Q&A: ICD-10-CM coding for cytokine release syndrome
Q: What is a cytokine storm and how is this condition reported in ICD-10-CM?
A: The fiscal year 2021 update to the ICD-10-CM code set introduced new codes to describe cytokine release syndrome (CRS), also known as a cytokine storm. This is an acute systemic inflammatory syndrome characterized by fever and organ dysfunction, as well as other symptoms caused by abnormally high cytokine levels.
CRS can have infectious and noninfectious etiologies and is often reported in patients suffering from viral respiratory infections such as COVID-19 or influenza. CRS is also a common adverse effect of chimeric antigen receptor T-cell therapy—immunotherapy that uses specially altered T cells to fight cancer.
Cytokines are small proteins that facilitate communication between body cells. When the immune system detects a threat, immune cells release cytokines to coordinate the body’s response. Elevated levels of cytokines in an overactive immune system can cause harmful levels of inflammation throughout the body and disrupt organ functioning.
Before the October update to the ICD-10-CM code set, there was no code specific to CRS, so coders had to report the manifestations of the syndrome. The following codes were recently introduced based on the different grades (severity levels) of CRS:
- D89.831, CRS; grade 1
- D89.832, …; grade 2
- D89.833, …; grade 3
- D89.834, …; grade 4
- D89.935, …; grade 5
- D89.839, …; grade unspecified
Notably, codes for grades 3-5 are complication or comorbidity conditions in 2021.
Information on the clinical indications associated with each grade of CRS is available here. You will need to query the provider if he or she reports CRS without a grade.
Editor’s note: This question was answered by Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O, director of HIM and coding for HCPro in Middleton, Massachusetts, during the HCPro webinar, “JustCoding's 2021 ICD-10-CM Code Updates.”
This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.