Revised ICD-10-CM and ICD-10-PCS Codes
Phoenix – March 23, 2021— CMS has announced code changes, effective January 1, 2021, which data analysts will be able to see and utilize starting Q1 2021. The updates primarily surround COVID-19, and as the pandemic progresses further changes are expected.
The changes were made to International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Codes and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS). These edits will not appear in the data before Q1 2021.
We’ve pulled the guidelines that will have the largest impact and listed them below for ease-of-reference:
There are new diagnosis codes and updated text in the guidelines for coding and reporting. Please see below for more information on the updates or visit their website here. On the website, you will find FY 2021 ICD-10-CM code files, updated FY 2021 ICD-10-CM Coding Guidelines, and additional information on the ICD-10-CM COVID-19.
COVID-19 Infections – Pages 28-33
For a confirmed COVID-19 Infection diagnosis, assign code U07.1, COVID-19, which should be sequenced first. Assign code(s) for the respiratory manifestation(s) as additional diagnoses.
Common respiratory manifestations of COVID-19:
- Pneumonia – Assign codes U07.1, COVID-19, and J12.82, Pneumonia due to coronavirus disease 2019.
- Acute bronchitis – Assign codes U07.1, and J20.8, Acute bronchitis due to other specified organisms. Bronchitis not otherwise specified (NOS) due to COVID-19 should be coded using code U07.1 and J40, Bronchitis.
- Lower respiratory infection – If the COVID-19 is documented as being associated with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS, codes U07.1 and J22. If the COVID-19 is documented as being associated with a respiratory infection, NOS, codes U07.1 and J98.8.
- Acute respiratory distress syndrome – For acute respiratory distress syndrome (ARDS) due to COVID-19, assign codes U07.1, and J80.
- Acute respiratory failure – For acute respiratory failure due to COVID-19, assign code U07.1, and code J96.0-.
- Non-respiratory manifestations of COVID-19 – Code U07.1, COVID-19, as the principal/first-listed diagnosis and assign code(s) for the manifestation(s) as additional diagnoses.
- Exposure to COVID-19 – For asymptomatic individuals with actual or suspected exposure to COVID-19, assign code Z20.822, Contact with and (suspected) exposure to COVID-19. For symptomatic individuals with actual or suspected exposure to COVID-19 and the infection has been ruled out, or test results are inconclusive or unknown, assign code Z20.822, Contact with and (suspected) exposure to COVID-19.
- Screening for COVID-19 – During the COVID-19 pandemic, a screening code is generally not appropriate. Do not assign code Z11.52, Encounter for screening for COVID-19. For encounters for COVID-19 testing, including preoperative testing, code as exposure to COVID-19 (guideline I.C.1.g.1.e).
- Signs and symptoms without definitive diagnosis of COVID-19 – Assign the appropriate code(s) for each of the presenting signs and symptoms (ex. R05 Cough, R06.02 Shortness of breath, R50.9 Fever, unspecified)
- Asymptomatic individuals who test positive for COVID-19 – For asymptomatic individuals who test positive for COVID-19, see guideline I.C.1.g.1.a. The individual has tested positive and is considered to have the COVID-19 infection.
- Personal history of COVID-19 – Assign code Z86.16, Personal history of COVID-19.
- Follow-up visits after COVID-19 infection has resolved – Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm, and Z86.16, Personal history of COVID-19.
- Encounter for antibody testing – Assign Z01.84, Encounter for antibody response examination.
- Multisystem Inflammatory Syndrome – For individuals with multisystem inflammatory syndrome (MIS) and COVID-19, assign code U07.1 and M35.81. If MIS develops as a result of a previous COVID-19 infection, assign codes M35.81 and B94.8. If an individual with a history of COVID-19 develops MIS and the provider does not indicate the MIS is due to the previous COVID-19 infection, assign codes M35.81 and Z86.16. If an individual with a known or suspected exposure to COVID-19, and no current COVID-19 infection or history of COVID-19, develops MIS, assign codes M35.81 and Z20.822.
Vaping-related disorders – Page 58-59
For patients presenting with condition(s) related to vaping, assign code U07.0, Vaping-related disorder, as the principal diagnosis. For lung injury due to vaping, assign only code U07.0. Assign additional codes for other manifestations, such as acute respiratory failure (subcategory J96.0-) or pneumonitis (code J68.0).
COVID-19 infection in pregnancy, childbirth, and the puerperium – Page 73
During pregnancy, childbirth or the puerperium, when COVID-19 is the reason for admission/encounter, code O98.5-, Other viral diseases complicating pregnancy, childbirth and the puerperium, should be sequenced as the principal/first-listed diagnosis, and code U07.1, COVID-19, and the appropriate codes for associated manifestation(s) should be assigned as additional diagnoses.
COVID-19 Infection in Newborns – Page 77
For a newborn that tests positive for COVID-19, assign code U07.1, COVID-19, and the appropriate codes for associated manifestation(s) in neonates/newborns in the absence of documentation indicating a specific type of transmission. For a newborn that tests positive for COVID-19 and the provider documents the condition was contracted in utero or during the birth process, assign codes P35.8, Other congenital viral diseases, and U07.1, COVID-19.
Assignment of the new ICD-10-CM Codes:
There are 21 new procedure codes for COVID-19 treatments, and a summary of the changes can be found below.
Click here for a full list of all new codes. You can also visit the CMS website here for more news and information.
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