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CMS also released Medicare Severity Diagnosis-Related Group (MS-DRG) V39.1

The Centers for Disease Control and Prevention (CDC) released its April 1, 2022 diagnosis files on Dec. 23, 2021. The updated files include a Tabular Addendum, Index Addendum, Official Coding and Reporting Guidelines update, ICD-10-CM Order File, and List of Codes and Descriptions. The Tabular Addendum and Index Addendum include minor updates to the classification, in addition to the new diagnosis codes.

The April 1 new diagnosis codes include:

  • Z28.310 – Unvaccinated for COVID-19;
  • Z28.311 – Partially vaccinated for COVID-19; and
  • Z28.39 – Other under-immunized status.

These codes have coding instructions. There is a note for the codes in subcategory Z28.31, which notes 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.

None of the new ICD-10-CM codes are designated as major complication/condition (MCC) or complication/condition (CC) status. These codes will become effective April 1, 2022, along with the previously released seven ICD-10-PCS codes.

In addition to the diagnosis codes released, the Centers for Medicare & Medicaid Services (CMS) also released Medicare Severity Diagnosis-Related Group (MS-DRG) V39.1, which also becomes effective April 1, 2022. The grouper update was created to include the new diagnosis and procedure codes.

There is also an update to the Medicare Code Editor (MCE). A new edit for unspecified laterality has been created as well. The diagnosis codes that trigger the new MCE are listed in the FY22 Inpatient Prospective Payment System (IPPS) Final Rule, Table 6P.3a.

There were also updates to the National Coverage Determination for Artificial Heart and Related Devices, with three procedure codes being removed from the Noncovered Procedure List and Limited Coverage Procedure List. These procedures are the following:

  • 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).

The National Coverage Determination for Ventricular Assist Devices was also updated, with the removal of these 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).

These two codes were removed from the Limited Coverage Procedure List for the Ventricular Assist Devices as well:

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

In addition to the grouper update, CMS has also publicized the process to request new procedure codes and MS-DRG changes. Currently, dedicated mailboxes are used to request changes.

At the Coordination and Maintenance Committee meeting in March 2022, the Medicare Electronic Application Request Information System (MEARIS), which is an electronic application system, will be introduced. This system will have a soft launch in January 2022. CMS also plans to have a discussion regarding the new system in the FY23 rulemaking process.

Programming Note:

Listen to Laurie Johnson and her coding report every Tuesday on Talk Ten Tuesdays, 10 Eastern.

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