The implementation of the new codes is April 1, 2022.
The new ICD-10-CM/PCS codes for implementation on April 1, 2022, were recently released by the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC). The CMS v39.1 version of the MS-DRG grouper will be released in February 2022. The notice from CMS included three diagnosis codes and seven procedure codes, which will be effective for discharges/visits on and after April 1, 2022.
The new diagnosis codes include the following:
- Z28.310 – Unvaccinated for COVID-19;
- Z28.311 – Partially vaccinated for COVID-19; and
- Z28.39 – Other under-immunization status.
- None of the new diagnosis codes has CC/MCC status.
The new procedure codes are the following:
- 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; and
- XW0H7R7 – Introduction of fostamatinib into lower GI, via natural/artificial opening, new technology group 7.
None of these procedures are identified as a DRG operating room procedure. The associated Current Procedural Terminology (CPT®) codes can be found online at https://www.cms.gov/medicare/covid-19/medicare-billing-covid-19-vaccine-shot-administration.
The Inpatient Prospective Payment System (IPPS) Final Rule for the 2022 fiscal year (FY) also included a new Medicare code edit effective April 1, 2022, for unspecified codes when there are alternatives for a specific anatomic site. Table 6P.3a provides a list of the ICD-10-CM codes that are considered to be unspecified. The Official Coding and Reporting Guidelines for FY 2022 were updated to allow coders to use other clinical documentation in the patient medical record to capture specificity.
This CMS announcement also mentioned that National Coverage Determination (NCD) 20.9 (Artificial Heart and Related Devices), effective Dec. 1, 2020, was inactivated and removed from the NCD Manual. These procedure codes have been removed from the non-covered procedure codes:
- 02RK0JZ – Replacement of right ventricle with synthetic substitute, open approach;
- 02RL0JZ – Replacement of left ventricle with synthetic substitute, open approach; and
- 02WA0JZ – Revision of synthetic substitute in heart, open approach.
These procedure codes have been moved from non-coverage to limited coverage:
- 02WA3QZ – Revision implantable heart assist system in heart, open approach; and
- 02WA4QZ – Revision implantable heart assist system in heart, percutaneous endoscopic approach.
These procedure codes have been removed from the limited coverage list:
- 02HA0QZ – Insertion, implantable heart assist system into heart, open approach; and
- 02WA0QZ – Revision, implantable heart assist system into heart, open approach.
Change Request 12290, Transmittal 10837, titled “Ventricular Assist Devices,” was issued on June 11, 2021 and is available in the NCD listing.
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