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Reporting the Health Effects of Vaping Now and in April 2020

Wyn Staheli, Director of Content - innoviHealth
2019-12-19

The World Health Organization (WHO) announced the emergency creation of a new ICD-10 code for vaping related disorders which became effective on September 29, 2019. However, the new code should not be used in the United States until April 1, 2020 at which time the new code (U07.0 “Vaping-related disorder”) should be used.

The emergency meeting of the WHO and other organizations took place in response to the reported increase of adverse health effects of vaping. This rare, mid-year addition of a new code enables health departments and government agencies to more accurately track the impact of vaping on health.

From October 1, 2019 until April 1, 2020, the following CDC coding guidelines (wording is all by the CDC) for reporting e-cigarette / vaping related disorders / conditions should be used. To enable stakeholders to better answer the question “what are the health risks of vaping”, healthcare providers should report the various health issues from vaping in the following manner.

E-cigarette / Vaping Associated Lung Injury (EVALI)

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

  • 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

For patients with acute lung injury but without further documentation identifying a specific condition (pneumonitis, bronchitis), assign code:

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

Poisoning and Toxicity Associated with E-cigarette / Vaping

Acute nicotine exposure can be toxic. Children and adults have been poisoned by swallowing, breathing, or absorbing e-cigarette liquid through their skin or eyes. For these patients 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)

Substance Use, Abuse, and Dependence Associated with E-cigarette / Vaping

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.

Diagnosis Codes for Signs and Symptoms Associated with E-cigarette / Vaping

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 such as:

  • 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)