News: CDC issues vaping coding guidelines

Due to nearly 1,300 cases and 26 deaths of e-cigarette or vaping product use associated with lung injury (EVALI), the Centers for Disease Control and Prevention (CDC) has released new official ICD-10-CM coding guidelines for capturing EVALI. These guidelines come close on the tail of the CDC’s newly released EVALI treatment guidelines.

To date, all patients admitted for EVALI have reported a history of e-cigarette, or vaping product, use with most reporting history using products containing tetrahydrocannabinol (THC). Latest national and state findings suggest that THC containing products, particularly those obtained from illegal or non-manufacturer sources, are linked to most cases of EVALI and play a major role in the outbreak.

No definitive cause has yet to be identified, only the commonality among all cases as the reported use of vaping products. The new coding guidelines for EVALI will serve as a tool to systematically link cases of this illness, according to the CDC.

Some highlights of the released coding guidelines include:

• For patients with documented EVALI, assign the code for the specific condition such as
  
  • J68.0, Bronchitis and pneumonitis due to chemicals, gases, fumes and vapors; includes chemical pneumonitis
  • J69.1, Pneumonitis due to inhalation of oils and essences; includes lipoid pneumonia
  • J80, Acute respiratory distress syndrome
  • J82, Pulmonary eosinophilia, not elsewhere classified
  • J84.114, Acute interstitial pneumonitis
  • J84.89, Other specified interstitial pulmonary disease
• For a patient with acute tetrahydrocannabinol (THC) toxicity, assign code T40.7X1- Poisoning by cannabis (derivatives), accidental (unintentional)
• For patients with documented substance use/abuse/dependence, additional codes identifying the substances should be assigned. Specifically, for vaping of nicotine, assign code F17.29, Nicotine dependence, other tobacco products. Electronic nicotine delivery systems are non-combustible tobacco products
• For patients presenting with any signs/symptoms where a definitive diagnosis has not been established, assign the appropriate code for each of the presenting symptoms such as M79.10, Myalgia, unspecified site, R06.00 Dyspnea, unspecified, or R06.02, Shortness of breath

In the guidelines, the CDC reminds healthcare professionals that the “clinical scenarios described are not exhaustive and may not represent all possible reasons for health care encounters that may be related to e-cigarette, or vaping, product use.”

Proposals for new codes to address additional e-cigarette products will be presented at the March 2020 ICD-10 Coordination and Maintenance Meeting. To communicate suggestions and concerns directly with the cooperating parties, email nchsICD10cm@cdc.gov.

Editor’s note: For the current ICD-10-CM classification guidelines, click here. For previous articles related to EVALI, click here.