At the ICD-10 Coordination and Maintenance (C&M) Committee meeting in March 2021, an announcement was made that there was consideration of an annual April 1 implementation date for ICD-10-CM and ICD-10-PCS code updates in addition to the October 1 date. This announcement was followed by its inclusion in the FY 2022 Proposed Rule for Inpatient Prospective Payment System (IPPS). The proposed rule requested that comments be submitted regarding an April 1 implementation date. After hearing comments at the C&M Committee meeting and reading submitted comments from the proposed rule, the FY 2022 IPPS Final Rule confirmed the adoption of the additional annual implementation date of April 1.
The new ICD-10-CM/PCS codes for April 1, 2022, implementation were released by the Centers for Medicare and Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) on November 16, 2021. There are three new diagnosis codes for April 1:
- Z28.310 – Unvaccinated for COVID-19
- Z28.311 – Partially vaccinated for COVID-19
- Z28.39 – Other underimmunized status
These codes include coding instructions in the Tabular List. There is a note for the codes in subcategory Z28.31 that says, “These codes should not be used for individuals who are not eligible for the COVID-19 vaccines, as determined by the healthcare provider.” The inclusion terms for Z28.39 include delinquent immunization status and lapsed immunization schedule status. None of the new diagnosis codes are designated as a major comorbid condition (MCC) or comorbid condition (CC). A new guideline, I.C.1.g.10 (n) Underimmunization for COVID-19 Status, related to the new codes is included in the updated Official ICD-10-CM Guidelines.
CMS followed up the initial release of procedure codes with a second release of two more new procedures codes on January 12, 2022. The entire list of new ICD-10-PCS procedure codes effective April 1, 2022, is:
- XW013V7 – Introduction of COVID-19 vaccine dose 3 into subcutaneous tissue, percutaneous approach, new technology group 7
- XW013W7 – Introduction of COVID-19 booster into subcutaneous tissue, percutaneous approach, new technology group 7
- XW023V7 – Introduction of COVID-19 dose 3 into muscle, percutaneous approach, new technology group 7
- XW023W7 – Introduction of COVID-19 booster into muscle, percutaneous approach, new technology group 7
- XW0DXR7 – Introduction of fostamatinib into upper GI, external approach, new technology group 7
- XW0G7R7 – Introduction of fostamatinib into upper GI, via natural/artificial opening, new technology group 7
- XW0H7R7 – Introduction of fostamatinib into lower GI, via natural/artificial opening, new technology group 7
- XW023X7 – Introduction of tixagevimab and cilgavimab monoclonal antibody into muscle, percutaneous approach, new technology group 7
- XW023Y7 – Introduction of other new technology monoclonal antibody into muscle, percutaneous approach, new technology group 7
Tixagevimab and cilgavimab monoclonal antibody is also known as Evusheld. This drug is used for treatment of COVID-19 and is not a substitute for a vaccine. None of the new procedures are identified as a diagnosis related group operating room procedure.
The CDC released the April 1, 2022, diagnosis files on December 23, 2021. The updated files include a Tabular List Addendum, Alphabetic Index Addendum, Official Coding and Reporting Guidelines FY 2022 update, ICD-10-CM Order File, and List of Codes and Descriptions. The Tabular List Addendum and Alphabetic Index Addendum include minor updates to the classification in addition to the new diagnosis codes. The links to the April 1 addenda can be found at the end of this article.
CMS also released the Medicare Severity Diagnosis Related Group (MS-DRG) V39.1 grouper, which is also effective April 1, 2022. The grouper update was created to include the new diagnosis and procedure codes.
There is also an update to the Medicare Code Editor (MCE). New MCE #20 for unspecified laterality has been created. The diagnosis codes that trigger the new MCE are listed in the FY 2022 IPPS Final Rule Table 6P.3a. The new MCE is effective April 1, 2022.
There were also updates to National Coverage Determination for Artificial Heart and Related Devices, with three procedure codes being removed from the Noncovered Procedure List and Limited Coverage Procedure List. The procedures are:
- 02RK0JZ (Replacement of right ventricle with synthetic substitute, open approach)
- 02RL0JZ (Replacement of left ventricle with synthetic substitute, open approach)
- 02WA0JZ (Revision of synthetic substitute in heart, open approach)
The National Coverage Determination for Ventricular Assist Devices was updated with the removal of these procedure codes from the Noncovered Procedure List:
- 02WA3QZ (Revision of implantable heart assist system in heart, percutaneous approach)
- 02WA4QZ (Revision of implantable heart assist system in heart, percutaneous endoscopic approach)
These two procedure codes were removed from the Limited Coverage Procedure List for the Ventricular Assist Devices, as well:
- 02HA0QZ (Insertion of implantable heart assist system into heart, open approach)
- 02WA0QZ (Revision of implantable heart assist system in heart, open approach)
Remember to update your facility specific coding guidelines with any changes based on the new codes and revised guidelines. Also, review the impact of new MCE #20 by pulling a frequency report of the diagnosis codes in Table 6P.3a. Communicate with the patient financial services department regarding the process to resolve MCE #20. It looks like April 1 will not be April Fool’s Day this year!
Laurie M. Johnson is a senior consultant with Revenue Cycle Solutions LLC.