News Alert: CDC Issues Coding Guidance for Vaping

New guidance for coding vaping is retroactive to Oct. 1 discharges.  

The Center for Disease Control and Prevention (CDC) has posted new coding guidance regarding e-cigarette lung injuries.

This guidance, posted Oct. 17, 2019, is retroactive to Oct. 1, 2019 discharges.   The guidance states that coding professionals should report lung injury based on clinical documentation.

Examples of reported conditions include J68.0 (Bronchitis and pneumonitis due to chemicals, gases, fumes and vapors); J69.1 (Pneumonitis due to inhalation of oils and essences); J80 (Acute respiratory distress syndrome); J82 (Pulmonary eosinophilia, not elsewhere classified); J84.114 (Acute interstitial pneumonitis); or J84.89 (Other specified interstitial pulmonary disease). If an acute lung injury is reported without specifics, the coding professional may assign J68.9 (Unspecified respiratory condition due to chemicals, gases, fumes, and vapors).   If the poisoning/toxic effect is due to nicotine, then T65.291- should be reported. If the poisoning/toxic effect is due to THC, the T40.7X- should be the assigned code. The seventh character (A, D, S) would be reported based on the patient’s presentation. This latest guidance should be used in conjunction with the Official Coding Guidelines for ICD-10-CM 2020 and was approved by the Cooperating Parties.

The CDC also reported that proposals for a new code would be presented at the Coordination and Maintenance Committee meeting in March 2020. New ICD-10-CM codes may be developed for public health issues and issued by the CDC.  The routine process is that an applicant will submit suggestions for a new code, rationale regarding the clinical relevance of a new code, and supporting clinical references and literature. This information is submitted to the CDC.  After review, selected proposals are presented and the Coordination and Maintenance Committee meeting which is held in March and September. This is a public meeting where attendees – physical and virtual – may comment on the proposals. The proposals may request an April or October release.  No decisions are made at this meeting. After further review and consideration of public comment, a proposed list of diagnosis codes is published.  After another round of public comment, the final list is published. When the diagnosis codes are associated with the Inpatient Prospective Payment System (IPPS) methodology, the proposed list is published late April/early May with the final list published in June. The ICD-10-PCS procedures use a similar process, but that classification is administered by the Centers for Medicare and Medicaid Services (CMS).

The Vaping Update

The CDC has a new term/acronym for the electronic cigarette/vaping associated lung illness, which is EVALI.  As of Oct. 17, 2019, there are 1,479 cases reported across 49 states and the District of Columbia.  The average length of stay for hospitalization is 6.7 days. There have been 33 deaths across 24 states according to the last CDC update.

The CDC continues its investigation, but the tetrahydrocannabinol (THC) products off-the-street or obtained from informal sources are the most linked to these cases. THC is a psychoactive or mind-altering drug associated with marijuana.  Nicotine has not been ruled out as a cause. The CDC recommends that people not use e-cigarette products containing THC. Another recommendation from the CDC is that the e-cigarettes should not be modified or have any substances added to the vaping products.

The reported symptoms of EVALI are the following:

• Respiratory – Cough, shortness of breath, or chest pain
• Gastrointestinal – Nausea, vomiting, or diarrhea
• Constitutional – fatigue, fever, or weight loss.

The symptoms may last several weeks or develop over a few days. These cases may be confused with influenza with the beginning of flu season upon us.  

The latest concern is for EVALI patients who may be readmitted for the same condition. The re-admissions may be due using e-cigarettes again or that the patients’ lungs are in a weakened state.

If you use e-cigarettes and are experiencing symptoms, you should see a healthcare provider as soon as possible or call the local poison control center at 1-800-222-1222.

Programming Note:

Listen to Laurie Johnson’s live reports every Tuesday during Talk Ten Tuesday, 10-10:30 a.m. EST.

References:

https://www.cdc.gov/media/releases/2019/t1011-lung-injury-investigation.html

https://www.reuters.com/article/us-usa-vaping-cdc/u-s-vaping-related-deaths-rise-to-33-cases-of-illness-to-1479-idUSKBN1WW2OS

https://www.fda.gov/news-events/public-health-focus/lung-illnesses-associated-use-vaping-products