On Dec. 9, 2019, the Centers for Disease Control and Prevention (CDC) published additional guidance regarding e-cigarette/vaping associated lung injury (EVALI). The new code is U07.0 (Vaping-related disorder). The CDC consulted with the World Health Organization (WHO) regarding this addition and the code became effective Sept. 24, 2019.
Even though the code is available for use now, it is suspected that it has not been included in current encoder software or the MS-DRG methodology or Hierarchical Condition Categories (HCCs). According to the CDC, the code can be reported beginning April 1, 2020. This is a rare instance of a new diagnosis code added in April. To date, ICD-10-CM does not have a U code. There should be additional guidance published in Coding Clinic regarding this latest code addition.
As of Dec. 10, the CDC reports that 2,409 patients have been impacted by this condition, with 52 deaths, across all 50 states and two territories. The CDC is only reporting hospitalized cases at the present time. Vitamin E acetate has been identified as a substance of concern. Vitamin E acetate is an additive to some vapes that contain tetrahydrocannabinol (THC). THC is the psychoactive substance in cannabis or marijuana. There is concern about heated vitamin E acetate when it is inhaled. The CDC has been reviewing samples from bronchoalveolar lavage (BAL) and found vitamin E acetate in these samples.
Characteristics of EVALI include respiratory symptoms such as cough, chest pain, and shortness of breath, and gastrointestinal symptoms including abdominal pain, nausea, vomiting, and diarrhea. Other symptoms may include fever, chills, weight loss, and possibly death. The CDC recommends that patients with suspected VAPI should be admitted if they have decreased O2 saturation (<95%) on room air, are in respiratory distress, or have comorbidities that compromise pulmonary reserve. Once admitted, initiation of corticosteroids should be considered, which have been found to be helpful in treating this injury. Several case reports describe improvement with corticosteroids, likely because of a blunting of the inflammatory response.
Things to consider as we await implementation of the new code U07.0 Vaping-related disorder:
- Will this code only be valid for discharges on or after 4/1/20 or can the code be used retrospectively?
- Will there be new coding and sequencing guidelines to ensure proper reporting?
- What will MS-DRG assignment(s) be for the new code?
- How are you coding these cases now?
- If the codes cannot be retrospectively updated, should your facility be capable of tracking older cases for any reason?
- How will you communicate and educate your coding staff for this update?
- Will your vendor be ready to implement the necessary system update to report this code by April 1st? If not, what is your contingency plan?
- Will your software updates allow reporting prior to April 1 if cases can be retrospectively reported?
- What other departments need to be informed of this update?
Hopefully many of these questions will be answered in the First Quarter 2020 Coding Clinic along with communication from the CDC and CMS. UASI will provide updates to this tip as information becomes available.