The Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) has released new ICD-10-CM/PCS codes for implementation on April 1, 2022. Medical billing and coding companies will use several new ICD-10 diagnosis and procedure codes for COVID-19 vaccination status.

  • New ICD-10 Codes for COVID-19 vaccination status

The Centers for Medicare & Medicaid Services (CMS) has expanded the ICD-10 diagnosis code list for reporting COVID-19 vaccination status effective April 1, 2022.

The April 1 new diagnosis codes include:

  • 310 – Unvaccinated for COVID-19
  • 311 – Partially vaccinated for COVID-19, and
  • 39 – Other under-immunized status

The guidelines for the use of the codes in subcategory Z28.31 state that “these codes should not be used for individuals who are not eligible for the COVID-19 vaccines, as determined by the healthcare provider.” The inclusion terms for Z28.39 include delinquent immunization status and lapsed immunization schedule status. Also, these three new codes will not impact the MS-DRG calculation as they are designated non-comorbid conditions (non-CC).

In response to the COVID-19 pandemic, CMS is implementing 9 new ICD-10 procedure codes effective April 1, 2022:

  • 7 New ICD-10 procedure codes for COVID-19 therapeutics and vaccines

In addition, effective April 1, 2022, CMS will implement the following seven new ICD-10 procedure codes for COVID-19 therapeutics and vaccines —

  • XW013V7 Introduction of COVID-19 vaccine dose 3 into subcutaneous tissue, percutaneous approach, new technology group 7
  • XW013W7 Introduction of COVID-19 vaccine booster into subcutaneous tissue, percutaneous approach, new technology group 7
  • XW023V7 Introduction of COVID-19 vaccine dose 3 into muscle, percutaneous approach, new technology group 7
  • XW023W7 Introduction of COVID-19 vaccine booster into muscle, percutaneous approach, new technology group 7
  • XW0DXR7 Introduction of fostamatinib into mouth and pharynx, external approach, new technology group 7
  • XW0G7R7 Introduction of fostamatinib into upper GI, via natural or artificial opening, new technology group 7
  • XW0H7R7 Introduction of fostamatinib into lower GI, via natural or artificial opening, new technology group 7

 

  • 2 codes added to V39.1, Medicare Severity Diagnosis Related Groups (MS-DRGs)

There are 2 new codes to describe the introduction or infusion of therapeutics, including vaccines for COVID-19 treatment —

  • XW023X7 – Introduction of tixagevimab and cilgavimab monoclonal antibody into muscle, percutaneous approach, new technology group 7; (tixagevimab and cilgavimab monoclonal antibody or Evusheld is used for treatment of COVID-19, and is not a substitute for a vaccine)
  • XW023Y7 – Introduction of other new technology monoclonal antibody into muscle, percutaneous approach, new technology group 7

Other changes effective April 1, 2022

  • MCE Edit update: The Medicare Code Editor (MCE) has been updated and CMS has created a new MCE for “unspecified” ICD-10-CM diagnosis codes where there are other diagnosis codes available in that diagnosis code subcategory that further specify the anatomic site.
  • National Coverage Determination (NCD) for Artificial Heart and Related Devices updated with the removal of the following 3 procedure codes from the Noncovered Procedure List and Limited Coverage Procedure List:
     

    • 02RK0JZ (Replacement of right ventricle with synthetic substitute, open approach);
    • 02RL0JZ (Replacement of left ventricle with synthetic substitute, open approach); and
    • 02WA0JZ (Revision of synthetic substitute in heart, open approach)
  • NCD for Ventricular Assist Devices was also updated with the removal of the following 2 procedure codes from the Noncovered Procedure List:
     

    • 02WA3QZ (Revision of implantable heart assist system in heart, percutaneous approach); and
    • 02WA4QZ (Revision of implantable heart assist system in heart, percutaneous endoscopic approach).

 

  • Two codes were removed from the Limited Coverage Procedure List for the Ventricular Assist Devices:
     

    • 02HA0QZ (Insertion of implantable heart assist system into heart, open approach); and
    • 02WA0QZ (Revision of implantable heart assist system in heart, open approach).

Medical coding outsourcing to an experienced service provider can help physicians update their practice software with the new codes, use the codes appropriately, and stay current with any changes to coding guidelines. Physicians and clinical documentation improvement professionals must also be aware of these diagnosis code updates to ensure accurate documentation and promote a successful transition.