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Electronic Cigarette-Related Lung Injury Coding

man vaping and being diagnosed with electronic Cigarette Related Lung Injury
Vaping can lead to EVALI, an e-cigarette or vaping use-associated lung injury.

The Coding Challenge

Question: A patient is seen for an electronic cigarette-related lung injury with cough, abdominal pain, and diarrhea. Assign for ICD-10-CM.

A. U07.0, R10.84
B. U07.0, R05.9, R10.9, R19.7
C. U07.0
D. U07.0, R10.84, R19.7

Answer:

D. U07.0, R10.84, R19.7

Electronic cigarette-related lung injury is a lung condition caused by vaping. EVALI is the new name given for e-cigarette or vaping use-associated lung injury. Originally, it was called VAPI, or vaping-associated pulmonary illness.  

Locate and Verify

“U” codes are listed in Chapter 22 of ICD-10-CM. This chapter is called “Codes for Special Purposes.”

Go to the Alphabetic Index in the ICD-10-CM coding manual and look up Injury/lung/electronic cigarette (related), U07.0. In the Tabular listing, we can verify our correct code as:

U07.0, Vaping-related disorder

Inclusion terms listed are:

  • Dabbing related lung damage
  • Dabbing related lung injury
  • E-cigarette, or vaping, product use associated lung injury [EVALI]
  • Electronic cigarette-related lung damage
  • Electronic cigarette-related lung injury

Therefore, when the documentation specifies, say, “dabbing-related lung damage” or “electronic cigarette-related lung injury,” U07.0 should be assigned. 

There is also an instructional note at U07.0 to use an additional code to identify manifestations such as:

  • abdominal pain (R10.84)
  • acute respiratory distress syndrome (J80)
  • diarrhea (R19.7)
  • drug-induced interstitial lung disorder (J70.4)
  • lipoid pneumonia (J69.1)
  • weight loss (R63.4)

Abdominal Pain and Diarrhea

The documentation states the patient had abdominal pain and diarrhea, so we need to assign codes R10.84 (generalized abdominal pain) and R19.7 (diarrhea, unspecified) as secondary codes.

Since a cough is routinely associated with vaping-related disorder (and there is no instructional note to code for it), it should not be reported. Furthermore, according to the ICD-10-CM Official Guidelines for Coding and Reporting:

“For patients presenting with condition(s) related to vaping, assign code U07.0, Vaping-related disorder, as the principal diagnosis. For lung injury due to vaping, assign only code U07.0. Assign additional codes for other manifestations, such as acute respiratory failure (subcategory J96.0-) or pneumonitis (code J68.0).”

“Associated respiratory signs and symptoms due to vaping, such as cough, shortness of breath, etc., are not coded separately when a definitive diagnosis has been established. However, it would be appropriate to code separately any gastrointestinal symptoms, such as diarrhea and abdominal pain.”

Something to keep in mind: The conventions and instructions of the classification take precedence over guidelines.

According to the coding guidelines related to signs and symptoms:

“Signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.”

“Additional signs and symptoms that may not be associated routinely with a disease process should be coded when present.”

Incorrect Answers

A, B, and C are incorrect.

A. U07.0, R10.84. The code for the diarrhea is missing.

B. U07.0, R05.9, R10.9, R19.7. R05.9 is the code for cough, unspecified, which should not be reported. R10.9 refers to Unspecified abdominal pain.

C. U07.0. The coding guidelines and instructional notes instruct us to report for the abdominal pain and diarrhea separately.

How did you do? If you had a little trouble, keep working. Go over the guidelines. Come back to this challenge again later. You’ll get there!

Don’t hesitate to share how you did at the bottom of this post. And if you have any other tips to help other coders related to this challenge, please share them.

motivation - the diference between who you are and what you want to be is what you do!

** This post has been updated to reflect the FY 2022 coding guidelines on 4/8/22. **


Related

4 Comments

  1. This was a hard one since I have not coded for ICD-20-CM in a while. We also never used the U codes, so I was lost as to where they were to look them up. Thank you for pointing out they are in chapter 22.

  2. my confusion comes from the 3m encoders that we use at my work. I’ve noticed that it doesn’t give me edits as I would find in my book and since we are pressed for time and productivity I sometimes will forget to look. So, the reason the cough is not reported is that it is a symptom of the vaping lung condition?

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