27 New ICD-10 Codes for COVID-19-Related Conditions, Approved Monoclonal Antibodies, & More Take Effect January 1, 2021

27 New ICD-10 Codes for COVID-19-Related Conditions, Approved Monoclonal Antibodies, & More Take Effect January 1, 2021

 

A total of 27 new codes for COVID-19 related conditions, circumstances, and treatment – including approved monoclonal antibodies – will be implemented on January 1, 2021. This includes six ICD-10-CM diagnosis codes and 21 ICD-10-PCS procedure codes. This off-cycle release of codes follows the early release of the COVID-19 code in April 2020, as well as the 12 new ICD-10-PCS codes for introduction or infusion of therapeutics that were implemented on August 1, 2020.

New ICD-10-CM Codes for COVID-19

The six new diagnosis codes were first introduced at the September 8, 2020, Coordination and Maintenance Committee meeting, and all of the codes have been approved for implementation on January 1, 2021 (CDC, 2020). A formal addendum with the tabular entries and index modifications will be published on the NCHS website soon (CDC, 2020).

The six new codes include a specific code for pneumonia due to COVID-19; two codes in the diseases of the musculoskeletal system and connective tissue; one for multisystem inflammatory syndrome (MIS), along with a code for other specified systemic involvement of connective tissue; and three Z codes for screening, exposure and personal history of COVID-19. Impending guideline updates will incorporate these new codes.

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

New ICD-10-PCS Codes for COVID-19

The procedure codes effective on January 1, 2021, are all found in the New Technology XW0 code table and represent substances used in the treatment of COVID-19. The codes are listed on the CMS ICD-10-PCS website as of December 1, 2020 (CMS, 2020). They include 10 codes for monoclonal antibodies, six codes for vaccine administration, and five codes for other specified substances.

The reporting of these codes will not affect the MS-DRG assignment. They are designated as non-OR procedures, and no MDC or MS-DRGs are assigned. See the CMS website under Latest News ICD-10-MS-DRSs 38.1 for an announcement of both the diagnosis and procedure codes and links to other resources (CMS, 2020).

Codes for Approved Monoclonal Antibodies

The 10 codes for approved monoclonal antibodies represent four specific types: Bamlanivimab, Etesevimab, Leronlimab, and REGN-COV2. Note that Leronlimab is injected subcutaneously, while the other three substances are administered intravenously via either central or peripheral vein. Three codes for non-specific monoclonal antibody substances via intravenous or subcutaneous injection are also included. This will allow for the coding of other monoclonal substances that may be developed in the future to treat COVID-19.

The codes are:

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

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

Codes for COVID-19 Vaccines

There are six new codes for inpatient COVID-19 vaccination. Though it is anticipated that most vaccinations will occur outside the inpatient environment, the new ICD-10-PCS codes will allow for tracking of these vaccines on the inpatient record.

Since Medicare will reimburse for the vaccine and administration separately from the MS-DRG payment, the CPT vaccine codes will likely be used for Medicare patients who are inpatients. See the CMS website for more information (CMS, 2020).

The ICD-10-PCS codes are subdivided based on the administration method: intramuscular or subcutaneous injection and whether this was the first, second, or single-dose/unspecified vaccinations.

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

Other Specific Substances

Five additional codes were added for two new substances: Baricitinib, which is administered orally or via a natural or artificial opening in the upper or lower GI system; and CD24Fc, which is administered intravenously.

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

Stay Tuned for More Updates

Updates to the ICD-10-CM Coding Guidelines and Addendum should be released soon. More information on the use of both the diagnosis and procedure codes specific to COVID-19 is also forthcoming. Stay tuned to the YES Blog for important updates!

In this unprecedented year for medical coding updates, coders may find it difficult to adjust to the changes. YES HIM Consulting’s education and coding support solutions are here to help coding teams navigate these changes. Contact YES today!

Ann Zeisset, RHIT, CCS, CCS-P, co-authored this article with Teri Jorwic, MPH, RHIA, CCS, CCS-P, FAHIMA.

Review these additional YES Blog resources that detail the ICD-10 and CPT codes developed to report, test, and treat the COVID-19 outbreak:

covid-19 icd 10 codesDo you want to learn how to apply the 27 new ICD-10 COVID-19 codes? Sign up for our COVID-19 Codes January 2021 webinar and find out how to code Coronavirus infections, symptoms, screening, treatments and vaccines. The webinar provides an update to the FY2021 Official Coding Guidelines for COVID-19.

 

 

Teri Jorwic

Contract Educator, MPH, RHIA, CCS, CCS-P, FAHIMA
monoclonal antibodies

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