CMS announces new ICD 10 codes for vaccination and COVID 19 treatments

CMS announces new ICD 10 codes for vaccination and COVID 19 treatments

icd 10 coding guidelines

In November, the Centers for Medicare & Medicaid Services (CMS) announced new ICD 10 vaccination and treatment codes for 2022. The agency will implement them effective April 1, 2022. The new codes are possible due to changes announced in the Inpatient Prospective Payment System final rule (which we discuss on our blog here), allowing for a regular code update on April 1st as well as the traditional October 1st changes. This first April 1st update includes three diagnosis and seven procedure codes, all related to COVID-19. View our ICD-10 coding updates training to learn more about these codes.

ICD-10-CM Codes

CMS announced three ICD-10-CM diagnosis codes, Z28.310, Z28.311 and Z28.39. These are expansions in subcategory Z28.3, under immunization status. All of the codes are Non-CCs. They group to MDC 23 and MS-DRG 951, Other Factors Influencing Health Status.

The three codes’ definitions are:

  • Z28.310: Unvaccinated for COVID-19
  • Z28.311: Partially vaccinated for COVID-19
  • Z28.39: Other underimmunization status

ICD-10-PCS Codes

Seven ICD-10-PCS codes describe the introduction of therapeutics for COVID-19, including vaccines. CMS notes that for hospitalized Medicare patients, payment for COVID-19 vaccines and administration is separate from the MS-DRG rate, and the applicable CPT codes are used for billing of these services. See the provider toolkit for more information: https://www.cms.gov/medicare/payment/covid-19/medicare-billing-covid-19-vaccine-shot-administration.

Doctor writing medical codes

All seven codes are designated as Non-OR and will not affect the assignment of the MS-DRG. The new codes are listed below:

  • XW013V7: Introduction of COVID-19 vaccine dose 3 into subcutaneous tissue, percutaneous approach, new technology group
  • XW013W7: Introduction of COVID-19 vaccine booster into subcutaneous tissue, percutaneous approach, new technology group 7
  • XW023V7: Introduction of COVID-19 vaccine dose 3 into muscle, percutaneous 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
  • XW0H7R7: Introduction of fostamatinib into lower GI, via natural or artificial opening, new technology group 7

Addenda for the seven new codes including code tables, index and other information, will become available at https://www.cms.gov/medicare/coding-billing/icd-10-codes/2022-icd-10-pcs.

The ICD-10 MS-DRG V39.1 Grouper Software, Definitions Manual Table of Contents, and the
Definitions of Medicare Code Edits V39.1 manual to accommodate these new codes is available
at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software.

To find information on Medicare Code Editor Version 39.1, as well as the ICD 10 code for vaccination update, click here (ZIP). View our ICD-10 Coding Updates Resource Center for complete information on the annual code and guideline changes.

Lastly, we have our own blog post on the CPT vaccine codes that CMS introduced in October. You can read about that here.

Ann Zeisset

Ann Zeisset, RHIT, CCS, CCS-P Contract Educator
icd 10 vaccination codes

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