RMC is thrilled to announce that we are joining forces with MRA. It has been an exciting journey for all of us here at RMC, and we can’t thank our HIM community enough. Here at MRA we will continue offering the highest quality of coding support, coding audits, HCC/Risk Adjustment Services and more.

Learn more about MRA.

When the final rule for the FY2022 Inpatient Prospective Payment System (IPPS) came out, it included the statement that we will now have clinical coding updates twice a year for ICD-10-CM and ICD-10-PCS, once in April and the usual large update in October. Keeping with their statement, the Centers for Medicare and Medicaid Services (CMS) announced that three (3) new ICD-10-CM codes and seven new ICD-10-PCS codes related to COVID-19 will be issued in an April 1, 2022, code set update.

ICD-10-CM

The diagnosis codes relate to immunization status and expand the existing code, Z28.3, to include the following new codes:

ICD-10-CM CodeCode Description
Z28.310 Unvaccinated for COVID-19
Z28.311 Partially vaccinated for COVID-19
Z28.39 Other underimmunization status

There three codes are designated as “NonCC” codes for the IPPS. Under category Z28 Immunization not carried out and underimmunization status you will find an “includes” note:

Includes: vaccination not carried out

In addition, there is a “Code also, if applicable, encounter for immunization safety counseling (Z71.85),” that should be followed. More details on the alpha index and tabular addenda will be available via the CDC website at: https://www.cdc.gov/nchs/icd/icd10cm.ht

ICD-10-PCS

The new procedure codes are New Technology codes that cover additional vaccines and boosters plus a new drug to treat COVID-19. Note that these codes are designated as “NonOR” procedure under IPPS.

ICD-10-PCS CodeCode Description
XW013V7Introduction of COVID-19 vaccine dose 3 into subcutaneous tissue, percutaneous approach, new technology group 7
XW013W7Introduction of COVID-19 vaccine booster into subcutaneous tissue, percutaneous approach, new technology group 7
XW023V7Introduction of COVID-19 vaccine does 3 into muscle, percut7R&aneous approach, new technology group 7
XW023W7Introduction of COVID-19 vaccine booster into muscle, percutaneous approach, new technology group 7
XW0DXR7Introduction of fostamatinib into mouth and pharynx, external approach, new technology group 7
XW0G7R7Introduction of fostamatinib into upper GI, via natural or artificial opening, new technology group 7
XW0H7R7Introduction of fostamatinib into lower GI, via natural or artificial opening, new technology group 7


CMS made the following comment regarding the use of the 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.

There are some key steps and action to take in preparation for these new codes:

  1. Educate and discuss with your coding staff
  2. Update and test your CDM with the appropriate CPT codes.
  3. Discuss clinical documentation with your vaccine unit/department
  4. Audit about 30 days after implementation to ensure accuracy and compliance

On the CMS website 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

Reimbursement Management Consultants (RMC) can provide assistance with medical coding support, auditing, education, compliance consulting, and HCC/risk adjustment services. RMC is a woman-owned, US-based and operated company which specializes in a variety of medical coding and auditing services. Contact us here.

Written by Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA Approved ICD-10-CM/PCS Trainer