EVALI, which stands for e-cigarette, or vaping, product use associated lung injury, according to new
healthcare recommendations CDC released on Oct. 11 2019.
The interim guidelines focus on initial assessment, criteria for hospital admission and treatment, patient
follow-up, considerations for high-risk groups and public recommendations regarding EVALI. Rapid
diagnosis and an understanding of treatment options could reduce EVALI morbidity and mortality, the
CDC said.
EVALI is considered a diagnosis of exclusion because, at present, no specific test or marker exists for its
diagnosis. Health care providers should consider multiple etiologies, including the possibility of EVALI and
concomitant infection. In addition, health care providers should evaluate alternative diagnoses as
suggested by clinical findings and medical history (e.g., cardiac, gastrointestinal, rheumatologic, and
neoplastic processes; environmental or occupational exposures; or causes of acute respiratory distress
syndrome).
CDC advises the health care providers evaluating patients for EVALI should ask about the use of ecigarette, or vaping, products and ideally should ask about types of substances used (e.g., THC, cannabis
[oil, dabs], nicotine, modified products or the addition of substances not intended by the manufacturer);
product source, specific product brand and name; duration and frequency of use, time of last use; product
delivery system, and method of use (aerosolization, dabbing, or dripping). Empathetic, nonjudgmental,
and private questioning of patients regarding sensitive information to assure confidentiality should be
employed.
ICD 10 CM Official Coding Guidelines for healthcare encounters and deaths associated with e-cigarette,
or vaping, product use associated lung injury (EVALI) was released on Oct. 17. Until we have more specific
codes available for EVALI, we are instructed to “Assign as many codes, as appropriate.”
As per ICD-10-CM Official Coding Guidelines – Supplement “Coding encounters related to E-cigarette, or
Vaping, Product Use,” we can expect the new diagnosis codes for EVALI by 2020. Until then, the guidance
in this supplement should be used in conjunction with current ICD-10-CM codes and the ICD-10-CM
Official Guidelines for Coding and Reporting.
General Guidance for EVALI Encounters
▪ For patients documented with 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, assign code:
▪ J68.9 – Unspecified respiratory condition due to chemicals, gases, fumes and vapors.
Poisoning and Toxicity
▪ For children and adults who have been poisoned by swallowing, breathing, or absorbing-cigarette
liquid through their skin or eyes, assign:
▪ T65.291- Toxic effect of other tobacco and nicotine, accidental (unintentional); includes toxic
effect of other tobacco and nicotine NOS. A seventh digit is required
▪ For a patient diagnosed with acute tetrahydrocannabinol (THC) toxicity, assign code:
▪ T40.7X1- Poisoning by cannabis (derivatives), accidental (unintentional). A seventh digit is
required.
Substance use, Abuse and Dependence
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 documented, assign only the code for dependence.
▪ If both use and dependence are documented, assign only the code for dependence.
• For patients with documented substance use, abuse, and/or dependence, additional codes
identifying the substances used should be assigned.
Signs and Symptoms
• For patients presenting with any signs/symptoms of EVALI (such as fever, dyspnea 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:
▪ R06.00 – Dyspnea, unspecified
▪ R50.- Fever of other and unknown origin
The following PDF is available for download:
https://www.cdc.gov/nchs/data/icd/Vapingcodingguidance2019_10_17_2019.pdf
Resources:
ICD 10 CM Official Coding Guidelines
AAPC Knowledge Center
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