New COVID-19 Codes To Be Implemented Soon

Sue Bowman, MJ, RHIA, CCS, FAHIMA

In response to the COVID-19 public health emergency, the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS) and the Centers for Medicare and Medicaid Services (CMS) are implementing six new ICD-10-CM and 21 new ICD-10-PCS codes, effective January 1, 2021.

The new ICD-10-CM diagnosis codes are:

New ICD-10-CM code M35.81 describes multisystem inflammatory syndrome (MIS), a hyperinflammatory syndrome associated with past or present COVID-19 (SARS-CoV-2 infection). It has been predominantly described in children with less frequent case reports in adults. The current US CDC case definition for MIS in children includes fever, laboratory markers of inflammation, severe illness requiring hospitalization with at least two organ systems involved and laboratory evidence of SARS-CoV-2 infection or a history of known exposure to a suspected or confirmed COVID-19 case within four weeks prior to symptom onset.

The ICD-10-CM Addenda and other code files are available on the CDC/NCHS ICD-10-CM web page: https://www.cdc.gov/nchs/icd/icd10cm.htm. The updated ICD-10-CM Official Guidelines for Coding and Reporting are expected to be posted on this page soon.

The new ICD-10-PCS procedure codes going into effect January 1 describe the introduction or infusion of therapeutics, including monoclonal antibodies, for COVID-19 treatment and vaccines. CMS stated 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 (see the discussion below concerning new CPT codes for COVID-19 vaccines) 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 the CMS website: https://www.cms.gov/medicare/covid-19/medicare-billing-covid-19-vaccine-shot-administration.

The new ICD-10-PCS procedure codes are:

The ICD-10-PCS Code Tables, Index, and Addenda for the new ICD-10-PCS codes are available on the CMS 2021 ICD-10-PCS web page: https://www.cms.gov/medicare/icd-10/2021-icd-10-pcs.

In the CPT code set, the American Medical Association (AMA) has created a new vaccine coding structure for COVID-19 vaccine candidates. This new structure differs from that of other CPT vaccine codes. A Special Edition of the AMA’s CPT Assistant indicated that this structural change is due in part to the rapid development of COVID-19 vaccines, a request to track the administration of each individual vaccine, and the need for a long-term solution to accommodate additional codes as new vaccines become available. A request to track both the specific vaccine and the dose received resulted in a series of alphanumeric COVID-19 vaccine administration codes. These administration codes include vaccine risk and benefit counseling, when performed.

The new CPT codes for COVID-19 vaccines, which will be effective upon receiving approval or Emergency Use Authorization from the US Food and Drug Administration, are:

Each COVID-19 vaccine administration code (0001A, 0002A, 0011A, 0012A) is specific to each individual vaccine product code (91300, 91301). The appropriate administration code is chosen based on the type of vaccine and which dose in the schedule (first or second dose) the patient receives.

Appendix Q provides a table that links the individual COVID-19 vaccine product codes to their associated immunization administration codes, manufacturer name, vaccine name(s), National Drug Code (NDC) Labeler Product ID, and interval between doses.

Detailed information about the COVID-19 CPT vaccine and immunization codes can be found on the AMA website: https://www.ama-assn.org/practice-management/cpt/covid-19-cpt-vaccine-and-immunization-codes.

Sue Bowman (sue.bowman@ahima.org) is senior director, coding policy and compliance at AHIMA.