Q4 2020 Coding Clinic changes and updates

January 8, 2021 / By Stacie Silvia, RHIT, CCS

It has been a wild year with many changes, but we are resilient and have adapted. From social distancing to shopping with a mask on to limiting our family/group gatherings, it has been challenging to say the least. With that being said, let’s review a few more changes/updates (what’s a few more, right?): the Q4 2020 Coding Clinic. There are 490 new ICD-10-CM codes effective October 1, 2020. In addition, there are 47 revised codes and 58 have been deleted.

Chapter 10

Let’s start with “Chapter 10: Disease of the Respiratory System” changes, specifically vaping-related disorders. When documenting any patient presenting with conditions related to vaping, we should use code U07.0 and use any additional codes for other manifestations including acute respiratory failure or pneumonitis. But remember, other associated signs/symptoms are not coded separately (cough, shortness of breath, etc.) when a definitive diagnosis has been established.

Y codes

Next, let’s consider our eyes and why we need Y codes. Y codes are tracked for public information, law enforcement, morbidity and mortality and really do help complete the “coding story.” There have been some changes to how we report ophthalmic adverse incidents which may make your eyes bulge when reading this, especially if you are a contact lens user. Friendly PSA: we should never wear contacts when sleeping. This can increase risk for corneal infections and who needs that, we have enough to worry about! Two new codes were created for this situation:

  • Y77.11, Contact lens associated with adverse incidents
  • Y77.19, Other therapeutic (nonsurgical) and rehabilitative ophthalmic devices associated with adverse incidents

Z codes

And what about those Z codes? Do you feel like catching some Zs while searching this category? Same here! Some new Z codes were created October 1, 2020. These three new codes were created to identify, track and justify resources when a patient may have the presence of a foreign body:

  • Ingested foreign body (Z03.821)
  • Aspirated (inhaled) foreign body (Z03.822)
  • Inserted (injected) foreign body (Z03.823)

Another change to the Z category (Z55-Z65) covers documentation by clinicians other than the patient’s provider. Effective October 1, 2020 “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.” We must ensure the provider agrees with the patient’s self-reporting before applying any of these codes.

In addition to the changes and updates described above, there are so many more great Coding Clinic topics to read up on. Take the time to get familiar with all the changes/updates quarterly!

Stacie Silvia, RHIT, CCS, is a Client Account Manager with 3M Health Information Systems.


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