For ICD-10-CM, the following new codes should be utilized starting on that date:
ICD-10-CM Code Description
Z28.310 Unvaccinated for COVID-19
Z28.311 Partially vaccinated for COVID-19
Z28.39 Other under immunization status
These three codes will be designated as “Non-CC” codes for IPPS, and would fall under MS-DRG 951, according to the grouper logic. A best practice is to educate your coding staff on these new codes and discuss the implications. Also, have an open dialogue about the situations when these codes would be assigned/used.
For ICD-10-PCS, the following new codes should be utilized starting on April 1, 2022:
PCS Code Description
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, percut7R&aneous approach, new technology group 7
XW023W7 Introduction of COVID-19 vaccine booster into muscle, percutaneous approach, new technology group 7
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
CMS made this comment regarding the use of ICD-10-PCS vaccine codes:
“CMS notes that 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. For details on billing Medicare for the COVID-19 vaccine
appropriately, please see this page in our provider toolkit: https://www.cms.gov/medicare/covid-19/medicare-billing-covid-19-vaccine-shot-administration
Be sure that your facility or practice chargemaster is updated, if appropriate (for the CPT® codes). In addition, ensure that your coding staff is aware of these new ICD-10-CM/PCS codes as well. Note that these new PCS codes are “Non-OR” codes for the IPPS, and thus will not impact the MS-DRG.
Two additional steps to take include the following:
Discuss clinical documentation with your vaccine unit/department; and
Audit about 30 days after implementation of these codes to ensure accuracy and compliance.
On the CMS web page on MS-DRG classifications and software, you can access the link to the file: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software
We are in very fluid times, so keeping up to date with code changes is essential.