Coding Tip: New COVID-19 Codes Effective January 1, 2021
Pat Maccariella‑Hafey
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador
We have seen many updates and changes to COVID-19 (SARS-CoV-2) since the pandemic started. On January 1, 2021 we will see even more changes as outlined below. Also the CMS MS-DRG grouper will be updated to version 38.1 to accommodate the changes. Be sure to review your facility’s encoder to be sure you have the correct codes as outlined below. I will not be discussing CPT codes for vaccines and therapeutic injections however I did include a link to these codes in the references. Coders should keep this list below handy as they begin coding January 1, 2021 cases.
What are the New Diagnosis Codes Effective January 1, 2021?
- Z11.52, encounter for screening for COVID-19 (We previously used Z11.59 before the pandemic. Do not use Z11.52 during pandemic. Must wait until pandemic is over to begin using this code)
- Reported for people who are asymptomatic and test negative
- Z20.822, contact with and (suspected) exposure to COVID-19 (We previously used Z20.828 for this)
- Z86.16, personal history of COVID-19 (We previously used Z86.19 for this)
In addition, the committee proposed adding a new code that would allow providers to report COVID-19-caused pneumonia:
- J12.82, pneumonia due to coronavirus disease 2019 (We previously used U07.1, J12.89 for this)
- Includes the inclusion terms, “pneumonia due to COVID-19” and “pneumonia due to severe acute respiratory syndrome coronavirus 2”
- Existing coding guidance (prior to 1/1/21) for COVID-19-related pneumonia instructs coders to report two ICD-10-CM codes for the condition: U07.1 (COVID-19) and J12.89 (other viral pneumonia).
- We wrote AHA to see if U07.1 and J12.82 would be reported, or only J12.82). AHA has replied that BOTH U07.1 AND J12.82 would be reported as of January 1, 2021 for viral pneumonia due to COVID-19. They are not following the existing OCG on using one combination code in this situation.
The creation of the new combined code would “improve coding specificity for pneumonia due to [COVID-19],” according to committee members.
Finally, the committee proposed adding a new code for multisystem inflammatory syndrome-a condition associated with COVID-19, particularly in children:
- M35.81, multisystem inflammatory syndrome (Previously M35.8)
- M35.89, Other specified systemic involvement of connective tissue (Previously M35.8)
What are the New Procedure Codes Effective January 1, 2021?
Remember, only assign the X COVID-19 codes when the drug is being used to treat COVID-19 ONLY, not some other disease.
The drug administration code should only be assigned ONCE even though it may be administered more than one time in the hospital stay. The first 12 codes below were created to be used starting August 1, 2020:
XW033E5 – Introduction of remdesivir (VEKLURY®) into peripheral vein, percutaneous approach
XW043E5 – Introduction of remdesirvir (VEKLURY®) into central vein, percutaneous approach
XW033G5 – Introduction of sarilumab (KEVZARA®) into peripheral vein, percutaneous approach
XW043G5 – Introduction of sarilumab (KEVZARA®) into central vein, percutaneous approach
XW033H5 – Introduction of tocilizumab (ACTEMRA®) into peripheral vein, percutaneous approach
XW043H5 – Introduction of tocilizumab (ACTEMRA®) into central vein, percutaneous approach
XW13325 – Transfusion of convalescent plasma (nonautologous) into peripheral vein
XW14325 – Transfusion of convalescent plasma (nonautologous) into central vein
XW013F5 – Introduction of other new technology therapeutic substance into subcutaneous tissue, percutaneous approach, new technology group 5
XW033F5 – Introduction of other new technology therapeutic substance into peripheral vein, percutaneous approach, new technology group 5
XW043F5 – Introduction of other new technology therapeutic substance into central vein, percutaneous approach, new technology group 5
XW0DXF5 – Introduction of other new technology therapeutic substance into mouth and pharynx, external approach, new technology group 5
The four codes above should only be assigned for therapeutic substances being used to treat COVID-19 that do not have their own specific code. For administration of “other therapeutic substances” that are being used to treat medical conditions other than COVID-19, see ICD-10-PCS table 3E0. For example, code 3E033GC describes “Introduction of other therapeutic substance into peripheral vein, percutaneous approach.” If a code exists elsewhere and is being used to treat COVID-19, then use that other code. Example includes stem cell transfusion. There is an existing code for stem cell transfusion so use that code.
Example for Dexamethasone (orally or intravenously) when used to treat COVID-19, assign the drug from the table 3E0 for introduction of anti-inflammatory drug. Do NOT assign an XWO drug code.
The below are valid as of 1/1/2021:
XW013U6 -Introduction of COVID-19 vaccine into subcutaneous tissue, percutaneous approach, new technology group 6
XW023U6 – Introduction of COVID-19 vaccine into muscle, percutaneous approach
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
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
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 peripheralvein, percutaneous approach.
XW043G6 – Introduction of REGN-COV2 monoclonal antibody (cocktail of casirivimab and imdevimab) into centralvein, 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, new technology group 6
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, new technology group 6
https://www.cms.gov/medicare/icd-10/2021-icd-10-pcs
Coders can find the official documents below at the link in the references.
The updated ICD-10-CM Official Coding and Reporting Guidelines are expected to be available here by 1/1/21 https://www.cdc.gov/nchs/icd/icd10cm.htm
What Will be the Challenges?
A big change will be the use of a new specific code for COVID-19 testing that turns out to be negative but patient is asymptomatic, Z20.822, contact with and (suspected) exposure to COVID-19. Coders are used to using the generic code of Z20.828. We are very glad that a new specific code has been developed for this situation. Remember that coders CANNOT use the screening code (Z11.52) until there is no longer a pandemic. During AHA’s COVID-19 coding presentation on December 1, 2020, Nelly stated that an official announcement will be given as to when the COVID-19 pandemic is official over. This change will once again affect data capture and reporting since the coding guidelines for negative testing of COVID-19 has changed 3 times since the pandemic began.
Personal history of COVID-19, Z86.16 is a welcome addition to specifically identify a history of this virus. This will greatly help statistical analysis. This code is only used when the patient no longer has COVID-19 and no longer is being treated for any residuals of COVID-19. This could get confusing in some cases if the documentation is not very clear. Coders are cautioned not to assume and to query the provider for an answer.
Remember, COVID-19 has to be confirmed in order to code U07.1, COVID-19. The test results can be coded as a confirmed COVID-19 case, U07.1. However if the test results are inconclusive and the MD documents “probable,” “suspected” or “inconclusive” COVID-19, do NOT assign code U07.1. Instead, code the signs and symptoms. This was validated during AHA’s presentation on 12/1/20. If there is ever any question, it is “best practice” to query the provider.
Be sure to keep a list of all COVID-19 procedures so that they can be identified in the medical record and reported with appropriate ICD-19-PCS codes.
References
https://www.cms.gov/files/zip/icd-10-ms-drgs-v381-effective-january-1-2021.zip
https://www.cms.gov/medicare/covid-19/medicare-billing-covid-19-vaccine-shot-administration
https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies
https://www.cdc.gov/nchs/icd/icd10cm.htm
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software
The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
Part 1: New 2021 CPT Codes | Integumentary System
This is Part 1 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include examples to help the coder understand the new codes. For 2021 in general, there were 199 new CPT codes added, 54 deleted and 69 revised.
2020: Year in Review | Coding Education
In January, new CPT codes were released. There were 248 new CPT codes added, 71 deleted and 75 revised. Most of the surgery section changes were in the musculoskeletal and cardiovascular subsections. These included procedures such as skin grafting, breast biopsies, deep drug delivery systems, tricuspid valve repairs, aortic grafts and repair of iliac artery.
New Technology Add-On Payments (NTAP) For FY2021 – Part 4
In the previous three parts of this four-part series, we discussed the new ICD-10-CM diagnosis code changes, ICD-10-PCS procedure code changes and FY2021 IPPS changes. In this last Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments for FY2021.
New ICD Codes and IPPS Changes for FY2021 (ICD-10-CM Diagnoses changes) – Part 3
In the previous two parts of this four part series, we discussed the new ICD-10-CM diagnosis code changes and ICD-10-PC procedure code changes. In this session we will review the major IPPS changes for FY2021.
New ICD Codes and IPPS Changes for FY2021 (ICD-10-CM Diagnoses changes) – Part 2
This is Part 2 of a 4 part series on the FY2021 ICD-10 Code and IPPS changes. In this part, the ICD-10-PCS procedure codes are presented. For FY2021 ICD-10-PCS there are 78,115 total codes (FY2020 total was 77,571); 556 new codes (734 new last year in FY2020)…
New ICD Codes and IPPS Changes for FY2021 (ICD-10-CM Diagnoses changes) – Part 1
This is Part 1 of a 4 part series on the FY2021 changes to ICD-10 and the IPPS. In this part, we discuss some of the new ICD-10-CM diagnosis changes. Here is the breakdown: 72,616 total ICD-10-CM codes for FY2021; 490 new codes (2020 had 273 new codes); 58 deleted codes (2020 had 21 deleted codes); 47 revised codes (2020 had 30 revised codes)
Coding Tip: Reporting “Flash” Pulmonary Edema
Acute pulmonary edema is the rapid accumulation of fluid within the tissue and space around the air sacs of the lung (lung interstitium). When this fluid collects in the air sacs in the lungs it is difficult to breathe. Acute pulmonary edema occurs suddenly and is life threatening.
Client S: $556 increase/record reviewed
“Client S” is a small, not-for-profit, 40 bed micro-hospital in the Southeast. HIA performed a 65-record review this year for Client S and found an opportunity with 15 of them. 9 had an increased reimbursement with a total of $43,228 found.
Coding Tip: Glasgow Coma Scale Coding OCG Update for FY2021
The coma scale codes (R40.2-) can be used in conjunction with traumatic brain injury codes, acute cerebrovascular disease or sequelae of cerebrovascular disease codes. These codes are primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma scale may also be used to assess the status of the central nervous system for other non-trauma conditions, such as monitoring patients in the intensive care unit regardless of medical condition.
Coding Tip: Cardiac Arrest and Cardiac Shock
In the past, there had been an Excludes1 note at I46.- Cardiac arrest that excluded R57.0, Cardiac shock. HIA had also received a letter from AHA on a case in the past that had stated that only I46.- Cardiac arrest would be coded if both were documented. In addition, the Third Quarter Coding Clinic page 26 had a similar case that asked if both could be coded, and AHA had instructed that only I46.9, cardiac arrest, cause unspecified would be coded if both were documented and that the CDC would be looking at possible revision to the Excludes1 note.
Client X: Let’s Talk Numbers
A higher CMI corresponds to increased consumption of resources and increased cost of patient care, resulting in increased reimbursement to the facility from government and private payers, like CMS. We know that documentation directly impacts coding.
Coding Tip: Endarterectomy During Coronary Artery Bypass
Lately we have seen several cases where the endarterectomy was assigned along with the coronary artery bypass (CABG) procedure when being performed on the same vessel to facilitate the CABG. A coronary artery endarterectomy is not always performed during a CABG procedure, so when it is performed it becomes confusing as to whether to code it separately or not.
Coding Tip: Update – Coding COVID-19 When the Test is Negative
Assign code Z20.828, “Contact with and (suspected) exposure to other viral communicable diseases” for all patients who are tested for COVID-19 and the results are negative, regardless of symptoms, no symptoms, exposure or not as we are in a pandemic.
New ICD-10-PCS Procedure Codes for COVID-19
The Centers for Medicare & Medicaid Services (CMS) announced new procedure codes for treatments of COVID-19 – effective as of August 1, 2020. Among the new codes are Section X New Technology codes for the introduction or infusion of therapeutics including Remdesivir, Sarilumab, Tocilizumab, transfusion of convalescent plasma, as well as introduction of any other or new therapeutic substances for the treatment of COVID-19.
New Rule Helps Medicare ACOs During COVID-19 Pandemic
One common element in many value-based programs is risk adjustment using Hierarchical Condition Categories (HCCs) to create a Risk Adjustment Factor (RAF) score. This method ranks diagnoses into categories that represent conditions with similar cost patterns.
Part 5: Reasons for AKI Denials and Prevention | AKI Series
Why are so many AKI records being denied? It’s hard to give one answer for why so many AKI records are being denied lately, but most appear to be due to the multiple sets of criteria available for use in determining if a patient has AKI, as well as physician documentation. As stated in Part 3 of this series, there are three main criteria/classifications used to diagnose AKI.
Part 4: Is Documentation Present to Report Acute Kidney Injury/Failure? | AKI Series
In previous parts of this series we looked at the definitions of AKI/ARF, causes, coding and sequencing, and the common clinical indicators that patients present with that are diagnosed with this condition. In Part 4, we will look at the documentation that should be present to report the diagnosis without fear of denial, as well as when a query is needed to clarify the diagnosis.
Coding Tip: Z Code Reporting for COVID-19
If the facility does a COVID-19 test, and test is negative, do I need a diagnosis code. The answer is yes, you will report a Z-code. The Z-code depends on the record documentation and circumstances of testing. For any patient receiving a COVID-19 test, if negative, there MUST e a Z-code to describe why the test was taken. (Test negative for COVID-19 and MD does not override negative results).
Part 3: Clinical Indicators for Acute Kidney Injury/Failure | AKI Series
In the first parts of this series we looked at definitions of AKI/ARF, causes, coding and sequencing. In Part 3, we will look at what clinical indicators would possibly be present to support the diagnosis of AKI/ARF.
FY2021 Proposed Rule and Code Changes Highlights
The FY2021 IPPS Proposed Rule is out and here are some highlights from it regarding ICD-10 Code proposals. We will know if these changes are permanent after the public comment period is over on July 10, 2020 and CMS prepares the Final Rule, usually out by August 1.
Part 2: Specificity Coding of Acute Kidney Injury (AKI) and Sequencing | AKI Series
As discussed in Part 1 of this series, AKI/ARF is a common diagnosis that coders see daily. In Part 2, we are going to focus on the different types/specificity of AKI/ARF. We’ll learn what they mean, as well as how to code the diagnosis.
Part 1: What is Acute Kidney Injury (AKI)? | AKI Series
This is part 1 in a series focused on coding of acute kidney injury (AKI) and/or acute renal failure (ARF). AKI/ARF is reported often, but is also one of the most common diagnosis found in denials.
Coding Tip: Covid-19 Diagnosis Coding Common Scenarios
With the proliferation of COVID-19 cases, we thought we would put together a quick reference listing of some of the common scenarios that coders have asked about. As with all coding, coders should follow Official Guidelines for Coding and Reporting and the COVD-19 Frequently Asked Questions document by the AHA.
Coding Tip: What is Single Path Coding?
The biggest reasons why some hospital systems are moving to single path coding is to eliminate duplicative processes and to optimize productivity. In addition, costs are reduced when only one coder “touches” the record and completes both types of coding.
Coding Tip: Reporting Vaping in ICD-10-CM | Effective on 4/1/2020
Effective with 4/1/2020 discharges, ICD-10-CM code U07.0 is used to report vaping -related disorders. ICD-10-CM code U07.0 (vaping related disorder) should be used when documentation supports that the patient has a lung-related disorder from vaping. This code is found in the new ICD-10-CM Chapter 22. U07.0 will be in listed in the ICD-10-CM manual under a new section: Provisional assignment of new disease of uncertain etiology or emergency use.
Telehealth and the Coronavirus
The US government and public-health officials are urging consumers to utilize telemedicine for remote treatment, fill prescriptions and get medical attention during the new coronavirus pandemic. The goal is to keep people with symptoms at home and to practice social distancing if their condition doesn’t warrant more intensive hospital care.
Coronavirus: Tips for Working from Home
Coronavirus: Tips for working from home. Companies around the world have told their employees to stay home and work remotely. Whether you’re a new to this concept or a work from home veteran, here’s some tips to staying productive from our #HIAfamily.
Part 3: Coder and CDI Communication Example | CDI Series
This is the final part of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we provide an actual example of an effective communication response to CDI.
Part 2: How Coders Can Address Coding Mismatches | CDI Series
This is part two of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we discuss mismatches and how to best go about resolving them. In part three we will provide a case example of best practice interaction.