In response to the national emergency declared for the COVID-19 pandemic, the CDC has implemented six new ICD-10-CM diagnosis codes and CMS has implemented 21 new ICD-10-PCS procedure codes for COVID-19, as well as an updated MS-DRGs Version 38.1, all effective January 1, 2021.
The six new diagnosis codes are:
J12.82 Pneumonia due to coronavirus disease 2019
M35.81 Multisystem inflammatory syndrome
M35.89 Other specified systemic involvement of connective tissue
Z11.52 Encounter for screening for COVID-19
Z20.822 Contact with and (suspected) exposure to COVID-19
Z86.16 Personal history of COVID-19
In addition to new ICD-10-PCS (PCS) codes for administration of remdesivir and transfusion of convalescent plasma implemented earlier this year and effective August 1, 2020 (I posted a blog on this subject too), the 21 new PCS codes effective January 1, 2021 include codes to capture the use of additional COVID-19 therapeutics as well as administration of COVID-19 vaccines.
All of the new PCS codes effective January 1 are classified in table XW0 of the ICD-10-PCS. The codes specify the substance name or type and the route of administration—whether by subcutaneous/intramuscular injection, IV infusion or oral administration.
Monoclonal Antibody (10 codes)
Four specific substances classified as monoclonal antibodies– Bamlanivimab, Etesevimab, Leronlimab and REGN-COV2—have new PCS codes to track their use in treating COVID-19. Leronlimab is administered by subcutaneous injection, and the other three substances are administered via IV infusion.
XW013K6 Introduction of Leronlimab Monoclonal Antibody into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 6
XW043E6 Introduction of Etesevimab Monoclonal Antibody into Central Vein, Percutaneous Approach, New Technology Group 6
XW033E6 Introduction of Etesevimab Monoclonal Antibody into Peripheral Vein, Percutaneous Approach, New Technology Group 6
XW033F6 Introduction of Bamlanivimab Monoclonal Antibody into Peripheral Vein, Percutaneous Approach, New Technology Group 6
XW043F6 Introduction of Bamlanivimab Monoclonal Antibody into Central Vein, Percutaneous Approach, New Technology Group 6
XW033G6 Introduction of REGN-COV2 Monoclonal Antibody into Peripheral Vein, Percutaneous Approach, New Technology Group 6
XW043G6 Introduction of REGN-COV2 Monoclonal Antibody into Central Vein, Percutaneous Approach, New Technology Group 6
Three non-specific monoclonal antibody codes were added to allow tracking of other monoclonal antibody drugs approved for treatment of COVID-19 in the coming months.
XW033H6 Introduction of Other New Technology Monoclonal Antibody into Peripheral Vein, Percutaneous Approach, New Technology Group 6
XW043H6 Introduction of Other New Technology Monoclonal Antibody into Central Vein, Percutaneous Approach, New Technology Group 6
XW013H6 Introduction of Other New Technology Monoclonal Antibody into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 6
Other Drug Class (5 codes)
Two specific substances—the drug baracitinib (trade name Olumiant®) and an immunomodulator drug known as CD24Fc—also have new codes for tracking their use as COVID-19 therapies. Baracitinib recently received FDA emergency use authorization (EUA) as a treatment for COVID-19 in combination with remdesivir. Baracitinib can be administered orally or via gastrostomy/jejunostomy tube. The immunomodulator substance designated CD24Fc is administered via IV infusion.
XW0DXM6 Introduction of Baricitinib into Mouth and Pharynx, External Approach, New Technology Group 6
XW0G7M6 Introduction of Baricitinib into Upper GI, Via Natural or Artificial Opening, New Technology Group 6
XW0H7M6 Introduction of Baricitinib into Lower GI, Via Natural or Artificial Opening, New Technology Group 6
XW043L6 Introduction of CD24Fc Immunomodulator into Central Vein, Percutaneous Approach, New Technology Group 6
XW033L6 Introduction of CD24Fc Immunomodulator into Peripheral Vein, Percutaneous Approach, New Technology Group 6
Vaccine (6 codes)
Six new PCS codes were added for tracking COVID-19 vaccination while a patient is in the hospital. Of course, the vast majority of vaccines will not be administered to patients while they are in the hospital; nevertheless, these PCS codes will allow for the data to be captured on an inpatient record.
The new PCS codes specify whether the vaccine was a subcutaneous or intramuscular injection, and whether the injection was dose 1 or dose 2 for vaccines that require two injections to complete the therapy. The codes that do not specify dose are to be used for single-dose vaccinations, or when information regarding the dose is not available in the medical record.
XW013S6 Introduction of COVID-19 Vaccine Dose 1 into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 6
XW013T6 Introduction of COVID-19 Vaccine Dose 2 into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 6
XW013U6 Introduction of COVID-19 Vaccine into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 6
XW023S6 Introduction of COVID-19 Vaccine Dose 1 into Muscle, Percutaneous Approach, New Technology Group 6
XW023T6 Introduction of COVID-19 Vaccine Dose 2 into Muscle, Percutaneous Approach, New Technology Group 6
XW023U6 Introduction of COVID-19 Vaccine into Muscle, Percutaneous Approach, New Technology Group 6
References: https://www.3mhisinsideangle.com/blog-post/more-covid-19-diagnosis-and-procedure-codes-icd-10-cm-pcs-and-ms-drgs-updated-for-january-1-2021/
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