Part 3: Cross the ICD-10-CM 2020 Update Finish Line With Chapters 18-21

ICD-10-CM 2020 update finish line!

Feeling energized for the last post in our ICD-10-CM 2020 update blog marathon? Today we’ll wrap up our overview of the main changes in each chapter of the diagnosis code set by covering symptoms, fractures, and more.

Read Part 1 for news about Chapters 1-10 and Part 2 for Chapters 11-17.

Chapter 18: Pick Up on New Code for Pyuria

In Part 1, you already read about R11.15 (Cyclical vomiting syndrome unrelated to migraine) being added to Chapter 18: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99). But you’ll also find new codes in commonly used category R82.- (Other and unspecified abnormal findings in urine):

  • R82.81 (Pyuria), which includes sterile pyuria
  • R82.89 (Other abnormal findings on cytological and histological examination of urine).

Chapter 19: Update Orbital Fracture, Poisoning, and Heatstroke Coding

A lot of different diagnoses fall under Chapter 19: Injury, poisoning and certain other consequences of external causes (S00-T88), and the new codes cover several different areas.

Orbital fracture: Three new ICD-10-CM fracture subcategories have separate codes for right, left, and unspecified side:

  • S02.12- (Fracture of orbital roof)
  • S02.83- (Fracture of medial orbital wall)
  • S02.84- (Fracture of lateral orbital wall).

S02.85 (Fracture of orbit, unspecified) is reportable at five characters. Be sure to check for note changes that go along with these additions.

Multiple drugs: New subcategory T50.91- (Poisoning by, adverse effect of and underdosing of multiple unspecified drugs, medicaments and biological substances) offers a way to code multiple drug ingestion NOS, but ICD-10-CM additionally instructs to “Code also any specific drugs, medicaments and biological substances.”

Heatstroke: Three new codes expand T67.0 (Heatstroke and sunstroke):

  • T67.01 (Heatstroke and sunstroke)
  • T67.02 (Exertional heatstroke)
  • T67.09 (Other heatstroke and sunstroke).

Chapter 20: Look for New Legal Intervention Codes

Chapter 20: External causes of morbidity (V00-Y99) has more than three pages of additions in the ICD-10-CM 2020 PDF addenda, and the PDF doesn’t even include the seventh character options, which could triple the length. There are two major areas of change.

Unspecified person: Most coders are unlikely to report a code for “unspecified person injured” on an average day, but ICD-10-CM 2020 is prepared in case you need those codes. Under Y35.- (Legal intervention) there will be dozens of new seven-character codes, such as Y35.049A (Legal intervention involving injury by rubber bullet, unspecified person injured, initial encounter).

Conducted energy device: Also under Y35 is new subcategory Y35.83- (Legal intervention involving a conducted energy device). Inclusion notes clarify that the codes apply to “Electroshock device (taser)” and “Stun gun.” You’ll base your code choice on whether the injured party is a law enforcement official, a bystander, a suspect, or an unspecified person, and also whether the encounter is initial, subsequent, or for sequela.

Chapter 21: Exams, Screenings, and Encounters, Oh My!

The last chapter of ICD-10-CM in 2020 is a worthy finale with numerous new codes and note changes to learn. Here are the highlights from Chapter 21: Factors influencing health status and contact with health services (Z00-Z99).

Eye exams: Add Z01.02- (Encounter for examination of eyes and vision following failed vision screen) to your options, with Z01.020 when there are not abnormal findings and Z01.021 when there are abnormal findings.

Tuberculosis: Check out these three codes if you see latent tuberculosis in the documentation:

  • Z11.7 (Encounter for testing for latent tuberculosis infection)
  • Z22.7 (Latent tuberculosis)
  • Z86.15 (Personal history of latent tuberculosis infection).

BMI: In ICD-10-CM 2019, the notes with Z68.- (Body mass index [BMI]) state that you should use BMI pediatric codes for persons 2-20 years of age and BMI adult codes for persons 21 and older. In ICD-10-CM 2020, the age break changes. You’ll use pediatric BMI codes for patients 2-19 and adult BMI codes for patients 20 and older.

Travel: Expect to see new code Z71.84 (Encounter for health counseling related to travel), which covers health risk and safety counseling for travel. You’ll report Z23 separately for immunization.

In-situ neoplasm hx: The list of codes under Z86.00- (Personal history of in-situ neoplasm) is about to get significantly longer. Watch for these additions:

  • Z86.002 (Personal history of in-situ neoplasm of other and unspecified genital organ)
  • Z86.003 (Personal history of in-situ neoplasm of oral cavity, esophagus and stomach)
  • Z86.004 (Personal history of in-situ neoplasm of other and unspecified digestive organs)
  • Z86.005 (Personal history of in-situ neoplasm of middle ear and respiratory system)
  • Z86.006 (Personal history of melanoma in-situ)
  • Z86.007 (Personal history of in-situ neoplasm of skin).

Neurostimulator: Keep new code Z96.82 (Presence of neurostimulator) in mind when the patient has a neurostimulator. Notes indicate the code applies to brain, gastric, peripheral nerve, sacral nerve, spinal cord, or vagus nerve neurostimulators.

What About You?

Did we skip a change that will be important to you? Were you hoping to see a change in ICD-10-CM 2020 that didn’t happen?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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