As of April 1, 2022 discharges, the following changes in ICD-10 and IPPS will be implemented. For years the coding community did not see changes occurring in April of the fiscal year. HIM professionals were used to not even worrying about April changes. This year, we do have some significant code additions and a change in the IPPS CC/MCC edit. The ICD10MCE and Grouper Version will be 39.1.
There are three new vaccine status codes that are being implemented as follows:
|Z28.310||Unvaccinated for COVID-19||NonCC||23||951|
|Z28.311||Partially vaccinated for COVID-19||NonCC||23||951|
|Z28.39||Other underimmunization status||NonCC||23||951|
The definitions for “fully vaccinated” to be followed is from the CDC and incorporated into the updated ICD-10 Guidelines for Coding and Reporting:
(n) Underimmunization for COVID-19 Status
Code Z28.310, Unvaccinated for COVID-19, may be assigned when the patient has not received at least one dose of any COVID-19 vaccine. Code Z28.311, Partially vaccinated for COVID-19, may be assigned when the patient has received at least one dose of a multi-dose COVID-19 vaccine regimen, but has not received the full set of doses necessary to meet the Centers for Disease Control and Prevention (CDC) definition of “fully vaccinated” in place at the time of the encounter. For information, visit the CDC’s website: www.cdc.gov/coronavirus/2019-ncov/vaccines/
According to the CDC table, “Fully vaccinated” for the companies that have two dose requirement, is 2 weeks after final dose in a primary series. For one dose, it is 2 weeks after first and only dose. It is unknown if the coder will be required to verify if the last dose has been at least two weeks before admission or not. It is probably safe to say that if the physician documents “fully vaccinated” that the patient can be considered meeting the CDC requirement. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html#vaccine-table
Additional codes are assigned, if applicable, to provide additional reasons for underimmunization, such as contraindication (Z28.0-) or the patient’s decision for reasons of belief or group pressure (Z28.1).
The new code for “other underimmunization status” includes delinquent immunization status and lapsed immunization schedule status.
The new codes for underimmunization for COVID-19 status should not be assigned for individuals who are not eligible for the COVID-19 vaccines (e.g., children under age 5).
The following nine ICD-10-PCS codes were added as of April 1, 2022. These should be reported on the claim however none of these impact the MS-DRG assignment.
– Introduction of tixagevimab and cilgavimab (Evusheld™) monoclonal antibody into muscle, percutaneous approach, new technology 7
The FDA granted Evusheld EUA for the pre-exposure prophylaxis of COVID-19 in adults and pediatric individuals who are not currently infected with SARS-CoV-2 and who have not experienced a known recent exposure to an individual infected with SARS-CoV-2 and who have moderate to severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments and may not mount an adequate immune response to COVID-19 vaccination, or for whom vaccination with any available COVID-19 vaccine, according to the approved or authorized schedule, is not recommended due to a history of severe adverse reaction (e.g., severe allergic reaction) to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s).
– Introduction of other new technology monoclonal antibody into muscle or intramuscularly,percutaneous approach, new technology group 7
– Introduction of fostamatinib (Tavalisse®) into mouth and pharynx, external approach, new technology group 7
– Introduction of fostamatinib (Tavalisse®) into upper GI, via natural or artificial opening, new technology group 7
– Introduction of fostamatinib (Tavalisse®) into lower GI, via natural or artificial opening, new technology group 7
Fostamatinib is approved as a treatment for adult chronic immune thrombocytopenia. A request for emergency use authorization (EUA) for fostamatinib is under review by the US Food and Drug Administration (FDA) for the treatment of hospitalized adult COVID-19 patients. Fostamatinib is a spleen tyrosine kinase (SYK) inhibitor. SYK is involved in the intracellular signaling pathways of many different immune cells.
– Introduction of COVID-19 vaccine dose 3 into subcutaneous tissue, percutaneous approach, new technology group 7
– Introduction of COVID-19 vaccine booster into subcutaneous tissue, percutaneous approach, new technology group 7
– Introduction of COVID-19 vaccine does 3 into muscle, percutaneous approach, new technology group 7
– Introduction of COVID-19 vaccine booster into muscle, percutaneous approach, new technology group 7
EDIT on Unspecified CC or MCC Codes
You will see that the new Edit 20 that has been talked about for a long time is finally going into effect as of 4/4/22 at least IN PART. Please read the link below for MM12471 on Edit 20. It has to do with unspecified MCC/CC codes that have unspecified anatomic sites and Medicare contractors using this edit when an unspecified code for MCC/CC is reported:
- Either a Complication or Comorbidity (CC), or Major Complication or Comorbidity (MCC)
- Includes other codes in that code subcategory that further specify the anatomic site (of above CC/MCC)
CMS is only concentrating on CC/MCC diagnoses right now that can specify the anatomic site, instead of “Unspecified” site. This is a quote from the federal register: “20. Unspecified Code Edit: Unspecified codes exist in the ICD-10-CM classification for circumstances when documentation in the medical record does not provide the level of detail needed to support reporting a more specific code. However, in the inpatient setting, there should generally be very limited and rare circumstances for which the laterality (right, left, bilateral) of a condition is unable to be documented and reported.”
There is a link to the Table 6P.3a in the above link that was given of unspecified codes back in 2022 Final Rule in. There is also information on how the client is to input on the claim that they are unable to get more information on laterality.
When a code from the list displayed in Table 6P.3a is entered on the claim, the edit will be triggered. It is the provider’s responsibility to determine if a more specific code from that subcategory is available in the medical record documentation by a clinical provider. If, upon review, additional information to identify the laterality from the available medical record documentation by any other clinical provider is unable to be obtained or there is documentation in the record that the physician is clinically unable to determine the laterality because of the nature of the disease/condition, then the provider must enter that information into the remarks section. Specifically, the provider may enter
“UNABLE TO DET LAT 1” to identify that they are unable to obtain additional information to specify laterality or they may enter
“UNABLE TO DET LAT 2” to identify that the physician is clinically unable to determine laterality.”
If not entered, claim returned.
You must follow your hospital’s policy on querying.
Profee Coding offers Evaluation & Management (E/M) and procedural CPT coding for all physician offices and clinics, Emergency Departments and Urgent Cares, specialty treatment facilities and hospital inpatient and outpatient. Profee Review is our professional fee consulting service. Our service identifies specific areas of risk, provides pertinent information and educates clients on proper coding, billing and documentation practices. Our main objective is to build long-lasting relationships with physician practices.
The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
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