Starting in 2019, we have experienced a national outbreak in vaping related pulmonary illnesses.  Per CDC, there is a strong association between e-cigarette, or vaping, product use-associated lung injury (EVALI) and the use of tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, products obtained from informal sources.  Vitamin E acetate is strongly linked to the EVALI outbreak, but evidence is not sufficient to rule out the contribution of other chemicals of concern.  As this investigation continues, CDC encourages clinicians to continue to report possible cases of e-cigarette, or vaping, product use-associated lung injury (EVALI) to their local or state health department for further investigation.

This outbreak has created a dilemma for coders, payers and researchers as well.  What is the best way to code and adjudicate medical services provided to the patient with vaping related illness?  How can the researcher isolate data associated with vaping related illness for analysis?  Previously there was no specific code nor clear coding guidance on how to translate such an illness onto a claim.  So, there was also no clear way for a payer to identify a pulmonary illness caused by vaping, for claim adjudication.

In October 17, 2019, the CDC posted a coding guidelines supplement regarding e-cigarette lung injuries retroactive to October 1, 2019. 

1. General Guidance for coding lung-related complications:

    

   When patients are documented to have a lung injury associated with EVALI, assign the code for the specific pulmonary condition.

   • 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

     When patients are documented with acute lung injury but the specific lung condition is not specifically identified, assign code:

2. General Guidance on coding poisoning and toxicity:

   For toxicity/poisoning as result of swallowing, breathing or absorbing e-cigarette liquid through skin or eyes, assign code:

   • T65.291-, Toxic effect of other nicotine and tobacco, accidental (unintentional);includes Toxic effect of other tobacco and nicotine NOS.

     For a patient with acute tetrahydrocannabinol (THC) toxicity, assign code:

   • T40.7X1- Poisoning by cannabis (derivatives), accidental (unintentional).

      

3. General Guidance on coding Substance use, abuse, and dependence

   For patients with documented substance use/abuse/dependence, additional codes identifying the substance(s) used should be assigned.

   When the provider documentation refers to use, abuse and dependence of the same substance (e.g. nicotine, cannabis, etc.), only one code should be assigned to identify the pattern of use based on the following hierarchy:

   • If both use and abuse are documented, assign only the code for abuse
   • If both abuse and dependence are documented, assign only the code for dependence
   • If use, abuse and dependence are all documented, assign only the code for dependence
   • If both use and dependence are documented, assign only the code for dependence.

          Assign as many codes, as appropriate. Examples:

     Cannabis related disorders: F12.---

     Nicotine related disorders: F17.----

     Specifically, for vaping of nicotine, assign code:

     F17.29-, Nicotine dependence, other tobacco products. Electronic nicotine delivery systems (ENDS) are non-combustible tobacco products.

      

4. General Guidance on coding Signs and symptoms:

• J68.9, Unspecified respiratory condition due to chemicals, gases, fumes, and vapors

   

For patients presenting with any signs/symptoms (such as fever, etc.) and where a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms:

• M79.10 Myalgia, unspecified site
• R06.00 Dyspnea, unspecified
• R06.02 Shortness of breath
• R06.2 Wheezing
• R06.82 Tachypnea, not elsewhere classified
• R07.9 Chest pain, unspecified
• R09.02 Hypoxemia
• R09.89 Other specified symptoms and signs involving the circulatory and respiratory
• systems (includes chest congestion)
• R10.84 Generalized abdominal pain
• R10.9 Unspecified abdominal pain
• R11.10 Vomiting, unspecified
• R11.11 Vomiting without nausea
• R11.2 Nausea with vomiting, unspecified
• R19.7 Diarrhea, unspecified
• R50.- Fever of other and unknown origin
• R53.83 Other fatigue
• R61 Generalized hyperhidrosis (night sweats)
• R63.4 Abnormal weight loss
• R68.83 Chills (without fever)

In response to vaping related illnesses, the World Health Organization (WHO) committees decided to add an emergency code to the base version of ICD-10 that became valid for immediate use as of September 24, 2019.

Following the WHO’s update, the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS) is implementing a new diagnosis code into the ICD-10-CM for reporting vaping-related disorder in the U.S., effective April 1, 2020 – U07.0, Vaping-related disorder. Context 4 Healthcare will be releasing an April 2020 update for all ICD-10-CM products to encompass this new code addition.

REFERENCES

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

https://www.cdc.gov/nchs/icd/data/Chapter-22-new-vaping-code-FINAL1.pdf

https://www.cdc.gov/nchs/data/icd/Vapingcodingguidance2019_10_17_2019.pdf