Each year with the annual code set updates, we see new codes being introduced into ICD-10-CM. At roughly the same time as CMS announced new codes for vaping, the world found itself immersed in a global pandemic. As coders, we were inundated with new codes for SARS CoV-2 and were struggling with the new codes, new guidelines, and constant changes the CDC was publishing surrounding this new respiratory virus. The new codes for SARS CoV-2 seem to have overshadowed the new vaping codes. Because research on data related to vaping is still very important, especially in relationship to COVID 19, we explore coding of vaping in this article.
People who smoke tobacco or vape are twice as likely to develop a severe case of COVID-19 than those who do not smoke. Smoking and vaping damage the respiratory tract cilia, making it much easier for COVID-19 to enter the lungs. Both habits also damage neutrophils and macrophages, important types of white blood cells involved in fighting infections, causing the body to work harder to ward off viral and bacterial infections. Tobacco also increases levels of angiotensin-converting enzyme 2 (ACE2), which is an enzyme that helps the SARS CoV-2 virus to attach to cells. Even though most statistics show teens and young adults to be at a lower risk for COVID-19, vaping could have a profound impact on susceptibility.
The general name for any lung injuries associated with electronic cigarette or vaping use is called “EVALI”, an acronym for E-cigarette or vaping product use associated lung injury. Although there are still questions surrounding the specific cause of EVALI, there are some commonalities; the highest number of EVALI cases arose from people vaping THC. That commonality has led to further questioning the types of thickeners or additives used in the vaping liquid.
The CDC has identified commonalities among the symptoms of EVALI, including cough, chest pain, flu-like symptoms, nausea, vomiting, diarrhea, although this is not an inclusive list. There are no specific tests to diagnose this type of lung damage, so it requires specific questioning and evaluation by the healthcare provider to determine if this is a possible diagnosis. Of note, many of the signs/symptoms of EVALI closely resemble some of the early symptoms of COVID-19. This can potentially complicate definitive diagnosis by the physician.
ICD-10-CM codes were created to enable us to reflect respiratory manifestations of vaping. U07.0, Vaping-related disorder will be assigned to cases where disease processes are attributed to vaping or e-cigarette use. This code will be listed first, followed by a code for the specific condition such as:
When acute lung injury due to vaping or e-cigarettes is documented but there is no further specificity, the coder should assign U07.0, followed by J68.9, Unspecified respiratory condition due to chemicals, gases, fumes, and vapors.
There are times when the patient presents with a multitude of symptoms due to vaping but the physician has not given a definitive diagnosis to the underlying symptoms. In this circumstance, the coder should assign U07.0 plus any associated signs and symptoms such as shortness of breath, chest pain, etc.
If the physician documents that the patient vapes nicotine, F17.29-, Nicotine dependence, other tobacco products would be assigned as an additional diagnosis.
As always, particular attention to the presentation of the patient and documentation by the physician is imperative in correct code assignment. The principal diagnosis should be assigned is based on the circumstances of admission. If the patient is admitted due to symptoms that are common to both vaping and COVID-19, sequencing will be based on physician documentation. Make sure to follow the alphabetical and tabular index guidance, along with recognized coding references to ensure the codes accurately reflect the patient’s condition.
Robyn McCoart, RHIT, Managing Auditor