In an off-cycle update to the 2021 International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding guidelines posted in December in response to the COVID-19 pandemic, the Centers for Disease Control and Prevention’s (CDC’s) National Center for Health Statistics (NCHS) implemented six new diagnosis codes into the ICD-10-CM, effective Jan. 1, 2021.
The new codes are:
- J12.82 – Pneumonia due to COVID-19
- M35.81 – Multisystem Inflammatory Syndrome
- M35.89 – Other specified systemic involvement of connective tissue
- Z11.52 – Encounter for screening for COVID-1 (Note: Per ICD-10-CM coding guidelines, this code should NOT be used during the pandemic.)
- Z20.822 – Contact with and suspected exposure to COVID-19
- Z86.16 – Personal history of COVID-19
See pages 28-33 of the update to the 2021 ICD-10-CM coding guidelines for specific details related to COVID-19 diagnosis coding situations and sequencing guidance. In addition, the files located in the downloads section of the CMS 2021 ICD-10-CM webpage contain additional details to the updated codes.
AHCA analysis of the new codes and updated coding sequencing guidance suggests that these new codes are typically expected to be used as secondary diagnosis codes to describe COVID-19 status or secondary or associated manifestations of COVID-19. When COVID-19 meets the definition of the principal diagnosis on the claim or reason for skilled nursing facility (SNF) stay in minimum data set (MDS) item I0020B, then code U07.1 should continue to be used for that purpose.
AHCA notes that at this point, the Patient-Driven Payment Model (PDPM) ICD-10 mappings file has not been updated to include these new ICD-10 codes, and using them in MDS item I0020B – primary reason for SNF stay, may create problems with MDS locking and submission with some software vendors. Additionally, case-mix assignment for Medicare prospective payment system (PPS) and some state OBRA PDPM assessments may be impacted.
Until CMS updates the PDPM mappings file, if a provider needs to use one of these new codes for stays beginning Jan. 1, 2021 as a primary or secondary diagnosis, AHCA recommends that provider MDS and billing staff contact their software vendors for guidance.