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More COVID-19 diagnosis and procedure codes: ICD-10-CM/PCS and MS-DRGs updated for January 1, 2021
In response to the national emergency declared for the COVID-19 pandemic, the CDC has implemented six new ICD-10-CM diagnosis codes and CMS has implemented 21 new ICD-10-PCS procedure codes for COVID-19, as well as an updated MS-DRGs Version 38.1, all effective January 1, 2021.
The six new diagnosis codes are:
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
The new diagnosis codes were proposed and discussed in detail at the September 2020 ICD-10 Coordination and Maintenance Committee (C&M). In a previous blog, I summarized the C&M proposals for these codes. The CDC announcement, along with the codes and their MS-DRG assignment, is available as a one-page PDF on the CMS website. The Index and Tabular Addenda for the new codes will be posted on the CDC’s ICD-10-CM page.
In addition to new ICD-10-PCS (PCS) codes for administration of remdesivir and transfusion of convalescent plasma implemented earlier this year and effective August 1, 2020 (I posted a blog on this subject too), the 21 new PCS codes effective January 1, 2021 include codes to capture the use of additional COVID-19 therapeutics as well as administration of COVID-19 vaccines.
All of the new PCS codes effective January 1 are classified in table XW0 of the ICD-10-PCS. The codes specify the substance name or type and the route of administration—whether by subcutaneous/intramuscular injection, IV infusion or oral administration.
Monoclonal Antibody (10 codes)
Four specific substances classified as monoclonal antibodies– Bamlanivimab, Etesevimab, Leronlimab and REGN-COV2—have new PCS codes to track their use in treating COVID-19. Leronlimab is administered by subcutaneous injection, and the other three substances are administered via IV infusion.
XW013K6 Introduction of Leronlimab Monoclonal Antibody into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 6
XW043E6 Introduction of Etesevimab Monoclonal Antibody into Central Vein, 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
XW043F6 Introduction of Bamlanivimab Monoclonal Antibody into Central Vein, Percutaneous Approach, New Technology Group 6
XW033G6 Introduction of REGN-COV2 Monoclonal Antibody into Peripheral Vein, Percutaneous Approach, New Technology Group 6
XW043G6 Introduction of REGN-COV2 Monoclonal Antibody into Central Vein, Percutaneous Approach, New Technology Group 6
Three non-specific monoclonal antibody codes were added to allow tracking of other monoclonal antibody drugs approved for treatment of COVID-19 in the coming months.
XW033H6 Introduction of Other New Technology Monoclonal Antibody into Peripheral Vein, Percutaneous Approach, New Technology Group 6
XW043H6 Introduction of Other New Technology Monoclonal Antibody into Central Vein, Percutaneous Approach, New Technology Group 6
XW013H6 Introduction of Other New Technology Monoclonal Antibody into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 6
Other Drug Class (5 codes)
Two specific substances—the drug baracitinib (trade name Olumiant®) and an immunomodulator drug known as CD24Fc—also have new codes for tracking their use as COVID-19 therapies. Baracitinib recently received FDA emergency use authorization (EUA) as a treatment for COVID-19 in combination with remdesivir. Baracitinib can be administered orally or via gastrostomy/jejunostomy tube. The immunomodulator substance designated CD24Fc is administered via IV infusion.
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
XW043L6 Introduction of CD24Fc Immunomodulator into Central Vein, Percutaneous Approach, New Technology Group 6
XW033L6 Introduction of CD24Fc Immunomodulator into Peripheral Vein, Percutaneous Approach, New Technology Group 6
Vaccine (6 codes)
Six new PCS codes were added for tracking COVID-19 vaccination while a patient is in the hospital. Of course, the vast majority of vaccines will not be administered to patients while they are in the hospital; nevertheless, these PCS codes will allow for the data to be captured on an inpatient record.
The new PCS codes specify whether the vaccine was a subcutaneous or intramuscular injection, and whether the injection was dose 1 or dose 2 for vaccines that require two injections to complete the therapy. The codes that do not specify dose are to be used for single-dose vaccinations, or when information regarding the dose is not available in the medical record.
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
For MS-DRGs, the new PCS codes are designated Non-OR and will not affect DRG assignment. However, CMS notes in the announcement, “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 will be used when a Medicare beneficiary is administered a vaccine while a hospital inpatient.”
The CMS announcement posted on the CMS website contains the list of 21 PCS codes I have reproduced here. It also contains useful links to the new CPT codes for COVID-19 vaccines, to the page in the Medicare provider toolkit with billing details, and the link to the ICD-10-PCS page on the CMS website, where the full FY 2021 update files will be posted.
Rhonda Butler is a clinical research manager with 3M Health Information Systems.
Visit the 3M HIS COVID-19 resource page.
During a pandemic, healthcare information is gathered, studied, and published rapidly by scientists, epidemiologists and public health experts without the usual processes of review. Our understanding is rapidly evolving and what we understand today will change over time. Definitive studies will be published long after the fact. 3M Inside Angle bloggers share our thoughts and expertise based on currently available information.
8 thoughts on “More COVID-19 diagnosis and procedure codes: ICD-10-CM/PCS and MS-DRGs updated for January 1, 2021”
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Rhonda Butler
Clinical research manager
Rhonda Butler is a clinical research manager with 3M Health Information Systems. Of the original team that developed ICD-10-PCS under contract to CMS, she is the “last nerd standing.” In…
Does this mean M35.8 is invalid after Dec 31st?
Thanks for your question. Yes, M35.8 is invalid after Dec 31st. This is standard practice when a new sub-category is added to ICD-10-CM; the old “parent” category is no longer valid as a code, and the new “children” become the valid codes. And, by the way, the terms “parent” and “child” are technical terms commonly used in this context—this is not me being metaphorical.
Below is the relevant snippet from the file icd10cm-codes-addenda-Jan-2021.txt on the CDC website.
Delete: M358 Other specified systemic involvement of connective tissue
Add: M3581 Multisystem inflammatory syndrome
Add: M3589 Other specified systemic involvement of connective tissue
The full update files for the January 1, 2021 release were posted a couple of days after my blog post. Here again is the link to the CDC’s ICD-10-CM web page: https://www.cdc.gov/nchs/icd/icd10cm.htm
is there a diagnosis code for someone getting the covid vaccine more specific than Z23?
Thanks for your interest. At present there are no ICD-10-CM codes specifically for getting the COVID-19 vaccine.
However, assigning “Z23 Encounter for immunization” for the diagnosis along with one of the COVID-19 vaccination codes should be sufficient to identify cases in the data.
Do any of these updates change sequencing guidelines for sepsis and covid? One of my superiors is claiming that guidelines were updated in December to allow covid to be sequenced as pdx when sepsis due to covid is present on admit. I disagree but can’t find any resources more recent than April
Thanks for your interest. Like you said, the announcement posted on the NCHS website Announcement New ICD-10 code for coronavirus 2 20 2020 (cdc.gov) regarding the January 1 ICD-10-CM COVID-19 codes contains the link COVID-19 Guidelines (cdc.gov) to the interim coding guidance posted earlier in 2020. So I agree, it doesn’t look like there are any guidelines specific to 2021.
How does CMS decide which therapies to assign these ICD-10-PCS codes to? Is it based on input from FDA?
Are these ICD-10-PCS codes assigned before or after the therapy gets EUA? If the code is assigned before EUA then would it be possible for the code to be assigned to a therapy that never gets EUA?
The internal decision-making process has not been shared that I know of, but it is reasonable to assume that FDA input was part of the process.
As for Emergency Use Authorization, FDA approval is not a prerequisite for creating and assigning new ICD-10 codes. Codes can be assigned for investigational procedures and therapies.