ICD-10 Code Updates for January 1st

by  Wyn Staheli, Director of Content - innoviHealth
Jan 11th, 2021

In a highly unusual, but anticipated move, new ICD-10-CM codes took effect on January 1, 2021. Rarely have ICD-10-CM codes been released in January, but as you may have guessed, these changes are in relation to COVID-19. It should be noted that there were also codes added to the ICD-10-PCS code set. See the end of this article for a list of those new codes. The following information will help your organization understand these changes.

Pneumonia due to Coronavirus Disease 2019 (COVID-19)

The Federal Drug Administration (FDA) requested a new code for pneumonia due to COVID-19 to enable tracking of this condition instead of reporting the other viral-associated pneumonia code. Interim coding guidance required the reporting of two separate diagnosis codes, one for COVID-19 and the other for ‘other viral pneumonia.’ According to their application:

“... the investigation using CMS data suggest that using two codes may substantially under record pneumonia-related COVID-19, with <50% of recorded COVID-19 cases having had ‘other viral pneumonia’ recorded. Also, CDC COVID-19 mortality data shows that less than 50% of COVID-related deaths have pneumonia recorded, suggesting a potentially substantial under-recording of pneumonia due to COVID-19. As such, the introduction of the specific code for pneumonia, including geographic distribution and severity of pneumonia-related cases, and will help to develop prevention strategies and assure public health safety in the U.S. The new code will also allow to distinguish the pneumonia due to COVID-19 from the previously approved SARS-associated pneumonia code and from other viral pneumonia code(s) and thus will improve accuracy of diagnosis and coding.”

The new code is:

J12.82 Pneumonia due to coronavirus disease 2019

Pneumonia due to COVID-19 

Pneumonia due to 2019 novel coronavirus (SARS-CoV-2)

Multisystem Inflammatory Syndrome (MIS) 

The news has kept us informed about this complex, severe condition which has been linked to COVID-19 in both children and adults. This condition is not unique to COVID, therefore  a new code was needed to track this complication when it is COVID-related. Although there was some discussion about creating a code for both the adult and child versions, at this time they only added a code for multisystem inflammatory syndrome in children (MIS-C).

According to the CDC Health Advisory, this condition is defined as follows:

• An individual aged less than 21 years of age presenting with fever¹, laboratory evidence of inflammation², and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological); AND
• No alternative plausible diagnoses; AND
• Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or COVID-19 exposure within the 4 weeks prior to the onset of symptoms

¹Fever >38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours

²Including, but not limited to, one or more of the following: an elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase (LDH), or interleukin 6 (IL-6), elevated neutrophils, reduced lymphocytes and low albumin

The new code for this condition (M35.81) is as follows and includes “code first”, “code also”, and “use additional code” guidance:

History, Encounter, and Screenings

Some new codes have been added which allow for better tracking of COVID and post-COVID encounters. Note that the screening code (Z11.52) is for asymptomatic individuals. Symptomatic patients would use other codes (e.g., U07.1)

The following are the new codes:

Z11.52 Encounter for screening for COVID-19

Z20.822 Contact with and (suspected) exposure to COVID19

Contact with and (suspected) exposure to SARSCoV-2

Z86.16 Personal history of COVID-19

It is recommended that organizations carefully review the new official ICD-10-CM Guidelines (see References below) to understand government expectations for their use. Also in the References section below is a link to an article discussing the new Z86.16 code.

ICD-10-PCS Code Updates for January 1st

There are some new ICD-10-PCS codes which became effective on January 1, 2021. Due to advancement in the treatment of COVID-19, ICD-10-PCS code updates have not been following the regularly scheduled update calendar. Be sure your organization is prepared to also include the following:

NEW COVID ICD-10-PCS Codes -- January 2021
Section            X    New Technology Body System   W    Anatomical Regions Operation         0    Introduction: Putting in or on a therapeutic, diagnostic, nutritional, physiological, orprophylactic substance except blood or blood products
Body Part	Approach	Device / Substance / Technology	Qualifier
1 Subcutaneous Tissue	3 Percutaneous	H Other New TechnologyMonoclonal Antibody K Leronlimab MonoclonalAntibody S COVID-19 Vaccine Dose1 T COVID-19 Vaccine Dose 2 U COVID-19 Vaccine	6 New Technology Group 6
2 Muscle	3 Percutaneous	S COVID-19 Vaccine Dose1 T COVID-19 Vaccine Dose 2 U COVID-19 Vaccine	6 New Technology Group 6
3 Peripheral Vein	3 Percutaneous	E Etesevimab MonoclonalAntibody	6 New Technology Group 6
3 Peripheral Vein	3 Percutaneous	F Bamlanivimab MonoclonalAntibody	6 New Technology Group 6
3 Peripheral Vein	3 Percutaneous	G REGN-COV2 MonoclonalAntibody	6 New Technology Group 6
3 Peripheral Vein	3 Percutaneous	H Other New Technolo	6 New Technology Group 6
3 Peripheral Vein	3 Percutaneous	L CD24FcImmunomodulator	6 New Technology Group 6
3 Peripheral Vein	3 Percutaneous	3 Durvalumab Antineoplastic	6 New Technology Group 6
4 Central Vein	3 Percutaneous	E Remdesivir Anti-infective	6 New Technology Group 6
4 Central Vein	3 Percutaneous	F Bamlanivimab MonoclonalAntibody	6 New Technology Group 6
4 Central Vein	3 Percutaneous	G REGN-COV2 MonoclonalAntibody	6 New Technology Group 6
4 Central Vein	3 Percutaneous	H Other New TechnologyMonoclonal Antibody	6 New Technology Group 6
4 Central Vein	3 Percutaneous	L CD24FcImmunomodulator	6 New Technology Group 6
D Mouth and Pharynx	X External	M Baricitinib	6 New Technology Group 6
G Upper GI H Lower GI	7 Via Natural orArtificial Opening	M Baricitinib	6 New Technology Group 6

Note that new ICD-10-PCS codes added outside the regular update schedule are still flagged as New.