This year has been filled with code updates as we make our way through the COVID-19 pandemic with at least three new code updates. Typically, mid-year updates are unheard of in the coding world, but as the need for correct data reporting is imperative for data collection and study, it was necessary.
January 1, 2021 will usher in a new year and additional ICD-10-CM and ICD-10-PCS codes for reporting diagnosis and therapeutic treatments for COVID-19. Following is a summary of the codes that coders will need to be familiar with and assign appropriately in the coming year.
|ICD-10-CM Codes Effective 10/1/2020||
ICD-10-CM Codes Effective 1/1/2021
|Code Descriptor Effective 1/1/2021|
|None||Z11.52||Encounter for screening for COVID-19|
|Z20.828||Z20.822||Contact with and (suspected) exposure to COVID-19|
|Z86.19||Z86.16||Personal history of COVID-19|
|M35.8||M35.81||Multisystem inflammatory syndrome (MIS)|
|M35.8||M35.89||Other specified systemic involvement of connective tissue|
|J12.89||J12.82||Pneumonia due to coronavirus disease 2019|
Z11.52 Encounter for screening for COVID-19
With the first release of COVID 19 specific codes in April 2020, it was suggested to use Z11.59 Encounter for screening for other viral diseases. With the October 1, 2020 updates, the code was deemed inappropriate for use in situations where patients were being routinely tested without signs and symptoms, and the CDC had recommended using Z20.828 for all people being tested, regardless of whether they had symptoms or not. Effective 1/1/2021, they have re-instituted a screening code that is specific to COVID-19. This code will be assigned when a patient is tested without any signs or symptoms and no concern for exposure (confirmed or suspected) and test negative.
PLEASE NOTE: Assignment of this code is only appropriate once the pandemic has ceased – until then the most appropriate code to use for testing is Z20.822 if COVID-19 is not confirmed with the test.
Z20.822 Contact with and (suspected) exposure to COVID-19
Until 1/1/2021, coders will assign the previously suggested code, Z20.828 Contact with and (suspected) exposure to other viral communicable diseases. The CDC has created a new code in the same code category that is specific to COVID-19, and this should be used in all instances where a patient is being tested during the pandemic.
Z86.16 Personal history of COVID-19
Previously, coders were instructed to assign Z86.19 Personal history of other infectious and parasitic diseases. Now a new code has been developed specific to a history of COVID-19 infection. This code can only be assigned when the patient is no longer being treated for an active COVID-19 infection or any residuals or sequela (see B94.8 for sequela of other specified infectious and parasitic diseases)
J12.82 Pneumonia due to coronavirus disease 2019
A more specific code has been added to reflect specifically that the patient’s pneumonia was caused by COVID-19. Until further clarification is received, continue to report U07.1 + J12.82. It is unknown at this time whether reporting of U07.1 will still be required since the pneumonia code now specifies “due to COVID-19.”
There are inclusion terms under J12.82 which defines this as the appropriate code for “pneumonia due to COVID-19” and “pneumonia due to severe acute respiratory syndrome coronavirus 2.”
M35.81 Multisystem inflammatory syndrome
M35.89 Other specified systemic involvement of connective tissue
Both codes are an expansion of M35.8 Other specified systemic involvement of connective tissue.
Coders may see this disease process documented as MIS-C (children) or MIS-A (adults), and it affects people who were previously diagnosed with COVID-19. The syndrome causes some organs and tissues to become severely inflamed, including the heart, lungs, blood vessels, kidneys, digestive system, or brain. Some commonly seen conditions are cardiomyopathy, pulmonary embolisms, venous thrombosis, renal insult to name a few. To correctly reflect MIS, assign M35.81 plus the manifestation (eg, pulmonary embolism).
There are also new ICD-10-PCS Introduction codes for the administration of the vaccine, monoclonal antibody therapy, and immunomodulator therapy. These should only be used when documentation supports the medication is specifically being used to treat COVID-19.
|ICD-10-PCS Code Effective 1/1/2021||Code Descriptor|
|XW013U6||Introduction of COVID-19 vaccine into subcutaneous tissue, percutaneous approach|
|XW023U6||Introduction of COVID-19 vaccine into muscle, percutaneous approach|
|XW013S6||Introduction of COVID-19 vaccine dose 1 into subcutaneous tissue, percutaneous approach|
|XW013T6||Introduction of COVID-19 vaccine dose 2 into subcutaneous tissue, percutaneous approach|
|XW023S6||Introduction of COVID-19 vaccine dose 1 into muscle, percutaneous approach|
|XW023T6||Introduction of COVID-19 vaccine dose 2 into muscle, percutaneous approach|
|XW033E6||Introduction of etesevimab monoclonal antibody (LY-CoV016) into peripheral vein, percutaneous approach|
|XW043E6||Introduction of etesevimab monoclonal antibody (LY-CoV016) into central vein, percutaneous approach|
|XW033F6||Introduction of bamlanivimab monoclonal antibody (LY-CoV555) into peripheral vein, percutaneous approach|
|XW043F6||Introduction of bamlanivimab monoclonal antibody (LY-CoV555) into central vein, percutaneous approach|
|XW033G6||Introduction of REGN-COV2 monoclonal antibody (cocktail of casirivimab and imdevimab) into peripheral vein, percutaneous approach|
|XW043G6||Introduction of REGN-COV2 monoclonal antibody (cocktail of casirivimab and imdevimab) into central vein, percutaneous approach|
|XW033H6||Introduction of other new technology monoclonal antibody into peripheral vein, percutaneous approach|
|XW043H6||Introduction of other new technology monoclonal antibody into central vein, percutaneous approach|
|XW013H6||Introduction of other new technology monoclonal antibody into subcutaneous tissue, percutaneous approach|
|XW033L6||Introduction of CD24Fc immunomodulator (SACCOVID™) into peripheral vein, percutaneous approach|
|XW043L6||Introduction of CD24Fc immunomodulator (SACCOVID™) into central vein, percutaneous approach|
|XW0DXM6||Introduction of baricitinib (Olumiant®) into mouth and pharynx, external approach|
|XW0G7M6||Introduction of baricitinib (Olumiant®) into upper GI, via natural or artificial opening|
|XW0H7M6||Introduction of baricitinib (Olumiant®) into lower GI, via natural or artificial opening|
|XW013K6||Introduction of leronlimab monoclonal antibody (PRO 140) into subcutaneous tissue, percutaneous approach|
For more information on code updates effective 1/1/2021, please check out the official CMS website.
Please note that the information in this document was valid at the time this was published. As information is constantly changing, you are encouraged to continue to monitor all coding resources for any changes or updates.
Robyn McCoart, Managing Auditor