The package includes three ICD-10-CM and seven procedure codes.
The Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS) have both stated that in April 2022, we will have three new ICD-10-CM codes and seven new procedure codes for COVID-19 therapeutics and vaccines.
You may recall that in the Inpatient Prospective Payment System (IPPS) Final Rule for the 2022 fiscal year (FY), it was stated that we would be moving to a twice-annual coding update, with the larger update being in October each year. With the continuing impact of the Public Health Emergency (PHE) and COVID-19 pandemic, we will see new codes initiated on April 1, 2022.
For ICD-10-CM, the following new codes should be utilized starting on that date:
ICD-10-CM Code Description
Z28.310 Unvaccinated for COVID-19
Z28.311 Partially vaccinated for COVID-19
Z28.39 Other underimmunization status
These three codes will be designated as “Non-CC” codes for IPPS, and would fall under MS-DRG 951, according to the grouper logic. A best practice is to educate your coding staff on these new codes and discuss the implications. Also, have an open dialogue about the situations when these codes would be assigned/used.
For ICD-10-PCS, the following new codes should be utilized starting on April 1, 2022:
PCS Code Description
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 does 3 into muscle, percut7R&aneous 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
CMS made this comment regarding the use of ICD-10-PCS vaccine codes:
“CMS notes that for hospitalized patients, Medicare pays for the COVID-19 vaccines and their administration separately from the Diagnosis-Related Group rate. As such, Medicare expects
that the appropriate CPT codes will be used when a Medicare beneficiary is administered a vaccine while a hospital inpatient. For details on billing Medicare for the COVID-19 vaccine
appropriately, please see this page in our provider toolkit:
Be sure that your facility or practice chargemaster is updated, if appropriate (for the CPT® codes). In addition, ensure that your coding staff is aware of these new ICD-10-CM/PCS codes as well. Note that these new PCS codes are “Non-OR” codes for the IPPS, and thus will not impact the MS-DRG.
Two additional steps to take include the following:
- Discuss clinical documentation with your vaccine unit/department; and
- Audit about 30 days after implementation of these codes to ensure accuracy and compliance.
On the CMS web page on MS-DRG classifications and software, you can access the link to the file: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software
We are in very fluid times, so keeping up to date with code changes is essential.