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2021: New Year, New ICD-10 Diagnosis & Procedure Codes Effective January 1, 2021

Published on 

Wednesday, December 16, 2020

 | FAQ 

Q: 

I have heard there are new ICD-10 codes related to COVID-19 that will be effective on January 1, 2021. Where can I find information about the new codes?

A:

CMS Guidance

On November 25th CMS released the following announcement regarding an updated ICD-10 MS-DRGs Version 38.1 and 2021 ICD-10-PCS Code Files that will be effective on January 1, 2021:

“In response to the national emergency that was declared concerning the COVID-19 outbreak, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is implementing new diagnosis codes into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), effective January 1, 2021.  In addition, the Centers for Medicare & Medicaid Services (CMS) is implementing 21 new procedure codes to describe the introduction or infusion of therapeutics, including monoclonal antibodies and vaccines for COVID-19 treatment, into the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS), also effective January 01, 2021.

The ICD-10 MS-DRG V38.1 Grouper Software, Definitions Manual Table of Contents, and the Definitions of Medicare Code Edits V38.1 manual to accommodate these new diagnosis and procedure codes, effective for discharges on or after January 01, 2021 will be available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software.html

CDC Guidance

On December 3rd, the CDC posted information about the new codes on their ICD-10-CM webpage. The new ICD-10-CM codes effective January 1, 2021 include:

  • Encounter for screening for COVID-19 (Z11.52)
  • Contact with and (suspected) exposure to COVID-19 (Z20.822)
  • Personal history of COVID-19 (Z86.16)
  • Multisystem inflammatory syndrome (MIS) ( M35.81)
  • Other specified systemic involvement of connective tissue ( M35.89)
  • Pneumonia due to coronavirus disease 2019 (J12.82)

The CDC goes on to note that “full addenda information regarding the new codes and the final code titles will be published shortly.”

AHACoding Clinic® Advisor Announcement

In addition to the CMS and CDC websites, you can read similar announcements on the AHACoding Clinic® Advisor home page at https://www.codingclinicadvisor.com/.

Article Author: Beth Cobb, RN, BSN, ACM, CCDS
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Protection Assessment Tool.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.