for
discharges/encounters on or after October
1, 2021, as a secondary diagnosis, for the
sequelae of COVID-19 infection, since the
patient has been documented as no longer
infectious for COVID-19.

Although the provider referred to “history
of COVID-19,” a personal history code is
inappropriate in this case. As defined in the
ICD-10-CM Official Guidelines for Coding and
Reporting, Section IB. “A sequela is the residual
effect (condition produced) after the acute
phase of an illness or injury has terminated.”
In addition, Section I. C.21,c,( 4) states
“Personal history codes explain a patient’s past
medical condition that no longer exists and is
not receiving any treatment, but that has the
potential for recurrence, and therefore may
require continued monitoring.”
Question:
Patient has a long history of multiple transfers
between short term acute care hospitals
(STACH) and long-term care hospitals (LTCH)
for nearly 8 months. Patient is status post
prolonged hospitalizations for respiratory failure
and critical illness secondary to COVID-19
pneumonia. He never fully recovered from a
respiratory standpoint. He is now admitted
into the LTCH with COVID-19 listed as past
history for continued treatment of respiratory
failure with prolonged mechanical ventilation for
further continuation of vent weaning and rehab
services. COVID-19 treatment was completed 8
months ago at the STACH.
Provider documentation states chronic

respiratory failure secondary to COVID-19
related ARDS, and status post tracheostomy.
Patient is currently on prolonged mechanical
ventilation most likely from diaphragm
weakness and tenacious secretions
complicated by pulmonary hypertension with
some degree of prominent lung dysfunction.
Would the correct coding and sequencing
for the above scenario be J96.10, Chronic
respiratory failure, followed by Z86.16, for
history of COVID, or B94.8 for sequela of
COVID? (3/1/21; revised 8/25/21)

Answer:
Assign code J96.10, Chronic respiratory
failure, unspecified whether with hypoxia
or hypercapnia, as the principal diagnosis
since the ARDS has resolved. In addition,
assign code B94.8, Sequelae of other
specified infectious and parasitic diseases,
for discharges/encounters prior to October 1,
2021, or code U09.9, Post COVID-19 condition,
unspecified, for discharges/encounters on
or after October 1, 2021, as a secondary
diagnosis, since the patient no longer has an
active COVID-19 infection.
Question:
A patient who tested negative for COVID-19
several times as an outpatient now presents
to the Emergency Department because of
worsening symptoms. The patient was admitted
for treatment of possible pneumonia. He was
retested for COVID-19, and the results were
still negative; however, a COVID-19 antibody
test was positive. The provider’s final diagnostic
statement lists, “Post COVID-19 organizing
pneumonia.” Would pneumonia be considered
an acute manifestation of COVID-19, a
late effect/sequela of COVID- 19, or is the
COVID-19 coded as a personal history since
the most recent COVID-19 test is negative?
What is the principal diagnosis, COVID-19 or
pneumonia? (3/1/21; revised 8/25/21)
Answer:
Based on the documentation provided, the
patient has an organizing pneumonia due
to previous COVID-19 infection. Assign
code J84.89, Other specified interstitial
pulmonary diseases, followed by code B94.8.
prior to October 1, 2021, or code U09.9,
Post COVID-19 condition, unspecified, for

discharges/encounters on or after October
1, 2021, for a diagnosis of post COVID-19
organizing pneumonia. Code J84.89 may be
located by the following Index entry:

Pneumonia
organizing J84.89
Question:
A patient with a history of COVID-19
infection was admitted for treatment of acute
hyperkalemia and acute kidney injury with
chronic kidney disease. Follow-up COVID-19
testing was positive. The provider documented,
“COVID likely reflective of old noninfectious
virus.” How is the COVID-19 status captured
for this patient? Does the Official Coding and
Reporting Guideline I.C.1.g.1.a., “code only
confirmed cases” apply when the provider
documents the patient as “noninfectious”
but has a positive COVID-19 test during the
admission? (8/25/21)
Answer:
Assign code Z86.16, Personal history of
COVID-19. While the patient had a positive
COVID-19 test, the provider documented that
the patient was not actively infectious during
this admission. When the provider documents
“noninfectious” or “not infectious” COVID-19
status, this indicates that the patient no longer
has an active COVID-19 infection, therefore
assign code Z86.16 instead of code U07.1,
COVID-19.
Although guideline I.C.1.g.1.a., states: “Code

only a confirmed diagnosis of the 2019
novel coronavirus disease (COVID-19) as
documented by the provider or documentation
of a positive COVID-19 test result,” in this
scenario the provider has clarified the patient
no longer has an active COVID-19 infection.

Therefore, code U07.1, COVID-19, is not
appropriate and the Official Coding Guideline
I.C.1.g.1.a., regarding a positive COVID-19 test
result would not apply.
If the documentation is unclear, as to whether

the patient has an active COVID-19 infection
or a personal history, query the provider for
clarification.
Question:
A patient presented to the hospital with acute
respiratory failure and COPD exacerbation.
It was noted that the patient tested positive
for COVID-19 approximately 80 days prior to
this admission. A repeat COVID-19 test was
performed and came back positive but the
provider documented she did not consider the
patient’s status to be a COVID-19 “reinfection.”
The discharge summary states: “history of
COVID infection currently still testing positive
for COVID.” Is it appropriate to assign code
Z86.16, Personal history of COVID-19, or code
U07.1, COVID-19 since there is a positive test?
(8/25/21)
Answer:
Although the patient is still testing positive for
COVID-19, the provider has documented the
patient’s condition was a previous history of
a COVID-19 infection and not a reinfection,
therefore it would be appropriate to assign code
Z86.16, Personal history of COVID-19.
Question:
A patient presented for treatment of bulbous
pemphigoid bulla with surrounding cellulitis.
During the admission, the patient was tested for
COVID-19. Although the patient was completely
vaccinated, the physician documented the
COVID-19 test was positive. The patient was
subsequently placed in isolation and instructed

to complete 10 days of self-isolation following
discharge. How is COVID-19 coded in this
scenario? (8/25/21)
Answer:
Assign code U07.1, COVID-19. The provider’s
assessment stated “COVID-19 virus detected,”
and it is possible for a COVID-19 infection to
occur despite vaccination. This is consistent
with Official Guidelines for Coding and
Reporting, Section I.C.1.g.1.a., which states:
Code only a confirmed diagnosis of the 2019
novel coronavirus disease (COVID-19) as
documented by the provider or documentation
of a positive COVID-19 test result.
Question:
A patient was recently discharged from the
hospital, admitted to a nursing home, and
subsequently tested positive for COVID-19
via a rapid antigen test. The patient was
readmitted to the hospital for COVID-19;
however was asymptomatic. Repeat testing
x2 including confirmatory testing of COVID
PCR was negative. The provider consulted
with infectious disease and hematology and
it was documented the patient had a false
positive that did not represent a true COVID-19
infection. How is COVID-19 coded in this
scenario? (8/25/21)
Answer:
Assign code Z20.822, Contact with and
(suspected) exposure to COVID-19, as
principal diagnosis, for a patient admitted and
found to have a false positive COVID-19 test.
ICD-10-CM Official Guidelines for Coding
and Reporting, Section I.C.1.g.1.e. states:
For asymptomatic individuals with actual or
suspected exposure to COVID-19, assign
code Z20.822, Contact with and (suspected)
exposure to COVID-19.

Although guideline I.C.1.g.1.a., allows coding
of confirmed cases of COVID-19 on the basis
of “documentation of a positive COVID-19 test
result,” in this scenario the provider clarified
the COVID-19 test as being a false positive;
therefore code U07.1, COVID-19, is not
appropriate and the Official Coding Guideline
I.C.1.g.1.a. regarding coding on the basis of a
positive COVID-19 test result would not apply
to this case.
However, it is always appropriate to query

the provider for clarification whenever the
coding professional finds the medical record
documentation to be unclear regarding the
patient’s COVID-19 status.
Question:
Is it appropriate to report code Z28.3,
Underimmunization status, for encounters
where the provider documents the patient has
not been immunized against COVID-19??
(8/27/21).
Answer:
No, code Z28.3, Underimmunization status,
is not appropriate for this purpose. There is
currently no ICD-10-CM code available to
identify lack of immunization against COVID-19.
ICD-10-PCS Questions
Question:
What ICD-10-PCS procedure code should be
assigned for a new drug or other therapeutic
substance administered in the hospital
inpatient setting to treat COVID-19 when there
is no unique code for the administration of
the specific substance? (7/30/2020; revised
8/5/2020, 8/25/21)

Answer:
Effective with discharges on or after August 1,
2020, the following ICD-10-PCS codes should
be used for administration of a new therapeutic
substance to treat COVID-19 when the
substance is not classified elsewhere in ICD-
10-PCS:
XW013F5 Introduction of other new

technology therapeutic
substance into subcutaneous
tissue, percutaneous approach,
New Technology Group 5

substance into peripheral vein,
percutaneous approach, New
Technology Group 5

substance into central vein,
percutaneous approach, New
Technology Group 5
XW0DXF5 Introduction of other new

substance into mouth and
pharynx, external approach,
New Technology Group 5
These codes should only be assigned for

new therapeutic substances being used to
treat COVID-19. For administration of “other
therapeutic substances” that are being used to
treat medical conditions other than COVID-19,
see ICD-10-PCS table 3E0. For example, code
3E033GC describes “Introduction of Other
Therapeutic Substance into Peripheral Vein,
Percutaneous Approach.”

Ask the Editor
Question:
The Official Guidelines for Coding and
Reporting section I.C.18.e. was revised
effective October 1, 2020 to indicate that coma
scale codes are to be used only in conjunction
with traumatic brain injuries (TBI). Subcategory
R40.2, Coma, was provided as the code range
in this guideline, which includes code R40.20,
Coma, unspecified. However, the coma scale
codes start at subcategory R40.21, Coma
scale, eyes open, and code R40.20 does
not appear to capture any coma scale score
information. Would code R40.20 be reported
with non-traumatic brain injury conditions, such
as intracerebral hemorrhage or stroke, when
the patient is also in a coma?
Answer:
Yes, it would be appropriate to report code
R40.20, Coma, unspecified, with non-TBI
conditions when the patient is also comatose.
The intent of the coma guideline revision was
to indicate that coma scale score codes should
only be reported with traumatic brain injuries.
Code R40.20 does not fall into the coma
scale score code range. Therefore, assign
code R40.20, when coma is documented and
reporting requirements have been met.
The Official Guidelines for Coding and

Reporting section I.C.18.e. has been revised to
clear up any confusion as follows:
“Code R40.20, Unspecified coma, may be

assigned in conjunction with codes for any
medical condition.”

Question:
A patient suffered a traumatic brain injury with
severe swelling of the brain due to a motor
vehicle accident. The patient was placed in a
medically induced coma to protect the brain
and minimize the swelling and inflammation.
Would it be appropriate to report code R40.20,
Coma, unspecified, for a medically induced
coma?
Answer:
No, it is not appropriate to report code R40.20
for a medically induced coma. The Official
Guidelines for Coding and Reporting section
I.C.18.e. states, “Do not report codes for
unspecified coma, individual or total Glasgow
coma scale scores for a patient with a medically
induced coma or a sedated patient.”

A Quarterly Publication of The Central Office On ICD-10-CM/PCS

Uploaded by

Copyright:

Available Formats

You might also like

A Quarterly Publication of The Central Office On ICD-10-CM/PCS

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

A Quarterly Publication of The Central Office On ICD-10-CM/PCS

Uploaded by

Copyright:

Available Formats

A quarterly publication of the

Central Office on ICD-10-CM/PCS

Coding advice and new code assignments contained in this issue

Section B – Imaging Section 3 – Administration

In response to the national emergency that was declared concerning

The information below regarding new or revised ICD-10-CM codes

There are 159 new ICD-10-CM codes effective October 1, 2021. In

Subcategory A79.8 Other specified rickettsioses, was expanded

Anaplasmosis is a tick-borne disease caused by the bite of an infected

4 Fourth Quarter 2021 Coding Clinic

The creation of this code will improve coding accuracy, as well as

Coding Clinic Fourth Quarter 2021 5

Code C56.3, Malignant neoplasm of bilateral ovaries, was created

Anaplastic Large Cell Lymphoma,

BIA-ALCL is a rare type of non-Hodgkin’s lymphoma that can develop

The most common symptoms are swelling of the lymph nodes,

Anemia Due to Pyruvate Kinase Deficiency

New codes have been created to describe anemia due to pyruvate

• D55.21 Anemia due to pyruvate kinase deficiency

6 Fourth Quarter 2021 Coding Clinic

The degree of hemolysis in PK deficiency is variable, ranging from

Other disorders of glycolytic enzymes include deficiencies of the

The creation of these new codes was supported by the American

Thrombocytosis and Essential Thrombocythemia

New subcategory D75.83, Thrombocytosis, has been created

Coding Clinic Fourth Quarter 2021 7

Thrombocythemia and thrombocytosis are characterized by an

Hereditary Alpha Tryptasemia

Subcategory D89.4, Mast cell activation syndrome and related

Hereditary alpha tryptasemia (HαT) is a genetic trait that is

Niemann-Pick disease Type A/B

Subcategory E75.24 Niemann-Pick disease has been further

Niemann-Pick disease (NPD) types A and B (and A/B) are also

8 Fourth Quarter 2021 Coding Clinic

NPD types C and D have a different pathophysiology and are not

Depression Not Otherwise Specified

A code has been created to identify depression (unspecified) and the

• F32.A Depression, unspecified

Depression is a common mental health disorder. Approximately

The exact etiology of depression is unclear; however, risk factors may

Coding Clinic Fourth Quarter 2021 9

Previously in ICD-10-CM, the default for Depression not otherwise

Other Intellectual Disabilities

Code F78, Other intellectual disabilities, has been expanded with

Code F78.A1, SYNGAP1-related intellectual disability, was

10 Fourth Quarter 2021 Coding Clinic

Code F78.A9, Other genetic related intellectual disability, was

Acute Flaccid Myelitis

A new code (G04.82) was created to identify acute flaccid myelitis

A new code (G44.86) was created to specifically capture cervicogenic

A CGH is a type of secondary headache that results from referred

Coding Clinic Fourth Quarter 2021 11

Immune Effector Cell-Associated

Code G92, Toxic encephalopathy, has been expanded based on the

• G92.00, Immune effector cell-associated neurotoxicity

12 Fourth Quarter 2021 Coding Clinic

Immune effector cell-associated neurotoxicity syndrome (ICANS) is a

ICANS can occur with or independently of cytokine release syndrome