A new ICD-10 diagnosis code for vaping-related illness (U07.0, vaping-related disorder) has been assigned due to the increase in vaping-related illness since 2017. The condition is termed “EVALI” for e-cigarette or vaping related lung illness, and the World Health Organization Family of International Classifications developed a temporary code for it effective for use starting Sept. 24, 2019. Additional code assignments are expected at the March 2020 ICD-10 Coordination and Maintenance Committee meeting.

Guidance suggests that all related signs, symptoms, and associated cannabis- and nicotine-related disorders should also be documented and coded. Toxic effects should be documented and identified with appropriate codes—for example, T40.7X1, poisoning by cannabis (derivatives), accidental (unintentional).

Documentation of any lung-related complications and substance use, abuse, and dependence requires a unique code to identify the condition accurately for payment purposes. Coding professionals should be advised to assign as many codes as appropriate to ensure recognition and payment for this problem (eg, cannabis-related disorders, nicotine-related disorders, and specifically for vaping of nicotine, F17.29-).

For patients who are diagnosed with EVALI, documentation should identify the specific condition such as bronchitis due to chemicals, pneumonitis due to inhalation of oils, acute respiratory distress syndrome, pulmonary eosinophilia, acute interstitial pneumonitis, or other specified interstitial pulmonary disease.

If no specific diagnosis can be made, any other relevant signs and symptoms should be documented and coded, such as myalgia, dyspnea, shortness of breath, wheezing, tachypnea, chest pain, hypoxemia, generalized abdominal pain, unspecified abdominal pain, vomiting, diarrhea, fever, fatigue, hyperhidrosis, abnormal weight loss, chills, etc.

The CDC coding guidelines for vaping can be found here.

Stay tuned for updates following the March ICD-10 Coordination and Maintenance Committee meeting. 

Brought to you by the ACEP Coding and Nomenclature Committee.

Ms. Edelberg is founder and chairman of Edelberg + Associates.

Resources

1. Ghinai I, Pray IW, Navon L, et al. E-cigarette product use, or vaping, among persons with associated lung injury—Illinois and Wisconsin, April–September 2019. MMWR Morb Mortal Wkly Rep. 2019;68:865-869.
2. National Academies of Sciences, Engineering, and Medicine. Public Health Consequences of E-Cigarettes. 2018. Washington, DC: The National Academies Press.
3. Perrine CG, Pickens CM, Boehmer TK, et al. Characteristics of a multistate outbreak of lung injury associated with e-cigarette use, or vaping—United States, 2019. MMWR Morb Mortal Wkly Rep. 2019;68:860-864.
4. Schier JG, Meiman JG, Layden J, et al. Severe pulmonary disease associated with electronic-cigarette–product use—interim guidance. MMWR Morb Mortal Wkly Rep. 2019;68:787-790.
5. Siegel DA, Jatlaoui TC, Koumans EH, et al. Update: interim guidance for health care providers evaluating and caring for patients with suspected e-cigarette, or vaping, product use associated lung injury—United States, October 2019. MMWR Morb Mortal Wkly Rep. 2019;68;919-927.