Sue Bowman, MJ, RHIA, CCS, FAHIMA

By 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:

ICD-10-CM

Code

Description
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-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:

ICD-10-PCS

Code

Description
XW013H6 Introduction of other new technology monoclonal antibody into subcutaneous tissue, percutaneous approach, new technology group 6
XW013K6 Introduction of leronlimab monoclonal antibody into subcutaneous tissue, percutaneous approach, new technology group 6
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
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
XW033G6 Introduction of REGN-COV2 monoclonal antibody into peripheral vein, percutaneous approach, new technology group 6
XW033H6 Introduction of other new technology monoclonal antibody into peripheral vein, percutaneous approach, new technology group 6
XW033L6 Introduction of CD24Fc immunomodulator into peripheral vein, percutaneous approach, new technology group 6
XW043E6 Introduction of etesevimab monoclonal antibody into central vein, percutaneous approach, new technology group 6
XW043F6 Introduction of bamlanivimab monoclonal antibody into central vein, percutaneous approach, new technology group 6
XW043G6 Introduction of REGN-COV2 monoclonal antibody into central vein, percutaneous approach, new technology group 6
XW043H6 Introduction of other new technology monoclonal antibody into central vein, percutaneous approach, new technology group 6
XW043L6 Introduction of CD24Fc immunomodulator into central vein, percutaneous approach, new technology group 6
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

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:

CPT Code Description
91300 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, for intramuscular use
91301 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, for intramuscular use
0001A Immunization 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
0002A Immunization 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
0011A Immunization 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
0012A Immunization 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

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.

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6 Comments

  1. For inpatient hospital claims that cross 2020 to 2021, the discharge date is to be used to process the claim. How do we handle the new ICD-10-PCS codes that have an effective date of 1/1/2021 but the procedure code date is during the inpatient stay but prior to 1/1/2021. Can the code, such as XW0DXM6, be billed for a prior date such as 12/30/2020 if the admission date is 12/1/2020 and the discharge date is 1/2/2021?

  2. Inpatient hospital accounts that cross 2020 to 2021. Do we use the admit date or discharge date for the new ICD9 coding?

  3. Question: Infusion of monoclonal antibodies along with other infusions.. where does the bamlanivimab fall in the hierarchy?
    Also do you code the M0239 code in addition to the traditional infusion code… or as a substitute? Appreciate the help.

  4. Is the new 2021 code for SARS COVID-19 associated pneumonia is U071 & J12.81?

  5. This is very interesting since it is essentially “history in the making” with COVID-19 threatening our very existing global environment for the past 9+ months and a new vaccine developed in “Warp Speed” time. The 6 new ICD-10-CM Codes
    are based on the system involved due to COVID-19 (i.e., pneumonia, Multisystem Inflammatory Syndrome – predominantly involving children and lesser case reports in adults, or other specific involvement of connective tissue). The last 3 ICD-10-CM codes involve the level of encounter for screening for COVID-19, contact with and suspected exposure to COVID-19 and/or a personal history of COVID-19.

    The 21 new ICD-10-PCS procedure codes are based upon the describe the introduction or infusion of therapeutics, including monoclonal antibodies, for COVID-19 treatment and vaccines. CMS stated for hospitalized patients, Medicare pays for the COVID-19 vaccines and their administration apart from the DRG rate and Medicare will expect that the appropriate CPT code will be used when a Medicare beneficiary is given a vaccine while a hospital inpatient. These procedure codes will be based upon the type of vaccine, the method of administration and which vaccine it is in the series.

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