CDC issues new diagnostic trouble codes

CMS also released Medicare Severity Diagnosis-Related Group (MS-DRG) V39.1

The Centers for Disease Control and Prevention (CDC) released their April 1, 2022 diagnostic files to December 23, 2021. Updated files include tabular addendum, index addendum, updated official coding guidelines and declaration, the ICD-10-CM command file, and List of codes and descriptions. The Tabular Addendum and Addendum Index include minor classification updates, in addition to new diagnostic codes.

New diagnostic trouble codes for April 1 include:

  • Z28.310 – Not vaccinated for COVID-19;
  • Z28.311 – Partially vaccinated against COVID-19; and
  • Z28.39 – Other under-immune status.

These codes have coding instructions. There is a note for the codes in subcategory Z28.31, which notes that “these codes are not to be used for people who are not eligible for COVID-19 vaccines, as determined by the supplier of health care “. The inclusion terms for Z28.39 include non-immunization status and expired immunization schedule status.

None of the new ICD-10-CM codes are designated as a major complication / condition (MCC) or complication / condition (CC) state. These codes will come into effect on April 1, 2022, along with the seven previously published ICD-10-PCS codes.

In addition to the published diagnostic codes, the Centers for Medicare & Medicaid Services (CMS) also released Medicare Severity Diagnosis-Related Group (MS-DRG) V39.1, which is also effective April 1, 2022. The update Grouper was created to include the new diagnostic and procedure codes.

There is also an update to the Medicare Code Editor (MCE). A new modification for unspecified laterality has also been created. The diagnostic codes that trigger the new ECM are listed in Prospective Inpatient Payment System (IPPS) Final Rule FY22, Table 6P.3a.

Updates were also made to the determination of national coverage for artificial hearts and related devices, with three intervention codes removed from the list of interventions not covered and from the list of interventions with limited coverage. These procedures are as follows:

  • 02RK0JZ (Replacement of the right ventricle by a synthetic substitute, open approach);
  • 02RL0JZ (Replacement of the left ventricle by a synthetic substitute, open approach); and
  • 02WA0JZ (Synthetic heart substitute review, open approach).

The determination of national coverage for ventricular assist devices has also been updated, with the removal of these procedure codes from the list of procedures not covered:

  • 02WA3QZ (Revision of the cardiac assistance system implantable in the heart, percutaneous approach); and
  • 02WA4QZ (Revision of the cardiac assistance system implantable in the heart, percutaneous endoscopic approach).

These two codes have also been removed from the list of limited coverage procedures for ventricular assist devices:

  • 02HA0QZ (Insertion of a cardiac assist system implantable in the heart, open approach); and
  • 02WA0QZ (Revision of the cardiac support system implantable in the heart, open approach).

In addition to the group update, CMS also made public the process for requesting new procedural codes and MS-DRG modifications. Currently, dedicated mailboxes are used to request changes.

At the Coordination and Maintenance Committee meeting in March 2022, the Medical Insurance Claim Electronic Infection Request System (MEARIS), which is an electronic application system, will be introduced. This system will have a soft launch in January 2022. CMS also plans to have a discussion regarding the new system in the FY23 rule-making process.

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