With the publication of the Final Rule for the inpatient prospective payment system (IPPS) for fiscal year 2022, CMS announced that beginning April 1, 2022, ICD-10-CM/PCS code updates will occur twice a year every April 1 and October 1. For this year, there is a limited code release of 3 new ICD-10-CM codes and 9 new ICD-10-PCS codes. Several of these code changes are related to COVID-19.
ICD-10-CM Updates
Code Z28.3, Underimmunization status, is being expanded to allow for reporting patients who are either unvaccinated or partially vaccinated for COVID-19.
| Z28.310 | Unvaccinated for COVID-19 |
| Z28.311 | Partially vaccinated for COVID-19 |
| Z28.39 | Other underimmunization status |
These codes include important instructional notes in the Tabular List. Specifically, these codes are not to be used for individuals who are not eligible for the COVID-19 vaccines, as determined by the healthcare provider. This includes patients with medical exemptions.
Tabular Listing for Underimmunization Status
The ICD-10-CM Official Guidelines for Coding and Reporting have also been updated, effective April 1, 2022, to include instruction for assigning these codes. These guidelines, which appear on page 31, define partially vaccinated according to the CDC’s definition. None of these new codes are designated as a major complication or comorbidity (MCC) or complication or comorbidity (CC).
ICD-10-PCS Updates
COVID-19 Vaccines and Therapies
Of the nine new ICD-10-PCS codes, four are being introduced to report administration of a third dose of the COVID-19 vaccine as well as boosters.
| Third Dose | Booster | ||
| XW013V7 | Introduction of COVID-19 vaccine dose 3 into subcutaneous tissue, percutaneous approach, new technology group 7 | XW013W7 | Introduction of COVID-19 vaccine booster into subcutaneous tissue, percutaneous approach, new technology group 7 |
| XW023V7 | Introduction of COVID-19 vaccine does 3 into muscle, percutaneous approach, new technology group 7 | XW023W7 | Introduction of COVID-19 vaccine booster into muscle, percutaneous approach, new technology group 7 |
One new code has been introduced for the administration of Evusheld (Tixagevimab/cilgavimab). This monoclonal antibody received emergency use authorization (EUA) by the FDA in December 2021 for pre-exposure prophylaxix of COVID-19 in certain adults and pediatric individuals. It is authorized for people who are not currently infected with COVID-19 and who have not been recently exposed. To be eligible to receive this monoclonal antibody therapy, the patient must be moderately to severely immunocompromised from disease or immunosuppressive drugs or treatments (e.g., CAR T-cell therapy, advanced or untreated HIV infection, corticosteroid therapy); or have a history of severe adverse reaction to a COVID-19 vaccine or a vaccine component.
| XW023X7 | Introduction of tixagevimab and cilgavimab monoclonal antibody into muscle, percutaneous approach, new technology group 7; and |
A code for other monoclonal antibody administration via intramuscular route was also added to report the use of other MABs used to treat COVID-19.
| XW023Y7 | Introduction of other new technology monoclonal antibody into muscle, percutaneous approach, new technology group 7. |
Tavalisse® (Fostamatinib)
Fostamatinib, sold under the brand name Tavalisse® is a tyrosine kinase inhibitor. It is used to treat chronic immune thrombocytopenia in patients who have had poor response to previous therapies. It works by reducing the immune system’s destruction of platelets, which allows the platelet count to increase and reduce the risk of excessive bleeding.
| XW0DXR7 | Introduction of fostamatinib into mouth and pharynx, external approach, new technology group 7 |
| XW0G7R7 | Introduction of fostamatinib into upper GI, via natural or artificial opening, new technology group 7 |
| XW0H7R7 | Introduction of fostamatinib into lower GI, via natural or artificial opening, new technology group 7 |
References:
- ICD-10-CM Official Guidelines for Coding and Reporting, FY 2022 --Updated April 1, 2022: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2022/10cmguidelines-FY2022-April%201%20update%202-3-22.pdf
- ICD-10-CM Tabular Addenda, codes effective April 1, 2022: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2022/icd10cm-tabular-addenda-2022-April-1.pdf
- New icd-10-PCS codes and related files: https://www.cms.gov/medicare/icd-10/2022-icd-10-pcs
- MS-DRG V39.1 updates: https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/ms-drg-classifications-and-software
- Johnson, Laurie M. “The April 1 ICD-10 Classification Update Is Coming.” Journal Of AHIMA, American Health Information Management Association, 3 Mar. 2022, https://journal.ahima.org/the-april-1-icd-10-classification-update-is-coming/.
- United States, Congress, Centers for Medicare and Medicaid Services. Federal Register, 154th ed., vol. 86, Office of the Federal Register, National Archives and Records Service, General Services Administration, pp. 44950–44956.
Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer
Senior Consultant
Kristi also performs DRG and APC audits and is known for her vast knowledge on coding vascular interventional radiology procedures. Kristi has an extensive background in coding education and consulting and is a national speakers on topics related to ICD-10 and CPT coding as well as code-based reimbursement.
I recently transferred from Op surgery coding to ED coding and while it is exciting it is very overwhelming when I can’t find an answer. I have many questions , but I think my most pressing is issue is when Imaging finds a condition and the Physician doesn’t report it in final Diagnosis and just report the symptoms . I was told we can’t Query in the Ed so I guess my question is can you report conditions from Imaging as primary or additional Dx
Hi Carman, In the ED, the ED provider is responsible for documenting the condition that prompted the ED visit. In the outpatient setting (e.g., ED), radiology documentation can be used for coding purposes because the radiologist is a physician. This differs from coding for the inpatient setting. However, the conditions on the radiology report should meet the guidelines for reporting additional outpatient diagnoses per the guidelines. This generally means that any condition that meets MEAT (monitored, evaluated, assessed, treated) criteria should be reported. Coding Clinic, 1st quarter 2017, page 4 addresses using radiology documentation for outpatient coding. Additionally, please refer to Coding Clinic, 3rd quarter 2021, page 32 for clarification on reporting additional diagnoses in the outpatient setting.