ICD-10 coding for vaping and e-cigarette related illness

Vaping has become a very hot topic recently, due to the rapid increase of patients showing up at physicians’ offices and ERs with lung injuries.  The Centers for Disease Control (CDC) recently held a conference call to discuss lung injuries related to e-cigarettes and vaping products.  It is likely we will continue to see an upward trend in care for lung related injuries due to e-cigarette and vaping use, which means coders will need to understand how to appropriately apply ICD-10 codes. 

Here are some statistics regarding vaping and e-cigarette use according to the CDC as of October 2019:

• 1,299 lung injury cases reported
• Issues have been reported by 49 states
• 26 deaths have been confirmed and reported to the CDC
• The age range for those who have died is from 17 to 75 years of age
• Most patients are male, with 80 percent of those being under the age of 35
• 15 percent of patients with lung injuries are under the age of 18

The CDC also reported that approximately 95 percent of the patients seen are experiencing respiratory symptoms such as chest pain (R07.9), cough (R05), and/or shortness of breath (R06.02).  Approximately 77 percent experience gastrointestinal symptoms such as abdominal pain (R10.9), nausea and/or vomiting (R11.0 without vomiting, R11.2 with vomiting), or diarrhea (R17.9).  I think what struck me while reading this transcript is that almost half of patients seen with these symptoms are transferred to intensive care units.  The fact that people have become seriously ill or died because of vaping or the use of e-cigarettes is heartbreaking and the cost to treat these preventable illnesses will only continue to increase.

On October 17, the CDC published a supplemental guidance for coding encounters related to vaping or e-cigarette use.  This is official guidance for encounters “related to the 2019 healthcare encounters and deaths related to e-cigarette, or vaping, product use associated lung injury (EVALI)” and is retro effective October 1, 2019.

For electronic cigarette (e-cigarette), or vaping, product use associated lung injury (EVALI), assign the code for the specific condition, such as:

If the final Impression is acute lung injury with no further clarification identifying a specific condition, such as pneumonitis or bronchitis:

For acute nicotine exposure, such as when children or adults have swallowed, breathed, or absorbed e-cigarette liquid either through the skin or eyes:

If a patient has documented substance abuse/use/dependence, use additional codes identifying the specific substance used and as always, if the physician is unable to determine a definitive final Impression, the appropriate sign and symptom code should be assigned.

As this epidemic increases and health organizations continue to track this trend, it will be vital for physicians to use complete and specific documentation and for coders to choose the appropriate ICD-10-CM codes.  It will also be important for those of us working in health care to be fully educated on the health dangers of vaping and e-cigarette use. 

Karla VonEschen is a coding analyst at 3M Health Information Systems.

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Sources

• https://www.cdc.gov/media/releases/2019/t1011-lung-injury-investigation.html
• Coding encounters related to E-cigarette, or Vaping, Product Use