Synopsis of 2022 Coding Changes: ICD-10 & CPT Annual Updates, New Codes Released Over the Course of the COVID-19 PHE

Synopsis of 2022 Coding Changes: ICD-10 & CPT Annual Updates, New Codes Released Over the Course of the COVID-19 PHE

The COVID-19 Public Health Emergency (PHE) has kept the healthcare industry very busy. Not only is the landscape for patient care changing, but the medical coding field is also rapidly evolving to keep up with the 2022 coding changes, too.

As a result of the COVID-19 PHE, many new HCPCS/CPT and ICD-10-CM/PCS codes have been developed for reporting of testing, treatment, vaccination and diagnoses. The YES Blog has reported on these codes as they have been released. The following is a comprehensive overview of the code changes from March 2020 through February 2022. We continue to follow and report on updates to codes, guidelines and other directives.

CPT/HCPCS

Vaccinations

AMA developed 10 unique codes for COVID-19 vaccines, with accompanying administration codes for applicable doses. These include products from Pfizer, Moderna Janssen, AstraZeneca and Novavax. Each of the vaccine product codes is five characters, the first three of which are 913. The fourth and fifth character represent the specific vaccine, for example 91307 is the code for the pediatric dose of the Pfizer COVID-19 vaccine, and the last two characters of the code represent this particular product.

The vaccine administration codes are also five characters and correlate to the vaccine product codes. The first character is 0, with the second and third character representing the specific vaccine product. The fourth character designates the dose being administered and the fifth character A indicates that this is an administration code.

Code Breakdown: 0073AStructure:
07Specific vaccine product & manufacturer
3Dose number
AAdministration

Consequently, new code 0073A represents the administration of the third dose of the Pfizer pediatric dose vaccine. This predictable code structure allows for the addition of new codes for vaccine products and administration as they become available and approved for EUA by the FDA.

Here are the CPT vaccine and administration codes developed by the AMA:

CodeDescription
91300Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use (Pfizer)
0001AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose (Pfizer)
0002AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose (Pfizer)
0003AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3mL dosage, diluent reconstituted; third dose (Pfizer)
0004AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3mL dosage, diluent reconstituted; booster (Pfizer)
91305Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 (Pfizer)
0051AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; first dose (Pfizer)
0052AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; second dose (Pfizer)
0053AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; third dose (Pfizer)
91307Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use (Pfizer)
0071AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; first dose (Pfizer)
0072AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; second dose (Pfizer)
0073AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; third dose (Pfizer)
0074AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; booster dose (Pfizer)
91301Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 100 mcg/0.5mL dosage, for intramuscular use (Moderna)
0011AImmunization administration by intramuscular injection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 100 mcg/0.5mL dosage; first dose (Moderna)
0012AImmunization administration by intramuscular injection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 100 mcg/0.5mL dosage; second dose (Moderna)
0013AImmunization administration by intramuscular injection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 100 mcg/0.5mL dosage; third dose (Moderna)
91308Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use (Pfizer)
0081AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; first dose (Pfizer)
0082AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; second dose (Pfizer)
91306Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.25 mL dosage, for intramuscular use (Moderna)
0064AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.25 mL dosage, booster dose (Moderna)
91309Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use (Moderna)
0094AImmunization administration by intramuscular injection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.5 mL dosage, booster dose (Moderna)
91302Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5×1010 viral particles/0.5mL dosage, for intramuscular use (AstraZeneca)
0021AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5×1010 viral particles/0.5mL dosage; first dose (AstraZeneca)
0022AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5×1010 viral particles/0.5mL dosage; second dose (AstraZeneca)
91303Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×1010 viral particles/0.5mL dosage, for intramuscular use (Janssen)
0031AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×1010 viral particles/0.5mL dosage, single dose (Janssen)
0034AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×1010 viral particles/0.5mL dosage, booster (Janssen)
91304Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5mL dosage, for intramuscular use (Novavax)
0041AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5mL dosage; first dose (Novavax)
0042AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5mL dosage; second dose (Novavax)
91310Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, monovalent, preservative-free, 5 mcg/0.5 mL dosage, adjuvant AS03 emulsion, for intramuscular use (Sanofi-GSK)
0104AImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, monovalent, preservative-free, 5 mcg/0.5 mL dosage, adjuvant AS03 emulsion, booster dose (Sanofi-GSK)

A comprehensive listing of the vaccine and administration codes, along with the manufacturer’s name and dosing schedule is available in the CPT Appendix Q, which is updated as new codes are released. A vaccine access tool to determine the appropriate CPT code combination for the type and dose of vaccine is also available on the AMA website.

For additional information, check out these articles on the YES Blog:

Testing

New codes were developed and existing codes revised for COVID-19 laboratory tests; the most recent code was effective on February 21, 2022. AMA has prepared a document that lists Category I and PLA codes for these tests with long descriptions, effective dates for the codes, as well as the edition of CPT that includes the code.

The newest code, 87913, for COVID-19 mutation identification in targeted region(s), took effect on February 21, 2022 and will be published in the 2023 edition of CPT. A comprehensive list of these codes, including revisions, can be downloaded from the AMA COVID-19 CPT coding and guidance website.

CodeDescription
99702Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease
87913Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) mutation identification in targeted region(s)
87811Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
87637Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique
87636Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique
87635Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), amplified probe technique
87426Infectious agent antigen detection by immunoassay technique, (e.g., enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (e.g., SARS-CoV, SARS-CoV-2 [COVID-19])
86769Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])
86413Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative
86409Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); titer
86408Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); screen
0226USurrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum
0225UInfectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected
86328Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

See these previous YES Blog articles for more information:

Additional Annual Updates

cpt code updates

The 2022 CPT updates encompass over 400 changes, with 249 additions, 63 deletions, and 93 revisions. New codes in the Technology Category III section and expansions in the Proprietary Laboratory Analysis subsection account for more than 40% of 2022’s updates. Appendix R, which covers Digital Medicine – Services Taxonomy, was added. Case management services received five new therapeutic remote monitoring and principal care management codes.

The COVID-19 PHE has resulted in an increase in the provision of telehealth services. To assist in the reporting of these services, AMA introduced CPT modifier 93 to report audio-only telehealth visits. This modifier was effective on January 1, 2022 and will appear in the 2023 print version of CPT. In addition, the Medicare Physician Fee Schedule’s 2022 list of audio-only eligible telehealth services was expanded. For example CPT code 90792, “Psychiatric diagnostic evaluation with medical services” was added to the list of services. Review this article for the full modifier description.

The Telehealth Services List was revised to include two additional telehealth services modifiers, FQ and FR, starting January 22, 2022. These modifiers are specifically used for telehealth mental health services.

ModifierDescription
FQA telehealth service was furnished using real-time audio-only communication technology.
FRA supervising practitioner was present through a real-time two-way, audio/video communication technology.

ICD-10-CM

approved monoclonal antibodies

As a result of the PHE, several diagnosis codes, including the first code for COVID-19, U07.1, have been developed as outlined below. Additional coding guidelines and revisions have also been released as applicable to accompany the codes as they are released.

Also, the 2022 Final Rule for the Inpatient Prospective Payment System (IPPS) included a provision for a regular code update on April 1st of every year in addition to the traditional October 1st update. This change is one of the most significant updates to ICD-10 as it allows the process to be more flexible. And for the release of codes reporting diseases and procedures to be done in a timelier manner. This change will allow for new codes for all types of conditions and procedures, however the first update mainly includes COVID-19 related changes.

Diagnosis Codes

The newest ICD-10-CM codes take effect on April 1, 2022. These three codes are related to COVID-19 and reflect immunization status:

CodeDescription
Z28.310Unvaccinated for COVID-19
Z28.311Partially vaccinated for COVID-19
Z28.39Other undervaccination status

U09.9 for Post COVID-19 condition, unspecified, took effect on October 1, 2021. This code allows a link for the long-term condition with COVID-19, with a code for the specific condition such as pulmonary fibrosis, J84.10 listed first, if known. See the YES Blog for more information.

Six COVID-19 related codes were released for implementation on January 1, 2021:

CodeDescription
J12.82Pneumonia due to coronavirus disease 2019
M35.81Multisystem inflammatory syndrome
M35.89Other specified systemic involvement of connective tissue
Z11.52Encounter for screening for COVID-19
Z20.822Contact with and (suspected) exposure to COVID-19
Z86.16Personal history of COVID-19

The original code for COVID-19, U07.1, was released on April 1, 2020. This code was fast-tracked to allow for rapid data collection.

SDH Codes

With the 2022 updates, 11 new codes were added to the Z55-Z65 block of the ICD-10-CM Official Guidelines. These codes report “persons with potential health hazards related to socioeconomic and psychosocial circumstances.” These social determinants of health (SDH) codes include:

CodeDescription
Z55.5Less than a high school diploma
Z58.6Inadequate drinking-water supply
Z59.00Homelessness unspecified
Z59.01Sheltered homelessness
Z59.02Unsheltered homelessness
Z59.41Food insecurity
Z59.48Other specified lack of adequate food
Z59.811Housing instability, housed, with risk of homelessness
Z59.812Housing instability, housed, homelessness in past 12 months
Z59.819Housing instability, housed unspecified
Z59.89Other problems related to housing and economic circumstances

More information regarding the history behind the new SDH codes can be found here.

ICD-10-PCS

ICD-10-PCS codes, used for inpatient encounters, have had additions for COVID-19 related services during the PHE. The most recent codes, effective on April 1, 2022, are a total of nine codes, three for fostamatinib administration and four vaccine codes as well as two additional codes for monoclonal antibody treatment. CMS does note that payment for COVID-19 vaccines are paid separately, and the CPT codes for vaccine and administration are used, the ICD-10-PCS codes for vaccines and other treatment are available for gathering information.

CodeDescription
XW013V7Introduction of COVID-19 vaccine dose 3 into subcutaneous tissue, percutaneous approach, new technology group
XW013W7Introduction of COVID-19 vaccine booster into subcutaneous tissue, percutaneous approach, new technology group 7
XW023V7Introduction of COVID-19 vaccine dose 3 into muscle, percutaneous approach, new technology group 7
XW023W7Introduction of COVID-19 vaccine booster into muscle, percutaneous approach, new technology group 7
XW0DXR7Introduction of fostamatinib into mouth and pharynx, external approach, new technology group 7
XW0G7R7Introduction of fostamatinib into upper GI, via natural or artificial opening, new technology group
XW0H7R7Introduction of fostamatinib into lower GI, via natural or artificial opening, new technology group 7
XW023X7Introduction of tixagevimab and cilgavimab monoclonal antibody into muscle, percutaneous approach, new technology group 7
XW023Y7Introduction of other new technology monoclonal antibody into muscle, percutaneous approach, new technology group 7

The FY 2022 code update included COVID-19 related codes in the new technology section, and 21 ICD-10-PCS codes took effect on January 1, 2021 along with the six diagnosis codes previously discussed. 12 ICD-10-PCS codes were released effective August 1, 2020, the only time an August 1st release date has been used for codes. All 12 of the codes are in the new technology section and represent introduction of infusion of Remdesivir, Sarilumab, Tocilizumab, or other therapeutic substances, as well as the transfusion of convalescent plasma specifically for the treatment of COVID-19.

CodeDescription
XW033E5Introduction of Remdesivir Anti-Infective into Peripheral Vein, Percutaneous Approach New Technology Group 5
XW043E5Introduction of Remdesivir Anti-Infective into Central Vein, Percutaneous Approach New Technology Group 5
XW033G5Introduction of Sarilumab Anti-Infective into Peripheral Vein, Percutaneous Approach New Technology Group 5
XW043G5Introduction of Sarilumab Anti-Infective into Central Vein, Percutaneous Approach New Technology Group 5
XW033H5Introduction of Tocilizumab Anti-Infective into Peripheral Vein, Percutaneous Approach New Technology Group 5
XW043H5Introduction of Tocilizumab Anti-Infective into Central Vein, Percutaneous Approach New Technology Group 5
XW013F5Introduction of Other New Technology Therapeutic Substance into Subcutaneous Tissue, Percutaneous Approach New Technology Group 5
XW033F5Introduction of Other New Technology Therapeutic Substance into Peripheral Vein, Percutaneous Approach New Technology Group 5
XW043F5Introduction of Other New Technology Therapeutic Substance into Central Vein, Percutaneous Approach New Technology Group 5
XW0DXF5Introduction of Other New Technology Therapeutic Substance into Mouth or Pharynx, External Approach New Technology Group 5
XW13325Transfusion of Convalescent Plasma (Nonautologous) into Peripheral Vein, Percutaneous Approach New Technology Group 5
XW14325Transfusion of Convalescent Plasma (Nonautologous) into Central Vein, Percutaneous Approach New Technology Group 5

Additional Annual Updates

2022 coding changes

Several ICD-10-CM guidelines were changed or added to include clarification on HIV coding guidelines, sequencing of history (of) codes with other codes, information on code Z71.85, “encounter for immunization safety counseling,” and much more. A description of the 2022 CM guideline changes can be read here.

A total of 191 new codes were included in the 2022 ICD-10-PCS updates, plus 107 codes were deleted, and 62 were revised. Several ICD-10-PCS guidelines were updated in 2022, including the Control guideline B3.7, the New Technology guidelines E1.a and E1.b, which can be reviewed here.

2022 coding changes

Future to Bring More Changes?

As more is discovered about COVID-19 and related conditions, as well as new vaccines and treatments are developed, additional codes, guidelines and other directives will likely be released. We will continue to report on these developments.

Teri Jorwic

Contract Educator, MPH, RHIA, CCS, CCS-P, FAHIMA
2022 coding changes

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